Suicidal behavior in dementia

Both cases of dementia and suicidal behavior (SB) are more common among elderly and senile people. However, opinions on their combination are contradictory. Aim of the review: to summarize the available literature data on SB in persons with dementia due to neurodegenerative diseases and vascular pathology of the brain (stroke). Results. Suicidal thoughts among patients with dementia are observed more often compared with the general population of the same age, other manifestations of suicidal activity are somewhat less common, except patients with Huntington's chorea. SB occurs much more often during the first years (1-3 years) after the diagnosis of dementia and discharge from hospital, with mild to moderate cognitive impairment. Of certain importance is the preservation of criticism of the disease (intellectual-mnestic decline). The established risk factors for SB in dementia are: depressive disorders, relatively young age (age of onset of the disease up to 65 years), concomitant somatoneurological pathology, lack of positive dynamics from the therapy, loss of autonomy and social isolation. Early loss of criticism, apathy, indifference, emotional dullness against the background of rapidly progressing cognitive disorders are protective factors against SB. SB prevention in patients with dementia should include: restricting access to dangerous means of committing suicide (toxic substances, drugs, vehicles, firearms, etc.), treatment of cognitive impairment (dementia), as well as concomitant comorbid mental disorders. This can be facilitated by screening for suicidal conditions. Psychocorrection (cognitive-behavioral therapy) is needed for symptoms of hopelessness, demoralization, stigma and self-stigmatization, for patients at risk with a history of SB episodes. It is important to organize follow-up and long-term care services for patients with dementia and integrate protective factors such as health conditions and social support into SB prevention program. Conclusion. Degenerative diseases (Alzheimer's disease, Lewy body dementia, frontotemporal dementia, Parkinson's disease, Huntington's chorea), as well as vascular dementia affect the suicidal risk among elderly and senile people. SB in patients with dementia is an urgent interdisciplinary problem that requires new qualitative research.