心身医学的側面よりみた老年期痴呆(生涯各期における心身症をめぐる諸問題 : 老年期)

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Dementia is one of the most common clinical symptoms among aged persons. According to the reports by Hasegawa et al. and Karasawa et al., approximate eight percent of the aged with the ages of 65 years and over are afflicted with some mental illnesses and about a half of them are suffering from demented state.In today's medicine, dementia refers only to deterioration of the mental function due to organic deseases of the cerebral hemisphere. However, the relationship between dementia and brain status has not been consistently observed. Few studies on dementia have paid attention to the somatic, psychological or social background of the subjects, although these socio-psychosomatic factors are known to influence intellectual function as well as certain variables such as the EEG. Especially at early stages of dementia, many of early symptoms of dementia differ little either quantitatively or qualitatively from those that occur in normal, healthy individuals who are exhausted, anxious or subject to severe environmental pressures.The intellectural deterioration commonly seen among aged persons undoubtedly is closely related to the structural and functional impairment of the brain. With a given brain impairment some individuals follow a pattern of simple and gradual intellectual deterioration and are without any significant complication. They are able to maintain a relatively active life and makes a reasonably good adjustment in the community. In contrast, many others deteriorate rapidly and present a variety of complications-depression, regression, agitation, paranoid symptoms. The differences between these two groups are very likely the result of the differences in their physical health, socio-economic status, environment and personality.Therefore, Wang points out that dementia as a clinical syndrome can be viewed as a socio-psycho-somatic disorder. Although brain impairment is an obligatory factor in most cases of intellectural deterioration, many socio-psychological factors also play an important contributory role. These factors may aggravate the behavioral manifestations of intellectual deterioration.They may also accelerate the decline of physical health, which, in turn, may affect the brain as well as the socio-psychological condition of the individual. Frequently all these factors interact with each other and form a vicious cycle that leads to further deterioration. The interaction of these social, psychological and somatic factors often becomes the most important determinant of hte course and outcome of dementia. Early recognition and correction of these factors may help prevent the development of complications and slow down the progression deterioration.This paper describes, a definition and causal diseases of dementia, clinical characteristics of of dementia in the aged, clinical symptoms which should be differentiated from demented state, factors which influence the clinical course and outcome of dementia, and psychotherapeutic approach for the aged with dementia. It also emphasises psychosomaitc aspects of dementia in the aged.
日本心身医学会の論文
1985-04-01

著者

本間昭
聖マリアンナ医科大学

心身医学的側面よりみた老年期痴呆(生涯各期における心身症をめぐる諸問題 : 老年期)

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