[Epidemiology of pathological cerebral impairment]

Among the over-65 aged patients of our division (848 in all), during a period of little more than a year, we wanted to determine the prevalence of dementia in absolute and per cent terms, using two neuropsychological tests for the evaluation of mental functions, estimating the most frequent forms according to their nature, referring to sex, considering different age groups and trying to find a connection with the pathologies that caused hospitalization and with particular social-environmental conditions. We attended also to the present therapeutical proposals and to the difficult problem of nursing demented people. We estimated the presence of a pathological cerebral impairment in 4% of the over-65 aged population; the prevalence reaches 3.5% in the group between 65 and 74 years and 12% in the one from 75 up to 80 years and over. 50% of dementia is due to Alzheimer's disease, which is more frequent among women, 26.5% to multi-infarction dementia (MID), which strikes more men, and 20.6% to a mixed form, degenerative and vascular; finally other pathologies can be responsible for dementia in the remaining percentage. It is difficult to find a certain relation between dementia and associated diseases, except for MID, which is clearly connected with cerebrovascular and cardiovascular disorders, as well as to consider particular social-environmental conditions as predisposing factors for cognitive impairment. At present, there is no way to remove causes of primary dementia with any kind of therapy, which is therefore only symptomatic. Families bear most of the burden of caring for patients. Most of Alzheimer victims remain at home and subject caregivers to prolonged emotional and physical stress, making them the "hidden victims" of the disease. Clearly, there is a desperate need for day-care help and nursing home-care facilities to make the final institutionalization less frequent or at least to delay it as much as possible.