Involution (medicine)
As involution is called the natural degeneration of an organ, the limited time is active. It can be complete or partial and is a late form of physiological atrophy .
Complete involution is typical in some lymphatic organs such as the thymus or the bursa fabricii . Immediately after a birth, in the puerperium , the uterus regresses, and after the suckling or breastfeeding period , the mammary gland also regresses . Involution processes also occur during fetal development. So the actual go kidney in the amniotes ( reptiles , birds , mammals ) two phylogenetically older generations kidney ( pronephros and mesonephros ) operating systems. The involution in the genital area is age-related, in particular the involution of the uterus after menopause and the testicular involution in old age.
The organs of speech are also subject to the principles of involution. The involution of the organs of speech is particularly noticeable in the area of dementia. Speech involution has also been described in physiological aging . In the course of psycholinguistic age research it has been shown that the processes of regression of linguistic functions are not limited to age and begin as early as 20-year-old people.
For Konrad Lorenz , involution means the "opposite of evolution " which he detests , as it is in the phylogenesis of parasites such as tapeworms . However, their evolution is generally seen as a specialization and thus a higher development . Lorenz's real reason for involution is his fear that humans or certain parts of humanity could degenerate due to a lack of biological selection (self-domestication, "disgrace").
history
The beginning of the study of the involution of language can be found in the description of presenile dementia by Alois Alzheimer (1907) . However, developmental psychology in the first half of the 20th century was initially still mainly oriented towards the phenomena of child and youth development. It was not until the 1960s and 1970s that research into aging people became a separate focus of psychology. At about the same time, patholinguistics dealt with the diagnosis and therapy of speech loss (aphasia). Neurolinguistics (Leuninger 1990), which emerged in the 1990s, broadened the focus of patholinguistics in two ways:
- In addition to aphasia research, there was more general dementia research.
- The involution of the language of healthy individuals was also discussed.
Therefore, the psycholinguistic involution theory (albeit rarely from a philological pen) has a rich knowledge of orthology (knowledge of the healthy) and pathology of language involution.
genetics
In higher organisms, the involution of language is genetically determined by telomeres in particular. Telomeres are small, frequently repeated base sequences (e.g. TTAGGG) that code for the designation of a chromosome end. They are not required for the synthesis of any kind of proteins, but serve overarching purposes for cell reproduction. With each cell division, one less telomere is transmitted to the daughter cell. When all telomeres are "used up", no further cell division is possible. In all tissues of the body, reproduction is limited in time. If the number of cells that are no longer able to divide is significant, the typical signs of aging (e.g. osteoporosis, skin folds, lymphocytopenia, immunodeficiency, anemia, postmenopause, impotence, etc.) occur.
physiology
The condition of an individual is called physiological when it corresponds to the average of a healthy population. With regard to involution, the following functional areas are primarily affected by healthy regression: voice , vision , hearing , non-verbalism , lexicons , articulation , mnemics and pragmatics .
voice
A woman's voice drops after reaching postmenopause (between the ages of 40 and 50) due to a relatively high level of testosterone in the blood. In this context, ´relative´ means that the amount of testosterone present in the serum is increased compared to that of estrogen. It is not absolutely more testosterone produced, but due to the drastically lowered estrogen level there is a relatively large amount of testosterone. Therefore, there is a growth spurt in the larynx. The enlarged larynx brings about a lowering of the basic intonation when speaking. The voice sinks by a third to a fifth compared to the mean intonation before postmenopause.
It is not uncommon for postmenopausal women to try to hide the lowering of their intonation by speaking and singing in high pitch. [ citation needed ] Chronic hoarseness is the result. It can result in leukoplakia with facultative precancerosis . (Popularly one speaks of "vocal cord nodules" and "larynx cancer".)
The so-called age rattle occurs in men. The voice appears hoarse, although there is no infection of the larynx. The cause is the consistency of the mucous membranes in the larynx (larynx). Age rattle is intuitively understood as an unmistakable sign of an aged voice and is seen by singers as a reason for ending their concert career.
VA
Also between the ages of 40 and 50 years old age ametropia ( presbyopia ) develops , which mainly affects reading without glasses. Since wearing these visibly signals the ametropia to the outside world, wearing reading glasses has a significant impact on the non-verbal expression of the aging person. Contact lenses are an increasingly chosen alternative. In women in particular, the attempt to get by without reading glasses despite the onset of presbyopia often becomes pathological: headache and vegetative exhaustion are considered the results of delayed reading aid.
Hearing
Hearing loss ( hypacusis ) already sets in at the age of 20 ("creeping") and manifests itself as a serious handicap in social communication from an age over sixty. In particular, the inability to filter out background noise is perceived as annoying. Elderly hearing impaired people fail in conversation when background noise is heard. Public transport, restaurants and meetings are no longer suffered. Loneliness and depression are often the result.
Non-verbal
White hair, hunched back, wrinkled skin, tremor at rest and impaired mobility are clearly visible signs of aging and thus involuntarily part of non-verbal expression ( non-verbalism ). More than the verbally performed utterance, the nonverbals mark the aging person at an early stage.
The aging of the skin is mainly due to two components:
- Wrinkle formation through alignment of the connective tissue fibers in the dermis ,
- Increase in the stratum disjunctum of the epidermis .
The formation of wrinkles is attributed to the alignment of the intercellular fibers in the rough dermis (so-called dermis). The stratum disjunctum is the outermost layer of the epidermis. It consists of dead epithelial cells, which are only superimposed as a protective layer on the living cells of the epidermis. The stratum disjunctum is usually thicker in old people than in young people.
The age of the skin (especially the facial skin) is usually perceived unconsciously in natural communication and is included in the assessment of the partner.
The phenomena mentioned occur particularly in the development of diseases of old age: osteoporosis (so-called bone loss), diseases of the spine, Parkinson's disease, etc. Voice tremor is understood as a paraverbal sign of a pathologically altered voice.
articulation
Articulation describes the process of speaking through the organs involved . It differs from the structure of language ( language center ) represented in the brain and spoken language as such. In aging people, the articulation changes due to changes in the central nervous system in the following points:
- As a result of cell loss or loss of function in the area of the extrapyramidal nervous system, the articulation becomes hypolalic (softly and weakly articulated).
- As a result of cell loss or functional disorders in the area of the pyramidal nervous system, articulation becomes slow (bradylalisch), and so-called word-finding disorders are increasingly evident.
Lexicons
In contrast to the youth language and the so-called age dialects of the child, the lexicons (e.g. vocabulary) of the aging person have so far been little researched. Characteristic are the reduced uptake of so-called neologisms and the retention of forms and word formations of expressions that have gone out of fashion. Lexemes in youth language such as "geil", "super", "mega" etc. are avoided, while genitive additions are preferred instead of datives that have become common. Expressions with an archaic character are also considered hallmarks of the lexicons of older people: z. B. "Giving yourself an advantage" etc. As jargon , the lexical signs of aging people are sometimes cultivated in various men's associations (e.g. Freemasons, Schlaraffen, Netherlanders, knight associations). [ citation needed ]
Mnemics
_presenile_onset.jpg)
The ability of the elderly to remember is increasingly limited in the areas of short and medium-term memory. The so-called poor memory is an outstanding sign of the onset of dementia and is checked in standardized tests by asking about the location and time orientation and by repeating word tasks. Even when calculating with two-digit numbers, it is more difficult to memorize intermediate results in old age (see arithmetic problems in dementia screening). Since the declining ability to remember is a healthy sign of age, dementia can only be indicated if there is an extreme deviation from the age mean.
In language behavior, the restricted mnemics become noticeable through so-called word finding disorders and insufficient processing of the conversation content of dialogues (see also lack of empathy ).
Pragmatics
The pragmatics of the aging person is sometimes characterized by the longing glorification of earlier times ( nostalgia ). Nostalgia is accompanied by a tendency to cling to outdated concepts ( rigidity ). The frequent violation of the gymnastics rules is particularly difficult . Old people tend to interrupt the other person, so to speak, without observing the rules for handing over the turn. The interlocutors often react by avoiding the elderly. The result is increasing isolation. Depression in a situation of social isolation is increasingly in need of treatment.
pathology
Aphasia (pathological loss of language) and dementia are the two main groups of language diseases in advanced age.
aphasia
Sudden loss of speech functions is observed, especially as a result of strokes and brain metastases from malignant diseases ( malignancy ). It may be that the language is "completely gone", so to speak (total aphasia). In the further course of the aphasic disease, there is usually a clarification in the direction of predominantly motor aphasia or predominantly sensory aphasia. Both can be associated with significant impairment of speech memory: motor-amnestic vs. sensory-amnestic. Particularly with circulatory disorders in central areas of the brain, a complex confusion of linguistic expression is referred to as central aphasia.
Diagnostically, the areas of linguistic disorder need to be clarified more closely. A rule of the clinician said for decades that speech therapy was contraindicated in the period of spontaneous remission after apoplexy. However, early onset of speech therapy exercise therapy appears to be useful in patients with good rehabilitation chances.
dementia
In contrast to debility as a term for insufficient language and intelligence acquisition, dementia is used to describe the loss of already acquired intelligence and language.
Alzheimer's dementias
Alzheimer's dementias are characterized by the destruction of nerve cells in the cerebral cortex as a result of amyloid deposits on the soma (cell body). Patients can no longer find their way home from a walk in familiar surroundings, miss fixed appointments and can no longer plan their daily routine extensively. Linguistic weaknesses in finding words and disorders of memorizing are leading symptoms.
A distinction is made between two types of Alzheimer's dementia, which show quite similar speech symptoms:
- Presenile Alzheimer's dementia
- senile Alzheimer's dementia.
Presenile Alzheimer's dementia manifests itself between the ages of 40 and 50. Senile Alzheimer's dementia does not break out until the age of over 60. Both types differ particularly in the course, because present Alzheimer's dementias show a more sudden onset and a "steeper" course of the disease. Linguistically, the areas of non-verbalism (especially loss of the "speaking" eye), mnemics, lexicons and pragmatics are affected.
Alcoholic dementia
In the presence of Wernicke encephalopathy as a result of chronic alcohol abuse, Korsakoff's syndrome develops as dementia with considerable speech symptoms. Motor weaknesses in the area of articulation, facial expressions and gestures are accompanied by sensory disorders (hallucinations, misunderstandings, deviating interpretations of the events observed).
Parkinson's disease
The Parkinson's disease is characterized by first motor speech disorders. Due to an early resting tremor, the patient's non-verbal use is indicative. Due to a lack of dopamine in the areas of the extrapyramidal nervous system, patients have poor control over the gross form of their movements. As a result, there are disturbances in writing (so-called scribble) and articulation (softness, "slurred" speech). The voice guidance in the course of a sequence is "monotonous", and the content of the contributions to the conversation is often "ridiculous".
On the street, Parkinson's patients are often mistaken for alcoholics, because if the effects of the medication suddenly wear off, they fall into a crisis of body movements. However, they are usually recognized by the emergency services by socially oriented statements.
More dementias
Further dementias are to be distinguished from the differential diagnosis; in particular Mb. Niemann-Pick , Mb. Binswanger , Mb. Kreuzfeld-Jacob, physiological senile dementia etc.
Physiological old age of the language functions
In the course of old age (often over 90) there is often a gradual increase in the processes of healthy speech involution, so that those affected ultimately need treatment. In this respect, the diagnosis "physiological senile dementia" is made.
Diagnosis
Diagnostically, so-called screenings are to be distinguished from comprehensive standard tests.
- Cognitive Minimal Screening is widespread in German-speaking countries.
- The so-called CAMDEX was standardized from English in Germany. It is a transfer of the standard test created in Cambridge for measuring linguistic and non-verbal intelligence in the elderly.
Early diagnosis is important for two main reasons:
- Practicing procedures can slow the course of the disease.
- New drugs can halt or slow down the course of the disease for years.
Prophylaxis and therapy
The main prophylactic recommendations are:
- Estrogen substitution in postmenopausal women
- Low fat diet
- Sports
- Creative activity
- Practicing memorization .
The primary objective of the therapies is to maintain quality of life. Since dementia diseases are currently not considered curable, slowing down the course of the disease is the top priority for all therapeutic interventions. For this purpose, the following points in particular have been emphasized:
- Care of family and other social ties
- Preservation of language functions (motor, sensory, cognitive)
- Care of hygiene and nutrition
- Accompaniment of dying .
literature
- Alois Alzheimer: About a strange disease of the cerebral cortex. In: Allg. Zschr. Psychiat. 64, 1907, pp. 146-114.
- Michael Argyle: The Anatomy of Human Relationships. Munich 1990.
- T. Bernhardt, A. Seidler, L. Fröhlich: The influence of psychosocial factors on the risk of dementia. In: Advances in neurological psychiatry. 70. 2002, pp. 283-288.
- W. Brehm, YP Duan, T. Mair, H. Strobl, S. Tittlbach: Physical-sporting activity as health behavior: The FIT-level model. In: Bayreuth contributions to sports science. H. 12, 2010.
- Claudia Büeler: Faces of people with dementia: An art therapy project for old people's and nursing homes. 2010.
- Barbara Dobrick : About Loving and Dying. Freiburg 2010. ISBN 978-3-7831-3497-1 .
- Franz Grehn: Ophthalmology. 29th edition. Heidelberg 2006.
- Kurt Jellinger (Ed.): Alzheimer's - Milestones from a hundred years of scientific and clinical research. Berlin 2006.
- J. Kessler, M. Grond, A. Schaaf: KMS Cognitive Minimal Screening. Hogrefe, Stuttgart 1991.
- Ursula Lehr : Psychology of Aging. Heidelberg et al. 1970.
- Konrad Lorenz: The eight deadly sins of civilized humanity. (= Piper. Volume 50). 34th edition. Munich 2009.
- Luise Lutz: MODAK - modality activation in aphasia therapy. Springer, Heidelberg et al. 2009.
- Konrad Maurer, Ulrike Maurer: Alzheimer's - The life of a doctor and the career of a disease. Piper, Munich 1998.
- Rudolf Probst, G. Grevers, H. Iro: Ear, nose and throat medicine. 1st edition. Stuttgart / New York 2008.
- Rolf Raasch: People with dementia and alcoholics in one facility? Alcoholism sequelae in retirement and nursing homes: Korsakov's syndrome. In: Psychiatry & geriatric care news. 2/2000, pp. 5-8.
- M. Roth, E. Tym, CQ Mountjoy, FA Huppert, H. Hendrie, S. Verma, R. Goddard: CAMDEX. A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. In: The British Journal of Psychiatry. (1986) 149, pp. 698-709.
- W. Seidner, U. Eysholdt, Jürgen Wendler (Hrsg.): Textbook of Phoniatrie and Pedaudiology. Bonn 1997.
- Wilhelm Seyfert: Textbook of Genetics. 2003.
- Jürgen Steiner: Speech therapy for dementia: scope and resource-oriented practice. Munich 2010.
- Wolfgang Storm: Down syndrome - medical care from childhood to adulthood. 1995.
- Reiner Thümler: Parkinson's disease: know more, understand better. Stuttgart 2006.
- Natalie Vorderwülbecke: Difficulties in communicating with aging people in the context of dementia - What help can speech therapy offer to support communication between nursing staff and people with dementia? Signum-Verlag, Seedorf 2005.
- Matthias Wenderlein: Psychosomatics in gynecology and obstetrics. 1988.
- Etta Wilken: Language training in children with Down syndrome. 10th edition. Kohlhammer, Stuttgart 2008.
- G. Zander-Schneider: Are you my daughter? Reinbek 2006.
- Yili Zhang, Liu Rong-Yu, George A Heberton, Paul Smolen, Douglas A Baxter, Leonard J Cleary, John H. Byrne: Computational design of enhanced learning protocols. In: Nature Neuroscience . 15 (2012), pp. 294-297. doi: 10.1038 / nn.2990
Individual evidence
- ↑ In young people with trisomy 21 in particular, early speech involution is clinically manifest. See Strom 1995.
- ↑ cf. Lorenz 1973.
- ↑ cf. Alzheimer's 1907; Mason 1998.
- ↑ cf. Lehr 1970.
- ↑ Leischner 1970, Peuser 1980.
- ↑ cf. Seyfert 2003.
- ↑ cf. Seidner 1995.
- ↑ cf. Grehn 2006.
- ↑ cf. Probst et al 2008.
- ↑ cf. Argyle 1990.
- ↑ cf. Vorderwülbecke 2005.
- ↑ cf. Lutz 2009.
- ↑ cf. Jellinger 2006.
- ↑ cf. Raasch 2000.
- ↑ cf. Thümler 2006.
- ↑ cf. Kessler 1991.
- ↑ cf. Roth 1986.
- ↑ cf. Wenderlein 1988.
- ↑ a b cf. Zander cutter 2006.
- ↑ cf. W. Brehm, YP Duan, T. Mair, H. Strobl & S. Tittlbach (2010).
- ↑ cf. Büeler 2010.
- ↑ cf. Zhang 2012.
- ↑ cf. Bernhardt 2002.
- ↑ cf. Steiner 2010.
- ↑ cf. Dobrick 2010.