Dementia is often one of the most misunderstood conditions in medicine history. Some scientists believe that senility or senile dementia is an inevitable result of aging, and never seek evaluation for family members who show signs of memory loss. Others believe that any evidence of forgetfulness is evidence of dementia.
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I (Dr Qaisar Ahmed) think Neither of these conclusions are accurate. Additionally, does dementia differ from Alzheimer’s disease, delirium or are all forms of dementia Alzheimer’s disease? If someone has memory loss associated with another condition, does that turn into Alzheimer’s disease?
Many patients with early Alzheimer’s disease, delirium or other types of dementia are unaware that they have any problems. As the disease progresses, behavioral changes can become evident.
Early signs of dementia
- Forgetfulness, losing items; Problems performing tasks or activities that were previously done without effort.
- Difficulty with learning new material (one of the earliest signs of dementia).
- Difficulty performing basic tasks, such as getting dressed or using the bathroom.
- Some patients begin to forget pieces of information about themselves, including their address or telephone number, or even their date of birth.
- They may have difficulty understanding what is occurring around them.
- Some patients have problems remembering to eat and may develop pronounced weight loss.
- In the late stages of dementia, patients often cannot recognize family members, and their ability to communicate effectively is markedly impaired.
- They are no longer able to effectively care for themselves and require assistance for all activities of daily living.
- Over time, patients can forget how to walk or even how to sit up.
- They may repeat questions or stories regularly or forget appointments.
- They may get lost in familiar environments. Personality changes, including irritability or agitation, may also occur.
- In some cases, people with dementia develop hallucinations (or see things that aren’t really there).
Causes of dementia
Dementia is a broad term that covers many different conditions, including Alzheimer’s disease, delirium, vascular dementia, frontotemporal dementia (the result of damage to neurons in the frontal and temporal lobes of the brain) and other disorders.
Simple forgetfulness is not enough to lead to a diagnosis of dementia, as there needs to be evidence of problems in at least two areas of cognition (brain function) to confirm this diagnosis.
Alzheimer’s dementia/Alzheimer’s disease (AD)
Alzheimer’s disease is the most common form of dementia.
Vascular dementia
Vascular dementia is the second most common cause of dementia and is due to multiple strokes occurring within the brain. Often, these strokes may have been unnoticed and patients may not have any associated symptoms such as weakness, visual loss, or numbness. (Patients with untreated high blood pressure or heart disease may be at risk of developing vascular dementia).
Frontotemporal dementia
Frontotemporal dementia is associated with pronounced atrophy or shrinkage of the frontal and temporal lobes in the brain. In addition to forgetfulness and word-finding problems, patients may have marked personality changes, impulsivity, or poor judgment. Some patients with frontotemporal dementia can develop incoordination or stiffness of their muscles.
Hydrocephalus, alcoholic, Huntington’s, and trauma dementia
Normal pressure hydrocephalus is an abnormal enlargement of the ventricles, or fluid-filled spaces within the brain, that causes pressure on areas of the brain. This leads to problems with walking, memory, and the ability to control urine flow (incontinence).
- Huntington’s disease causes characteristic abnormal movements, called chorea, in affected individuals. The movements are the hallmark of the diagnosis. However, in some cases, problems with memory can precede the development of the chorea by many years.
- Alcoholic dementia is caused when patients drink heavily and develop a deficiency in one of the B vitamins. When this happens, brain cells are unable to function normally and memory loss can occur. This is called Korsakoff syndrome. Although it is most commonly seen in alcoholics, patients who are malnourished from other causes are also at risk of developing this disorder.
- Traumatic brain injury (concussion)/dementia) pugilistic can lead to memory problems. In some cases, recurrent brain injuries or repeated concussions can contribute to the underlying changes identified in Alzheimer’s disease.
Lewy body, Creutzfeldt-Jakob, and mixed dementia
Lewy body dementia/Lewy body disease is caused by Lewy bodies, which are abnormal clumps of certain proteins, accumulating inside of neurons. Forgetfulness and other signs of cognitive decline are the primary features of this condition, but patients can also develop prominent hallucinations which seem very real to them. Some patients with Lewy body disease develop symptoms that look like Parkinson’s disease, such as tremors and slowness.
- Creutzfeldt-Jakob disease is a rare condition where an abnormal protein leads to the destruction of brain cells and dementia. While most cases occur without an underlying cause, in some patients there is a family history of this disorder. Even less often, patients might be exposed to the abnormal protein. Mad cow diseaseis one example of external exposure. This condition tends to progress rapidly, over only a few years and is often associated with abnormal muscle movements.
- Mixed dementia refers to patients who have evidence of two (or more) types of dementia. They are often described as having mixed dementia. Alzheimer’s disease and vascular dementia are the most common causes of mixed dementia.
Stages of dementia
The stages of dementia are loosely grouped into mild, moderate, and severe categories or
- Stage 1: No cognitive decline.
- Stage 2: Mild cognitive decline.
- Stage 3: Moderate cognitive decline, for example, dementia impairment like memory lapses, and losing objects daily.
- Stage 4: Moderately severe cognitive decline, for example, poor short-term memory, forgetting personal details, and difficulty with basic math. This is usually the longest stage of dementia.
- Stage 5: Moderately severe cognitive decline, for example, increasing problems planning or organizing, disorientation, and may no longer be able to live alone.
- Stage 6: Severe cognitive decline, for example, problems recognizing friends and family members, and memory loss that worsens.
- Stage 7: Very severe cognitive decline. This is the final stage of dementia. Body systems decline, and communication is limited.
Patients may seem to fall into two different stages at the same time, depending on what symptoms they are experiencing. The different stages of dementia cannot be used to predict how rapidly someone’s condition might progress and patients may remain in one stage for many years or for only a few months. Every patient has a different progression of their disease.
What are the risk factors?
The risk factors for developing dementia include age and family history. Age and a family history of dementia are non-modifiable risk factors.
- Abnormal genes which are associated with Alzheimer’s disease have been identified but are only rarely involved in the development of Alzheimer’s disease.
- Conditions such as high blood pressure, high cholesterol, or diabetes increase the risks of developing either Alzheimer’s disease or multi-infarct dementia.
- Some allopathic medications can lead to memory problems that look like dementia.
Diagnosis
To diagnose dementia, in-office screening assessments are sometimes enough to confirm a diagnosis, at other times a more in-depth evaluation is required. Blood testing and imaging studies are often completed to confirm that reversible conditions such as thyroid disease or certain vitamin deficiencies are not present.
Allopathic treatment for dementia
Treatment options for dementia are very limited in allopathic drugs. While there are medications available to try to improve the symptoms, the effect of these medications is limited.
Physical exercise has been shown to be of some benefit in helping to maintain cognition. Staying engaged and participating in social events may also be of some help.
To date, no treatment which can reverse the process of Alzheimer’s disease, delirium, dementia etc, has been identified.
Homeopathic treatment for dementia
Anacardium Orientale
Neurasthenics patients; who have nervous dyspepsia, relieved by food; impaired memory, depression, and irritability; diminution of senses (smell, sight, hearing). Fears. Weakening of all senses, sight, hearing, etc. Aversion to work; lacks self-confidence; irresistible desire to swear and curse. Sensation of a plug in various parts-eyes, rectum, bladder, etc; also of a band. Empty feeling in stomach; eating temporarily relieves all discomfort. Alzheimer’s disease. Dementia. Delirium. Intermittency of symptoms.
Fixed ideas. Hallucinations; thinks he is possessed of two persons or wills. Anxiety when walking, as if pursued. Profound melancholy and hypochondriasis, with tendency to use violent language. Brain-fag. Impaired memory. Absent mindedness. Very easily offended. Malicious; seems bent on wickedness. Lack of confidence in himself or others. Suspicious. Clairaudient, hears voices far away or of the dead. Senile dementia. Absence of all moral restraint. Vertigo. Pressing pain, as from a plug; worse after mental exertion-in forehead; occiput, temples, vertex; better during a meal. Itching and little boils on scalp.
Rhododendron
Dread of a storm; particularly afraid of thunder. Forgetful. Dementia. Delirium; staggers; falls asleep on his knees. Frightful visions. Sombre, morose humour. Excessive indifference. Sudden loss of ideas. Leaves out whole words when writing. While talking forgets what he is talking about. Reeling sensation in head; brain feels as if surrounded with a fog.
Helleborus Niger
Melancholy taciturnity. Excessive, and almost mortal anguish. Home-sickness. Hypochondriacal humour. Taedium vitae; envious seeing others happy. Dementia. Delirium. Suicidal. Indolence. Sobbing lamentation. Obstinate silence. Irritable – feel better from consolation. Suspicious. Dullness of the internal senses. Stupidity and want of reflection, with (thoughtless) fixedness of look on one single point, much moaning, and inability to think. Weakness of the memory. The mind seems to lose command over the body; the muscles refuse their office as soon as the attention is diverted (if the will is not strongly fixed upon their action; if he talks he lets fall what he holds in his hand). Giddiness on stooping. Stupefying headache. Face pale – dropsical swelling of the face and body.
Absinthian
Forgets what has recently happened. Insane; idiotic; brutal. Idiotic manner doesn’t care whether she dies or not. Wants nothing to do with anybody. Delirium. Dementia. Frightful visions and terrifying hallucinations. Stupor alternating with dangerous violence. Insensible with the convulsions. Vertigo – when he/she rises up; tendency to fall backward. Confusion in head. Headache. Wants to lie with the head low. Congestion of the brain and spinal cord.
Causticum
Does not want to go to bed alone. Least thing makes cry. Sad, hopeless. Intensely sympathetic. Ailments from long-lasting grief, sudden emotions. Dementia. Thinking of complaints, aggravates, especially hemorrhoids. Delirium. Sensation of empty space between forehead and brain. Pain in right frontal eminence.
Hyoscymaus Niger
Disturbed nervous system. It is as if some diabolical force took possession of the brain and prevented its functions. Mania of a quarrelsome and obscene character. Inclined to be unseemly and immodest in acts, gestures and expressions. Very talkative, and persists in stripping herself, or uncovering genitals. Is jealous, afraid of being poisoned, etc. Its symptoms also point to weakness and nervous agitation – Alzheimer’s disease. Tremulous weakness and twitching of tendons. Subsultus tendinum. Muscular twitchings, spasmodic affections, generally with delirium. Non-inflammatory cerebral activity. Toxic gastritis. Very suspicious. Obscene, lascivious mania, uncovers body; jealous, foolish. Great hilarity; inclined to laugh at everything. Delirium, with attempt to run away. Dementia. Low, muttering speech; constant carphologia, deep stupor.
Head feels light and confused. Vertigo as if intoxicated. Brain feels loose, fluctuating. Inflammation of brain, with unconsciousness; head is shaken to and fro. Alzheimer’s disease.
Conium Maculatum
Stabbing pains. Weak-spells; faintness; sudden loss of strength while walking. Paroxysms of hysteria and hypochondriasis from abstinence from sexual intercourse. Photophobia; ptosis. When turning in bed (vertigo) moving the head ever so little; turning head sideways. In the dark; from letting the affected limb hang down; from moving; when walking; by stooping. Aversion to open air. Desire for warmth. Apoplexy with paralysis (in old people). Falling off of the hair.
Alumina
Low spirited; fears loss of reason. Confused as to personal identity. Hasty, hurried. Time passes slowly. Variable mood. Better as day advances. Suicidal tendency when seeing knife or blood. Alzheimer’s disease. Dementia. Stitching burning pain in head, with vertigo relieved by food. Pressure in forehead. Inability to walk closed eyes. Throbbing headache, with constipation. Vertigo, with nausea; better after breakfast. Falling out of hair; scalp itches and is numb.
Rauwolfia Serpentina
Melancholia include are Abasement, Abaser, Abjection, Abjectness, Bleakness, Bummer, Cheerlessness, Delirium, Dejection, Desolation, Desperation, Dementia, Despondency, Disconsolation, Discouragement, Dispiritedness, Distress, Dole, Dolor, Dreariness, Dullness, Dumps, Ennui, Gloom, Gloominess, Hopelessness, Lowness, Melancholy, Misery, Mortification, Qualm, Sadness, Sorrow, Trouble, Unhappiness, Vapors, Woefulness, Worry, Downheartedness, Dolefulness, Blue Funk, Blahs, Heaviness Of Heart and Lugubriosity. Paranoia, Paranoea. Alzheimer’s disease.
Vicum Album
Incoherent talk and spectral illusions; inclined to be violent. Insensibility. Stupor, succeeded by almost entire insensibility, lying motionless, with eyes closed, as if in a sound sleep, but easily roused by a loud noise, and then would answer any question, but when he/she relapsed into his/her former condition there was a slight disposition to stertorous breathing. Dementia. Feels as if going to do something dreadful while the tremblings are on. Delirium. Keeps waking in night thinking the most horrible things imaginable. If awake seemed to be dreaming, if asleep she was dreaming. Felt in bad temper. Great depression.
Giddiness. Intense throbbing headache. Sharp pain in head and face. Numb feeling in head. Tightening sensation of the brain once or twice. Sharp shooting in occipital bone.
Lac Caninum
Very forgetful; in writing, makes mistakes. Despondent; thinks her disease incurable. Attacks of rage. Visions of snakes. Dementia. Thinks himself of little consequence. Alzheimer’s disease. Sensation of walking or floating in the air. Pain first one side, then the other. Blurred vision, nausea and vomiting at height of attack of headache. Delirium. Occipital pain, with shooting extending to forehead. Sensation as if brain were alternately contracted and relaxed. Noises in ears. Reverberation of voice.
Medorrhinum
Severe disturbance and irritability of nervous system. Dwarfed and stunted. State of collapse and trembling all over. History of sycosis. Dementia. Alzheimer’s disease. Delirium. Intensity of all sensations. Weak memory. Loses the thread of conversation. Cannot speak without weeping. Time passes too slowly. Is in a great hurry. Hopeless of recovery. Difficult concentration. Fears going insane. Sensibility exalted. Nervous, restless. Fear in the dark and of some one behind her. Melancholy, with suicidal thoughts. Burning pain in brain; worse, occiput. Head heavy and drawn backward. Headache from jarring of cars, exhaustion, or hard work. Weight and pressure in vertex.
Macinela
Silent mood, sadness. Wandering thoughts. Sudden vanishing of thought. Bashful. Dementia. Fear of becoming insane. Delirium. Vertigo; head feels lights, empty. Scalp itches. Hair falls out after acute sickness. Fear: of getting crazy; of evil spirits. Alzheimer’s disease. Averse to work and answering questions. Sadness. Anxiety; before menses. Homesick. Bashful and taciturn; timid look.
Datura Metel
soporose condition, and later delirium and spasms. The soporose state may be absent. Delirium may be vociferous, or merely garrulous. Patient usually manifests excessive timidity. Picks at real or imaginary objects. Performs ridiculous antics. Several movements appear due to perverted vision, and inability to judge distances. After the delirium, patient remembers nothing of what has occurred. Extreme dilatation of pupils. Flickering before eyes with photophobia. Pulse and temperature undergo extremes of exaltation and depression. Alzheimer’s disease. Convulsions. Delirium. Epilepsy. Eye affections. Mania. Timidity. Dementia.
Aethusa Cynapium
Incapacity to think; confused. Loss of comprehension. Idiocy, in some cases alternating with furor. Great anxiety and restlessness, followed by violent pains in head and abdomen. Dementia. Bad humour; irritability. Irritability, especially in the afternoon, and in the open air. Delirium: sees cats and dogs; tries to jump out of the window. Loquacious gaiety.
Confused; brain feels bound up. Vertigo, with sleepiness, can’t raise the head. Headache in whole front part of head. Sensation, as if both sides of the head were in a vice. Distressing pains in the occiput, down nape of neck, and spine. Heat rises to the head; the body becomes warmer; the face becomes red and the giddiness ceases. Stitches and pulsations in the head. Can’t hold head up, or sit up. Sensation as if constantly pulled by the hair.
Argentum Metallicum
Restlessness – which forces him to walk quickly. Ill-humour and aversion to talking. When pleased, excessively merry, but cries a long time about a trifle. Dementia. Delirium (mania; after epilepsy). Dulness, and sensation of emptiness in the head. Dizziness, with obscurity of vision, or with drowsiness, and falling of the eyelids. Migraine. Compression in the brain, with nausea and burning in the epigastrium, on reading and stooping for any time.
Argentum Nitricum
The neurotic effects of Argentum Nitricum are very marked, many brain and spinal symptoms presenting, head symptoms often determine the choice of this remedy. Symptoms of incoordination, loss of control and want of balance everywhere, mentally and physically; trembling in affected parts. Dementia. Alzheimer’s disease. Gastroenteritis. Great desire for sweets, the splinter-like pains, and free muco-purulent discharge in the inflamed and ulcerated mucous membranes. Sensation as if a part were expanding and other errors of perception are characteristic.
Withered up and dried constitutions present a favorable field for its action, especially when associated with unusual or long continued mental exertion. Pains increase and decrease gradually. Flatulent state and prematurely aged look. Explosive belching especially in neurotics. Upper abdominal infections brought on by undue mental exertion. Paraplegia Myelitis and disseminated sclerosis of brain and cord. Intolerance of heat. Sensation of a sudden pinch. Destroyed red blood corpuscles – anaemia.
Thinks his understanding will and must fail. Fearful and nervous; impulse to jump out of window. Faintish and tremulous. Melancholic; apprehensive of serious disease. Time passes slowly. Memory weak. Errors of perception. Impulsive; wants to do things in a hurry. Peculiar mental impulses. Fears and anxieties and hidden irrational motives for actions. Delirium.
Headache with coldness and trembling. Emotional disturbances cause appearance of hemi cranial attacks. Sense of expansion. Brain-fag, with general debility and trembling. Headache from mental exertion, from dancing. Vertigo, with buzzing in ears and with nervous affections. Aching in frontal eminence, with enlarged feeling in corresponding eye. Boring pain; better on tight bandaging and pressure. Itching of scalp. Hemicrania; bones of head feel as if separated.
Arsenicum Album
Melancholy, sometimes of a religious character, sadness, care, chagrin, cries and complaints. Anguish. Restlessness. Great fear of being left alone. Anger, with anxiety, restlessness and sensation of coldness. Anxiety of conscience, as if a crime had been committed. Inconsolable anguish, with complaints and lamentation. Hypochondriacal humor. Fear of solitude, of specters, and of robbers, with desire to hide oneself. Indecision and changeable humor, which demands this at one time, that at another, and rejects everything after having obtained it. Despair: he finds no rest with anguish. Despondency, despair, weariness of life, inclination to suicide, or excessive fear of death, which is sometimes believed to be very near. Dementia.
Too great sensibility and scrupulousness of conscience, with gloomy ideas, as if one had offended all the world. Ill-humor, impatience, vexation, inclination to be angry, repugnance to conversation, inclination to criticise, and great susceptibility. Caustic and jesting spirit. Extreme sensibility of all the organs; all noise, conversation, and clear lights are insupportable. Great apathy and indifference. Great weakness of memory. Delirium. Stupidity and dullness. Delirium, with great flow of ideas. Loss of consciousness, and of sensation; dotage; maniacal actions and frenzy. Madness; loss of mind (from the abuse of alcoholic drinks).
Heaviness, sensation of weakness, and confusion in the head. Vertigo on shutting the eyes, on walking, or in the open air, and sometimes with tottering, with danger of falling, intoxication, loss of sense, obscuration of the eyes, nausea, and headache. Tearing in the head, with vomiting, when raising up the head. Cracking or buzzing in the head. Excessive swelling of the head and face. Erysipelatous burning, swelling of the head (face and genitals) with great weakness and coldness.
Cannabis Indica
A condition of intense exaltation, in which all perceptions and conceptions, all sensations and all emotions are exaggerated to the utmost degree.
Subconscious or dual nature state; Dual personality disorder. Dementia. Apparently under the control of the second self, but, the original self, prevents the performance of acts which are under the domination of the second self. Apparently the two natures cannot act independently, one acting as a check, upon the other. Delirium.
Most remarkable hallucinations and imaginations, exaggeration of the duration of time and extent of space. Conception of time, space and place is gone. Extremely happy and contented, nothing troubles. Ideas crowd upon each other. Epilepsy, mania, dementia, delirium tremens, and irritable reflexes. Exophthalmic goitre. Catalepsy. Alzheimer’s disease.
Excessive loquacity; exuberance of spirits. Constantly theorizing. Anxious depression; constant fear of becoming insane. Mania, must constantly move. Very forgetful; cannot finish sentence. Is lost in delicious thought. Uncontrollable laughter. Delirium tremens. Clairvoyance. Emotional excitement; rapid change of mood. Cannot realize her identity, chronic vertigo as of floating off. Feels as if top of head were opening and shutting and as if calvarium were being lifted. Shocks through brain. Uraemic headache with flatulence. Involuntary shaking of head. Migraine attack preceded by unusual excitement with loquacity.
Ignatia Amara
Hyperaesthesia of all senses. Tendency to clonic spasms. Mentally, the emotional element is uppermost, and co-ordination of function is interfered with. It is one of the chief remedies for hysteria. Dementia. Nervous temperament-women of sensitive, easily excited nature, dark, mild disposition, quick to perceive, rapid in execution. Rapid change of mental and physical condition, opposite to each other. Alzheimer’s disease. Delirium. Alert, nervous, apprehensive, rigid, trembling patients who suffer acutely in mind or body, at the same time. Effects of grief and worry. Cannot bear tobacco. Pain is small, circumscribed spots. The plague. Hiccough and hysterical vomiting.
Changeable mood; introspective; silently brooding. Melancholic, sad, tearful. Not communicative. Sighing and sobbing. Aftershocks, grief, disappointment. Head feels hollow, heavy; worse, stooping. Headache as if a nail were driven out through the side. Cramp-like pain over root of nose. Congestive headaches following anger or grief; worse, smoking or smelling tobacco, inclines head forward.
Coca
Melancholy. Hypochondriasis. Mental depression with drowsiness. Bashfulness. Prefers solitude and darkness. Alzheimer’s disease. Muddled feeling in brain. Loss of energy. Dementia. Great mental excitement. Delirium. Vertigo and fainting. Tension over forehead. Headache just over eyebrows. Shocks in head; dull, full feeling in occiput with vertigo, the only possible position is on the face.
Kali Phosphoricum
One of the greatest nerve medicine. Prostration. Weak and tired. Marked disturbance of the sympathetic nervous system. Conditions arising from want of nerve power, neurasthenia, mental and physical depression. Alzheimer’s disease. The causes are usually excitement, overwork and worry. Adynamia and decay, gangrenous conditions. Suspected malignant tumors. After removal of cancer when in healing process skin is drawn tight over the wound. Delayed labor.
Anxiety, nervous dread, lethargy. Indisposition to meet people. Extreme lassitude and depression. Very nervous, starts easily, irritable. Dementia. Brain-fag; hysteria; night terrors. Somnambulance. Delirium. Loss of memory. Slightest labor seems a heavy task. Great despondency about business. Shyness; disinclined to converse.
Occipital headache. Vertigo, from lying, on standing up, from sitting, and when looking upward. Cerebral anaemia. Headache of students, and those worn out by fatigue. Headaches are relieved by gentle motion. Headache, with weary, empty, gone feeling at stomach.
Aurum Metallicum
Feeling of self-condemnation and utter worthlessness. Profound despondency, with increased blood pressure, with thorough disgust of life, and thoughts of suicide. Talks of committing suicide. Fear of death. Peevish and vehement at least contradiction. Delirium. Alzheimer’s disease. Dementia. Anthropophobia. Mental derangements. Constant rapid questioning without waiting for reply. Cannot do things fast enough. Over sensitiveness; to noise, excitement, confusion.
Violent pain in head; worse at night, outward pressure. Roaring in head. Vertigo. Tearing through brain to forehead. Pain in bones extending to face. Congestion to head. Boils on scalp.
Nux Moschata
Tendency to fainting fits, with heart failure. Cold extremities, extreme dryness of mucous membranes and skin. Strange feeling, with irresistible drowsiness. Indicanuria. General inclination to become unconscious during acute attacks. Alzheimer’s disease. Lypothymia. Staggers on trying to walk.
Delirium. Mind changeable; laughing and crying. Confused, impaired memory. Dementia. Bewildered sense, as in a dream. Thinks she has two heads. Vertigo when walking in open air; aches from eating a little too much. Feeling of expansion, with sleepiness. Pulsating in head. Cracking sensation in head. Sensitive to slightest touch in a draught of air. Bursting headache; better hard pressure.
P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).
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None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.
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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
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