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Yıl:2001; Cilt: 5; Sayı: 2>> Özet
Psikiyatri Dünyası; 2001;5(2):49-54
Demans ve Komorbid Durumlar
İ İçelli
Celal Bayar Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Manisa
Demans denildiğinde, ağırlık olarak %75 oranında Alzheimer tipi demans ile vasküler demans kastedilmektedir. Etiyolojide ilaçlar ve toksinler, kafa içi yer kaplayan oluşumlar, anoreksiya, travma, normal basınçlı hidrosefali, nörodejeneratif hastalıklar, enfeksiyonlar, beslenme bozuklukları, metabolik hastalıklar, kronik iltihabi hastalıkların varlığından söz edilir. Alzheimer tipi demansın nedeni bilinmemektedir. Kesin tanı beynin nöropatolojik incelenmesi ile konur. Beynin fronto temporal bölgelerinde daha belirgenleşen sulkus düzleşmesi ve ventrikül genişlemesi tipiktir. Genetik olarak 21. kromozomun uzun kolunda lokalize bir gen tarafından kodlanan amiloid prekürsör protein birikimi sonucu beyinden senil plaklar oluşur, algı, iletişim, duygulanım, konuşma, psikomotor aktivite, işlevsellik bozuklukları ve hareketlerde bozulma görülür. Vasküler demans görülme sıklığı yönünden ikinci sırada yer alır. İskemik lezyonun oluştuğu bölgeye göre demans erken veya geç gelişebilir.Demansın seyri sırasında deliryum, şizofreni, depresyon, anksiyete, konversiyon, yapay bozukluk, günbatımı sendromu (sundowning syndrome) görülebilir. Tedavide hastaya bakım veren kişilerin hastalık konusunda bilgilendirilmesi ve eğitilmesi önem taşır. Ayrıca hastanın yaşadığı ortamda bazı düzenlemelerin yapılması ve önlemlerin alınması gerekir. Medikal ve psikoterapötik uygulamalar hastanın ve hastalık belirtilerinin özelliklerine göre düzenlenir.

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