Vascular dementia: symptoms, treatment

Dementia is a frequent neurological syndrome that significantly affects the morbidity and mortality of older persons. One of its common forms is vascular dementia. Vascular dementia is a group of diseases with a large number of clinical and pathological manifestations, which are inextricably linked with the violation of blood supply to the cortical and subcortical structures of the brain and the corresponding changes in them, due to the pathology of large and small vessels.

Contents of

1 What's this?
2 Forms of vascular dementia
3 Causes and structural changes
4 Clinical manifestations of the disease
5 Stages of development of dementia disorders
6 Treatment

What is this?

Vascular dementia is defined as a syndrome with characteristic gross changes in cognitive function due to acute cerebral infarctions( strokes) or chronic cerebrovascular insufficiency, leading to social disadaptation, disruption of professional skills and self-care.

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It is the second most common form of dementia;
is the main cause of disability and people's attachment to society. The person, in this case, needs constant help and attention of relatives, being a physical, psychological and economic problem;
The pronounced cognitive defect( of higher brain or mental functions) comes to the fore, thus, serious changes occur in memory, intelligence, behavioral skills, understanding of speech, orientation in place and self, and the ability to acquire, store and use various motorskills( praxis).All this is evaluated in comparison with the initial level. There are cases when the memory remains safe with significant changes in other areas. To all this, emotional and behavioral disorders are added. Changes occur against a background of clear consciousness due to organic damage to the brain substance - either directly( by the mechanism of developmental change or trauma of the nervous tissue), or indirectly( vascular and toxic mechanism) or a possible combination thereof;
constitutes 10-15% of all dementia;
The greatest peak in the development of this pathology occurs at the age of 65 years( from 5-25%).

Forms of vascular dementia

With acute onset - occurs after the transferred ONMK for 1 month;
Multi-infarction - develops suddenly about six months after several large or medium-sized ischemic episodes with periods of small clinical improvements. Structurally, the white matter of the brain changes mainly in the area of the cortex. They are represented by multiple sections of the vacuum;
Subcortical form( subcortical) - its cause is a disease leading to the pathology of small-caliber vessels, blood supply subcortical and underlying parts of white matter of the brain. A variant of this form is Binswanger's disease - progressive dementia( or subcortical atherosclerotic encephalopathy) with pronounced persistent neurological disorders, its main cause is hypertonic disease, atherosclerosis and cardiogenic diseases( diseases of the heart and vessels, which increase the risk of blood clots and emboli in the cerebral arteries).He makes his debut at the age of 50-70 years. On the tomograms you can see the zones with a change in the density of white matter in the brain, the so-called leukoarysis located around the ventricles, as well as single heart attacks;
Combined - pathology at the level of the cortex and subcortical structures.

Causes and structural changes

The disease is characterized by an acute or gradual onset, a staged course with periods of stabilization and regression of symptoms, it is aggravated by the presence of progressive vascular risk factors - decompensation of discirculatory encephalopathy( DEP or CHEM - chronic brain ischemia), arterial hypertension, chronic heart disease, obesity,lifestyle, pronounced atherosclerosis, diabetes mellitus, frequent transient( transient ischemic attacks) and acute cerebrovascular accidents( multiplegovernmental lacunar or single, but large in size pockets), the most significant for the higher cortical function locations( forehead, crown, temple, neck, thalamus), systemic vascular disease( vasculitis).

In addition to vascular mechanisms, dementia can occur against a background of various degenerative diseases of the nervous system( Alzheimer's, Huntington's, Parkinson's), as an outcome of intoxication with carbon monoxide, alcohol, drugs, manganese, drug psychotropic drugs, neurosyphilis, HIV infection, Creutzfeldt-Jakob diseaseor be the result of a traumatic brain injury.

The pathogenesis of neurodegenerative diseases is associated with the accumulation of various toxic substances in the neurons of the brain, leading to atrophy( depletion) of the nervous tissue, a decrease in the functions of the central brain structures, and the rapid development of cognitive disorders.

In cases of brain damage in cardiovascular diseases large and small vessels of the brain are affected, chronic cerebral ischemia( CHM) develops, leading to the development of cerebrovascular accidents( multiple lacunar infarcts).As a result, the blood supply to the brain tissue is disrupted, many small lesions of sclerosis( destruction of the nervous tissue) are formed in the white matter of the brain, cavities( cysts), lacunae in the cortex, subcortical structures, temporal, frontal lobes, ventricles expand,brain substance on the tomograms or destruction of the myelin sheath of nerves with a characteristic localization around the ventricles with impaired brain function and the appearance of a clinic of vascular dementia.

SEEALSO: Dementia with Levi bodies

Clinical manifestations of the disease

The clinic of lesions in people is different and depends on the impact of the disease and the general condition of a person before the disease.

Upon examination, the neurologist can identify focal features: bilateral asymmetric pyramidal failure is a very slight degree of reduction in muscle strength( paresis), reflexes become animated, pathological stop signs appear. In the framework of pseudobulbar syndrome, swallowing( popping with solid or liquid food) is violated, speech is fuzzy, greased, when the conversation is replaced with letters and words, the voice becomes nasal( dysphonia), patients can involuntarily cry or laugh( violent laughter, crying), symptoms of oral automatism develop(when you touch a neurological hammer to your lips, they are stretched out by a tube, the so-called proboscis reflex).The gait can be shaky, unstable, drops can not be ruled out, "throwing" in different directions. The meanness of facial expressions and the lowering of the emotional background of mood, slowing down the pace of performance of any actions, constrained movements, trembling of the head, hands, increased muscle tone can be put into the notion of parkinsonism syndrome. Disorders of pelvic functions - increased frequency of urination, urinary incontinence are not excluded.

Stages of development of dementia disorders

There are three clinical stages:

Early: often goes undetected, because it develops gradually and includes complaints about insufficient attention concentration, slowly increasing memory impairment, fast fatigue, reduced range of interests and initiative, difficulties in performing complex household tasks( praxis) and orientation in space, loss of accounttime, the weakening of thought processes( abstraction, logic), a low background of mood, a general alarm. Perhaps the development of speech problems - a person uses simplified phrases in conversation, hardly understands complicated expressive turns( aphasia).
Medium: The clinic becomes more apparent with strong personality limitations. This stage includes: patients forget the recent events and names of relatives and friends, the name of household items, they can not work and are able to orient themselves in a familiar environment( they can get lost within the apartment, can not get to the neighboring store independently), the difficulty incommunication with others, the need for help to care for themselves increases( the ability to use household appliances, performing hygiene procedures, dressing) is lost, behaviorals disorder - they are mindlessly walking around the room and ask same questions.
Late: with almost complete dependence on society and passivity. Memory disorders become significant right up to agnosia - inability to recognize received information from the outside, and physical signs and symptoms are more obvious. This includes the total disorientation of a person in space and time, the reduction of motivation to perform daily activities, the neglect of individual hygiene, the violation of social behavior, the reduction of criticism to his condition, difficulties in moving, behavioral traits inherent in him before the illness, sharpen up to aggressiveness ordepression, for example, a previously cheerful, full of energy a person can start to fuss, expresses his concern, and in the past neat and thrifty acquiresmouths of selfishness, greed, becomes a slut. It shows some suspicion in communicating with surrounding people, often enters into quarrels with them, takes offense at trifles. Patients may leave home, begin to wander, show interest in collecting unnecessary things. Men are most often subjected to delusional jealous ideas and the occurrence of visual and auditory hallucinations.

The severity of cognitive functions, depending on the disturbances in the patient's daily activity and age-related changes in the brain, is distributed in degrees of severity:

Lungs - the changes are almost invisible to the environment, but they are felt by the person himself. They are nonspecific and have a connection with age. The nearest events, names and names of previously familiar people are worse, but professional knowledge remains intact, there are no restrictions on daily activity. The evaluation is carried out on frequent distractions and slower rates of performing neuropsychological tasks;
Moderate - have a different genesis of their origin and are not limited to aging of the brain due to age;Changes in intellectual functions are determined on the basis of personal complaints and complaints of his relatives. They are compared with the previous ones, there is a clear deterioration, which is also confirmed by psychological tests. Everyday activity of a person does not change.
Severe - the stage of dementia signs.

The cognitive deficiency in the dementia stage is almost irreversible and testifies to the organic( structural) changes in the nervous system and correlates with the amount of damage to the brain tissue, it can be used to judge the severity of the patient's condition and further prognosis.

SEEALSO: Dementia with Levi bodies

Treatment of

When choosing a treatment, two main goals are taken as a basis:

Do not allow further mismatch of mnemonic-intellectual functions;
To improve the quality of life of patients and caregivers by reducing the severity of existing pathology.

First of all, it is necessary to assess the existing risk factors: hypertension, atherosclerosis, diabetes mellitus.

During the day, observe changes in blood pressure and blood sugar.

Use drugs that reduce blood pressure - ACE inhibitors( perindopril, lisinopril, enalapril), when lifting blood pressure more than 180/100 mm / Hg st.- diuretic drugs( furosemide, lasix) or captopril. Sartans( losartan, candesartan, eprosartan), statins( simvastatin, atorvastatin) - are effective at elevated cholesterol. They reduce the overall mortality in DAP, acute ischemic heart and vascular infarction, delay the progression of cognitive function disorders and reduce their severity after the first and subsequent strokes.

Normalizes the parameters of the blood coagulation system in the presence of CVD( cardiovascular diseases) and prevents the formation of thrombi in order to avoid repeated strokes: thrombolytics( streptokinase, urokinase, alteplase, actilise), anticoagulants( heparin, warfarin), antiplatelet agents( aspirin, cardiomagnesium, thromboAss), and should also give up smoking, adhere to a healthy diet and optimal exercise.
Inhibitors of acetylcholinesterase( donepezil, rivastigmine, galantamine, ipidacrin) - block the disintegration of acetylcholine( an organic molecule involved in the transfer of momentum between nerve cells), thereby activating the central nervous system and intellectual abilities, but one should be careful in receiving them, since theytend to trim the heart rate to critical numbers and there is a need for a pacemaker.
Treatment with nootropics, in other words, means having a direct activating influence on the processes of learning, memory and thinking, as well as protecting the brain from various injuries( eg, ischemia) and participating in the initiation of metabolic processes in nerve cells - neuroprotection( mexidol, mildronate, glycine, magnesia), ensure the processes of neuroplasticity due to the ability of brain structures to change in response to environmental stimuli, such as training, new experience or damage, include here actovegin, cytoflavin, phenotropil, tsticoline, neurogenesis - trigger mechanisms for the formation of new nerve cells, carry out neurotrophic regulation, that is, conditions are created to maintain all these processes at the optimal level( piracetam, cerebrolysin, semax, gliatilin, memantine), but their positive assessment is questionable, because until the endstudied.
The group of vasoactive drugs( cinnarizine, vinpocetine, Cavinton) dilate the brain and heart vessels, thereby increasing blood flow to these organs and enriching them with oxygen, but people taking medications to lower blood pressure can lead to a sharp drop in blood pressure and deterioration, and hence, the development of ischemia.
Symptomatic therapy is also essential for relieving episodes of arousal, insomnia, anxiety and depression with drugs such as: anvifen, fluoxetine, paroxetine, fluvoxamine, feravin, sertaline and citalopram), but there is a risk of a high incidence of side effects, so avoid uncontrolled use of these drugs.

In case of partial or complete narrowing of the lumen of the head of the head with atherosclerotic plaques, more than 70% is required to consult a vascular surgeon with the decision of the question of an operative method of treatment.

In addition, patients can not be denied physical and intellectual activity and isolation from society. It is necessary to perform exercises to increase mental functions: reading books, playing chess, solving crossword puzzles, memorizing with the subsequent reproduction of short stories, complicated series of numbers - at first unambiguous, then double-valued, and so on. Speech with a speech therapist can help high efficiency in the development of speech.

The patient is supervised and treated by a therapist, cardiologist, neurologist, and psychiatrist in a polyclinic and at home. Indication for hospitalization is deterioration of the patient's condition, which will require the use of instrumental research methods, continuous supervision of specialists and carrying out intensive measures with subsequent rehabilitation.

Psychiatrist Abrosimova Yu. S. talks about vascular dementia:

Vascular dementia - Center for Mental Health and Neuroscience Sphere