From this article you will learn: what is dyscirculatory encephalopathy, what diseases lead to its development. What methods are used to establish the diagnosis. Treatment of this disease and patient care.
The causes of the pathology
Discirculatory encephalopathy( abbreviated DE) is a disruption in the functioning of the brain that develops as a result of diffuse lesions of its tissues due to chronic insufficiencycerebral blood supply( that is, in the vessels of the brain).
With chronic blood supply deficiency, brain tissue is constantly experiencing a deficit of oxygen and nutrients supplied by blood. As a rule, DE is caused by a common lesion of small blood vessels, therefore, cell functioning disorders occur throughout the brain.
It is almost impossible to eliminate pathological changes in small cerebral vessels and the consequences of prolonged deficiency of oxygen and nutrients.
DE is a slowly progressing disease, which in severe cases leads to complete loss of ability to work, self-service and social skills.Neurologists and psychiatrists are concerned with DE.
Causes of
The causes of DE combine their harmful effects on cerebral blood vessels. To them belong:
- atherosclerosis of the brain;
- hypertension;
- diabetes mellitus;
- cardiovascular diseases with signs of chronic circulatory failure;
- heart rhythm disturbances;
- arterial hypotension.
All these diseases lead to a deterioration of the blood supply to the brain due to decreased blood flow or disturbances from the vascular walls. Due to chronic deficiency of oxygen and nutrients, there is a diffuse death of brain cells and its atrophy.
With complete blockage of tiny cerebral vessels with atherosclerotic plaques, patients develop multiple small strokes that do not cause any noticeable symptoms. However, such people are at increased risk of developing dyscirculatory encephalopathy.
Symptoms of
The main symptoms of DE can be divided into cognitive and neurological disorders. In addition to these signs, emotional disorders are observed in patients with discirculatory encephalopathy, which are manifested by sharp mood swings, causeless crying or laughing, inertia, loss of interest in the surrounding environment.
Cognitive impairment of
Cognitive impairment is a deterioration in mental abilities, which mainly affects memory, thinking, the ability to learn, solve everyday problems and perceive new information.
Early signs of cognitive impairment in AD:
- Delay in thinking.
- Difficulties with planning their actions.
- Problems with understanding.
- Problems with concentration of attention.
- Behavior or mood changes.
- Problems with short-term memory and speech.
In the initial stages of DE, these symptoms can be hardly noticeable, sometimes they are taken for signs of some other disease - for example, depression. However, their presence indicates that a person has a certain degree of brain damage and that he needs treatment.
Over time, the clinical picture of cognitive impairment is deteriorating. The progression of the disease develops slowly, although in some patients it can occur quickly enough for several months or years. The late symptoms of cognitive impairment in AD include the following:
- Significant slowing of thinking.
- Disorientation in time and place.
- Memory loss and severe difficulty with concentration of attention.
- Difficulties in finding the right words.
- Severe personality changes - for example, aggressiveness.
- Depression, mood swings, lack of interest or enthusiasm.
- Increased difficulties with the performance of everyday tasks.
Neurological disorders of
In addition to cognitive impairment, patients with severe DE develop neurologic symptoms, which include:
- dizziness;
- headache;
- instability during walking, gait disturbance;
- impaired coordination of movements;
- slowing movements;
- tremor of the extremities;
- speech and swallowing disorders;
- loss of control over urination and defecation.
Diagnosis
To determine the diagnosis of dyscirculatory encephalopathy, doctors interview the patient or his relatives about symptoms that concern him, find out the presence of diseases that can lead to a deterioration in the blood supply to the brain. After this, a general and neurological examination is carried out, including the determination of tendon reflexes, muscle tone and strength, sensitivity, coordination and balance.
Laboratory and instrumental examination, assessment of cognitive impairment are used to confirm the diagnosis.
Laboratory research
Laboratory tests try to clarify the causes of DE development. For this, the following is determined:
- A general blood test with a leukocyte formula.
- Coagulation characteristics( coagulogram).
- Lipid profile( level of different kinds of cholesterol).
- Blood glucose level.
- The level of thyroid hormones.
Instrumental examination
The purpose of the instrumental examination with DE is to visualize the lesions of blood vessels and brain tissues, as well as to identify the causes of this disease.
The main examinations to get an image of the brain tissue:
- Computed tomography( CT) is a painless examination, during which a large number of X-rays are taken at different angles. Then the computer, using the information received, creates a detailed image of the brain. CT provides information on the structure of the brain, allows you to detect foci of strokes and micro strokes, changes in blood vessels and tumors. Sometimes, for more detailed visualization and increasing the diagnostic value of the examination, the patient is given CT with contrast, during which he is intravenously injected with an X-ray contrast drug.
- Magnetic resonance imaging( MRI) - a method that uses for the visualization of the brain radio waves and strong magnetic fields. This examination lasts longer than CT scan, however it is also completely painless. With the help of MRI, you can get more detailed information about strokes, micro strokes and pathology of cerebral vessels.
At DE also carry out a number of other examinations:
- Ultrasound examination of carotid arteries is an examination that, with the help of high frequency sound waves, allows to detect atherosclerosis or structural changes from the main blood vessels supplying the brain.
- Electroencephalography is a method for recording electrical brain activity.
- Ophthalmoscopy - examination of the fundus, on which the blood vessels are located. If a person has a lesion of the cerebral arteries, this is most often reflected in the state of the retinal vessels.
- Electrocardiography is a method of recording the electrical activity of the heart, with which you can detect many of its diseases leading to heart failure - for example, arrhythmias.
Evaluation of cognitive functions
The main problem for patients with DE and people close to them is cognitive impairment. To assess cognitive functions, there are many special neuropsychological tests that are designed to assess a patient's ability:
- to speak, write, understand oral and written speech;
- work with numbers;
- to perceive and remember information;
- develop an action plan;
- effectively respond to hypothetical situations.
Treatment of
Dyscirculatory encephalopathy treatment is aimed at slowing or slowing the progression of brain damage, preventing the development of strokes, therapy for diseases that lead to cerebral circulatory insufficiency.
Usually the therapeutic plan includes lifestyle changes:
- Healthy nutrition.
- Weight normalization.
- Refusal from smoking and drinking alcohol.
- Physical activity.
Drug therapy for DE is conducted in the following areas:
- Hypotensive therapy aimed at normalizing blood pressure. Maintaining normal blood pressure levels can help prevent or slow the progression of AD.Most often, in the presence of chronic cerebral circulatory failure, doctors recommend the use of drugs belonging to groups of angiotensin converting enzyme inhibitors( ramipril, perindopril) or angiotensin receptor blockers( candesartan, losartan), since they are believed to have protective properties relative to the brain, blood vessels,heart and kidneys. If these drugs are not enough to control blood pressure, they are combined with other drugs - diuretics( indapamide, hydrochlorothiazide), beta-blockers( bisoprolol, nebivolol), calcium channel blockers( amlodipine, felodipine).Suitable for patients with DE preparations from pressure can appoint only a doctor.
- Reducing blood cholesterol. Since the other main cause of DE is cerebral atherosclerosis, patients with this disease are often prescribed drugs that reduce the level of cholesterol in the blood. The most commonly used statins( atorvastatin, rosuvastatin), which - in addition to reducing cholesterol - also improve the condition of the inner layer of the vessels( endothelium), reduce the viscosity of the blood, stop or slow the progression of atherosclerosis, and have an antioxidant effect.
- Antiaggregant therapy. One of the mandatory components of the curative plan for DE.Antiaggregants affect platelets, preventing their gluing( aggregation), which improves cerebral circulation. The most commonly prescribed aspirin in low doses.
These three areas of drug therapy for dyscirculatory encephalopathy are recognized by almost all doctors. In addition, many neurologists recommend the following types of treatment:
- Antioxidant therapy is a method of treatment based on the assumption of the benefits of drugs that suppress the harmful effects of free radicals. These include vitamin E, ascorbic acid, actovegin, mexidol.
- Use of combined action drugs. It is believed that these funds normalize blood coagulability, blood flow through small cerebral vessels, venous drainage from the brain, and also have antioxidant, angioprotective and neuroprotective properties. Most often neurologists prescribe vinpocetine, pentoxifylline, pyracetam, cinnarizine.
- Metabolic Therapy. Many doctors believe that improving the metabolism in the brain cells is an integral part of the treatment of discirculatory encephalopathy. The most commonly prescribed cerebrolysin, cortexin, glycine.
- Improvement of cognitive functions. In order to treat disorders in memory, thinking, judging and planning actions, drugs that increase the level of neurotransmitters are most often prescribed. They include donepezil, galantamine, memantine.
In most patients, it is not possible to completely eliminate discirculatory encephalopathy with drug therapy. A good result of treatment is the arrest or slowdown of disease progression and cognitive impairment.
Facilitating life in patients with severe dyscirculatory encephalopathy
There are many different methods by which you can make life easier for patients with severe DE.These include:
- Labor therapy - to identify problems in daily life, which may include dressing or washing, and their solutions.
- Speech therapy - helps to eliminate problems with communication.
- Therapeutic physical training - is useful for eliminating problems with movements.
- Psychotherapy - to improve memory, mental capabilities, social interaction.
- Changes at home - for example, providing good lighting in all rooms, eliminating slippery seats and carpets, adding handrails and handrails, creating comfortable conditions, non-slip footwear.
In patients with DE, deterioration and anxiety can occur in any new conditions for them( for example, when hospitalized in a hospital), when exposed to excessive noise, when they enter a large cluster of strangers, when complex tasks are required.
Care for a patient with severe DE is a physically and psychologically debilitating process. The person who has it, can feel anger, anger, guilt, disappointment, despondency and sorrow. Therefore, paying more attention to one's own health, to rest, to satisfy one's needs is very important both for people caring for a patient with DE, and for the patients themselves.
Prognosis
The prognosis depends on the stage and cause of the disease. Dyscirculatory encephalopathy of the brain practically does not lend itself to complete cure. The purpose of the therapy is to slow or stop the progression of cognitive impairment and neurological symptoms.
DE increases mortality, the risk of injury from falls.
