I once believed that cancer was the worst thing that could happen to a person. Of course, we must fight to the last, but the stereotype established in society said that the days of life are numbered, have time to live them in a little bit of a state of joy, do not miss the important things, finish what has been put off, enjoy communication with loved ones. If you're lucky, there will be recovery or remission. The “psychologist” turns on and I understand: on each day, in most cases, a person with this diagnosis remains a person. While experiencing suffering, his personality is alive. And in some cases, this person undergoes a spiritual transformation, transformation, opens up new facets of perception of the world, himself and his neighbor. Someone comes to God, and this faith helps them leave with a blessing or stay with hope and gratitude. And what happens to people who also have palliative status, but suffer from the most terrible disease today? A disease whose causes have not yet been identified, has no quality diagnosis, and no medical treatment. The situation is aggravated by the catastrophic shortage of professional practitioners in matters of interaction with people suffering from neurodegenerative diseases, the open question of training staff providing care, the total lack of information in society, the insufficiency of accessible specialized institutions, the lack of systemic quality care and the frightened relatives of the sick, suffering in their lonely ordeals to cope with senile ailments, in an attempt to save themselves and their families. Dementia is a persistent decline in cognitive activity with the loss, to one degree or another, of previously acquired knowledge and practical skills and the difficulty or impossibility of acquiring new ones. Nowadays it is not customary to say, but this is dementia, chronic progressive neurological symptom leading to disability. It can be caused by various brain diseases that affect memory, thinking, behavior and the ability to perform daily activities (sensation, perception, orientation, understanding, numeracy, language functions, the ability to compare, evaluate and make choices), affects the emotional background and social behavior. Features of dementia appear in 10% of people over 65 years of age, and the earlier the disease begins, the more rapidly it progresses, the faster the person’s personality is destroyed. The phrase that even among specialists does not have an accurate understanding of the number of dementias will not sound at all encouraging. Several years ago I mentioned 70 types, now I name the number 120. The most common cause of dementia is Alzheimer's disease, it affects 60-80% of patients with symptoms of dementia, followed by stroke, dementia with Lewy bodies, Parkinson's disease, and brain injuries. Most often, a person has two or more causes of dementia. Alzheimer's disease is a type of senile dementia, manifested by total dementia with progressive memory decay and focal cortical disorders. It is a neurodegenerative incurable disease, a progressively structured and developing chronic condition of mental retardation. First described in 1907 by German psychiatrist Alois Alzheimer. The cause of the intellectual degradation of his patient Augusta was a disease unknown to science that affects the brain. The average life expectancy of a patient is about seven years. Alzheimer's disease develops slowly and undetected twenty years before diagnosis, and only a pathologist can confirm the disease. But, you see, this is quite late for everyone and everything. Today, what have we come to in communicating with our beloved elderly people who have cognitive impairment? The main symptom of their illness is memory loss, especially short-term. It's not just forgetfulness. The person forgets the entire context of the event. He has difficulty with daily activities: toileting, dressing, preparing and eating food. There are difficulties with choosing a word,forgetting words, distortions, inventing new, non-existent ones. The ability to maintain contact during a conversation, receive information, and the ability to analyze, repeat, and remember it is lost. Disorientation in time and space with the inability to distinguish day from night, to recognize known surroundings, the possibility of getting lost, lost, with loss of the ability to assess the environment: putting on winter clothes on a warm day or the “cabbage effect.” Constant loss of objects, searching for them. Total changes in well-being and behavior: low mood or unexpected emotional reactions, inappropriate situations. A state of laziness, loss of initiative and interests, passive daily position. A changing personality demonstrates suspicion, constant irritability, apathy, negativity, aggression. We begin to speak different languages, live according to different laws in completely different worlds, while being in the same room. Once upon a time we understood and loved each other. Now all that remains is hateful fatigue, anger, despair. What have we come to? To the point of attacks of paranoia, delusions of harm and persecution, sexual disinhibition, hallucinations... It’s as if old people are “writing a plan of abominations” for the day: pee on the floor, smear themselves with what comes out of them, put on whatever they find, tear, cut anything you can get your hands on, piss your family off, throw a tantrum, hide your keys, throw away your medicine, make dinner out of a garbage bag. It seems like “they” are just making fun of us. In this case, relatives or staff slowly and quietly begin to go crazy. When we hear that by 2050 152 million people will have a decline in cognitive status, this seems like a very distant event that has no relation to us. World statistics are conjectural in calculations. Much closer and more realistic, and therefore even more shocking, is the statistics of requests from relatives of elderly people to only one specialist. Over the course of 4 months, 61 clients approached me as a clinical psychologist for the purpose of diagnosing their mental status. The study used diagnostic techniques that studied: 1. Cognitive status: brief scale for assessing mental status Mini-mental state examination (MMSE); test for identifying memory impairment “Clock Drawing” S. Lovenstone, S. Gauthier, 2001; Montreal Cognitive Function Rating Scale; Frontal Dysfunction Battery (English) Frontal Assessment Batter - FAB, B. Dubois et al., 1999); six-item cognitive test (6CIT).2. Presence of depression (to avoid pseudodementia): short form of the Geriatric Depression Scale (GDS-15); Cornell Depression Scale for Depression in Dementia; Beck questionnaire; Hamilton scale.3. Methods for persons providing round-the-clock care in situations where a person cannot tell anything about himself: Arizona test for relatives of the patient (The Alzheimer's Questionnaire, 2012); Questionnaire on the state of cognitive functions in an elderly person. (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Jorm A., 2004). Children who were concerned about the state of the cognitive functions of their elderly parents sought help. Thirteen men, forty-eight women. The age of the subjects ranged from 60 to 100 years: “60+” - two, “70+” - eighteen, “80+” - thirty-five, “90+” - six, “100+” - one person. The results of the study showed the following numbers. Absence of cognitive impairment in 7, pre-dementia impairment in two, mild cognitive impairment in 5, moderate in 18, severe cognitive impairment, diagnosis of Alzheimer's disease in 29 people. 20 subjects had an official diagnosis of Alzheimer's disease. Significant hearing impairment was noted in 19, visual impairment in 12, and speech impairment in 20 people. The presence of depression in 30 people, 7 of which were severe at the time of the study .In terms of independence, only 9 people have the opportunitylive and serve themselves independently, 44 dependents, 8 bedridden people. Over the past six months, of this number of subjects, 30 suffered a stroke, 11 suffered a hip fracture. Mortality was 3 people. The results regarding marital status are impressive. Only 9 out of 61 people live in a partnership, 52 are single. We may not notice the onset of the disease or the severity of the parents’ condition if they live as a couple. One complements the other, life follows an established pattern, “automatically,” and when a person is suddenly left alone, “all dementia” suddenly comes out in emptiness, without love. The conclusion is sad. Out of 61 people, only 9, if nothing is changed in their way of life, can live and work independently. They still can. Please don’t think that I’m talking about rare things! The number of people with cognitive impairments is growing every second, and what’s even worse is that these numbers are getting younger. Previously, at lectures, I voiced the earliest case of the disease at 42 years old, today it is a 37-year-old patient. Senile and no longer senile dementia is progressing... We move by touch, in complete darkness, in our painful, forced isolation from misunderstanding and confusion in front of this avalanche of madness. Why am I sharing this? For our competence! When a doctor at an appointment is surprised by the persistence of an older patient: “What do you want? How old are you? These are age-related changes!”, we get up, slam the door, and run. Neurodynamics decreases with age, but the brain should work the same, only a little slower. There are only two types of old age: pathological and healthy. There are and cannot be any other options! We know that memory, speech and the ability to cope with simple everyday and financial issues are the first to suffer. I would recommend paying attention to these factors. “Brain fog” - “brain fog”. Feeling of brain fog, fogginess, emptiness. This is one of the first warning signs, along with the appearance of forgetfulness. The presence of “bad” and “good” days. The growth of this division. Staying in a state of laziness. Increasing level of demands, claims, grievances, whims. Criticism of everything and everyone. Playing to the public, demonstrative behavior, attracting attention. Devaluation of everyone and everything, especially those close to you. “Know-it-all.” Frequent changes of mood. Distance from reality, withdrawal into the painful world of fantasy. Absence, decreased joyful perception. Decreased sense of humor. Violation of the associative series. Forgetting new information. Difficulty in using simple household appliances. Tying knots. Storing expired products, excessive amounts of them, forgetting about them. Frequent changes in the location of objects. The appearance of “stashes.” A shuffling gait. If you suddenly begin to notice such manifestations in yourself, your family, or your patients, you should immediately consult a doctor. However, remember that even experts cannot come to an accurate understanding of the situation. The age at which signs of impairment appear, as well as the set and degree of physical changes that affect intelligence, vary. Most are found between 50 and 60 years of age. Some become noticeable only after age 70, but the greatest changes are observed after age 80. If your doctor mentions the word dementia, you need to find out its causes. Did you know about boxer's dementia? It exists. It is extremely important to know about the potentially reversible causes of dementia, and only by eliminating them can we talk about Alzheimer's disease or dementia. We must exclude delirium, dehydration, exhaustion, trauma, tumors, brain infections, vitamin B deficiency, drug overdose, metabolic disorders, chronic alcoholism, normal pressure hydrocephalus. Before drawing conclusions and assuming the worst, it is necessary to find an explanation for the changes that have appeared in human behavior, anxiety, screaming, attacks of pain, temperature, poor health, fear. Pay special attention to the emotional background and categorically exclude depression. If it is present, the cognitive status decreases, and a person’s behavior may be inappropriate. The soonerAn examination is carried out, a diagnosis is made, the causes are identified, the more time and opportunities will remain for both the sick person and his family. This is the time to rationally resolve legal issues, no matter how immodest and cruel it may sound. We do not betray, we ensure the future. The sick person and his loved ones also have it. In my professional practice, I never voice diagnostic results over the phone. This is a categorical prohibition. The results of a neuropsychological study are bad news, which must be communicated humanely, carefully, eye to eye. Even guessing about the problems, realizing that something is “going wrong”, that the grandmother is “playing naughty”, hearing a presumptive diagnosis is painful. The conditions for the meeting, the atmosphere and sufficient time must be created. It doesn’t matter whether the client himself suffers from cognitive impairment or his relatives came. We must take care of the person, because news of illness in most cases is perceived as real grief and recognition of this will take the form of the grieving process. This is natural. The work of grief will be equally strong during divorce, and during job loss, and during retirement, and during a cancer diagnosis, death or dementia. Knowing the stages of grief will help you understand everything that is happening, will help relatives not only now accept the disease, but also in the future to survive the loss. To loved ones or to the sick person himself, if he realizes the presence of a defect, everything that happens may seem abnormal, pure madness. In order not to drive yourself into a corner of unresolvedness, it is important to get acquainted with the stages of grief and their characteristic features. This information is vital for people who are personally faced with a diagnosis. To be honest, in my practice there was only one case when the person himself asked for help “on time.” In ordinary stories, illness “rules the roost.” It will sound cruel, but we are obliged to tell a person only the truth. The defense mechanisms of the psyche will still temporarily repress some of the “stifling” information. This is a kind of salvation from suffering. Emotions will subside, giving way to reasonable planning for the future. We need to help the person and his family accept everything as it is, build a life within the disease, and take his time to live. As a person and a professional, I give up at the moments when children whose parents suffer from cognitive impairment say: “Inna! What psychologist? What activities?! He has dementia, he will die soon!” And wings appear when I receive letters: “Your reports give hope to our entire family. I liked my mother’s eyes and the emotions that returned to her. She can again experience happy and different moments. Thank you!"; “The grandmother’s condition has returned to what it was a year ago or earlier. I look at her and can't believe my eyes. How do you do this?! She remembers many things that she has not returned to for a long time. He is interested in our affairs. We haven't seen her smile for so long! You can't even imagine how surprised and happy we are. We didn’t suspect that it was possible to restore a person like this!” Organic changes lead to the emergence of negative compensatory manifestations: cognitive and emotional disorders, obsessive and delusional ideas, hallucinations. After identifying the degree of violations of higher mental functions, considering characterological, behavioral, emotional disorders in an elderly person, the psychologist prepares an individual program of cognitive training to support, restore, preserve the functions of memory, thinking, speech, attention, fine motor skills of the hand in order to restructure impaired brain functions and create compensating funds. Our task is to provide positive compensation through communication, training, play, sound, art therapy, etc. Therapy should include pedagogical and animation activities, physical activity aimed at reducing emotional stress, increasing self-esteem, self-confidence, and activating skills communication, increasing an elderly person’s own social significance in realitytoday. One of the main goals of the work is to maintain communication with the outside world, prevent emotional deprivation, and the emergence of suicidal behavior at the onset of the disease. I dare to say: despite the age, diagnosis and condition, with a properly selected integrated approach, with the daily work of a sick elderly person with specialists, we We not only slow down the degradation and destruction of personality, but we are also able to achieve the restoration of criticality! There are results, no matter what. This fact gives hope not only to the family of the sick person, but also to the specialists themselves, which means we have the opportunity to improve the quality of a person’s life, extend the days of his life, filling them with meaning, joy, a sense of need and skill. No one can stop Alzheimer’s, but we are able to create a territory of success and complete acceptance, where an elderly person, who asked “Where am I?” up to 20 times in the first 60-minute classes, will not ask this question even once in a couple of months A 77-year-old woman with this disease calls a psychologist “a medicine for my head” precisely because she sees the result of the work. She can't put the picture together. It would seem, what could be simpler? She speaks out loud, making excuses: “I’m used to speaking out loud, since I live alone, I have no one to talk to.” And even if in an hour she does not remember what is happening, the emotions remain inside. We will rely on them in the future. The client’s language is sacred to me. Can anyone say better and more truthfully about his intention except the sick person himself? “Don’t tell me!” Your hint doesn't let me think! It turns out that I'm not working! I need to figure it out on my own!” “Are we tired or should we continue working? Let's continue! They praise me here!” “I thought everything was bad with me. But now I see - no!” “I guess, I’m happy, you’re happy, and my health is improving!” An elderly man gives a feeling of need to the specialist himself when he tries hard in class, boasting about his successes: “Come, at least I’ll remember who I am like this...” “Don’t leave me, otherwise I’ll become completely abnormal...” “Make me a man...” “Thank you, you’re saving me...” “I’m completely abnormal, but there’s nothing wrong with you. Yes?..” “You’ll teach me a little, otherwise life will get out of hand...” “You’re saving me, my friend...” “Help me become a person...” “You’re just giving birth to me!” “I didn’t do your work before.” I thought, and now I want to invite everyone to you! It’s just a job, and yours is wonderful!” “You’re warm! You bring me back from a bad state to joy. It turns out that I didn’t forget everything...” “I was waiting for you, I wanted to study. You want me to succeed so much, you react in such a way that I try, and I really succeed. My head wants to think. I say to myself: “Annichka, come on, work!” “You come and I come to life!” “You help me live.” “I was dying at night, and now I’m laughing!” “I’m an old fool. With you I become young and the same as before. Alive!” To be honest, it is important for us to create a space for the Meeting, where everyone can be themselves. This is the beginning of a new path based on past experience and a resource for the future, this is support for an elderly person in his desire to be independent for as long as possible. Only in such a joint search, where no one does anything for him, he works on his own, at his own pace and rhythm, is a small victory over the disease, over himself, over circumstances born. Next to palliative patients, no longer able to give a verbal answer, we pray , listen to music, “dance with our hands” and immerse ourselves in a state of goodness, absence of pain and fear of loneliness. We are able to hear, understand, and be close. When our mentee feels that he is interesting, important to someone, that his experiences today or in the very distant past are valuable to another, when he can allow himself to voice what he has been hiding for many decades out of fear, shame, bitterness, pain, when someone... then, being nearby in these moments of revelation, experiencing and feeling together, together looking for joy in the soul and readiness for change, then faith awakens and the strength for life here and now is born. Elderly.