Vascular dementia - how to recognize the disease. Treatment of vascular dementia

Vascular dementia is a syndrome in which a person’s mental abilities and behavior deteriorate. Similar condition caused by damage to the blood vessels of the brain.

Medical indications

People at risk for vascular dementia include the following:

patients who have had a stroke;
people suffering from ischemia;
aged people.

The syndrome in question can occur in mild, moderate and severe degrees. Separately, experts distinguish senile or senile dementia. The reasons for the development of such a syndrome are changes in the structure of the brain, taking into account age factor. Senile dementia manifests itself against the background of metabolic problems, immunodeficiency, malignant tumor. The changes in question are irreversible. In this case, thinking, speech, and memory are impaired. As the disease progresses, the patient loses all acquired skills and abilities. Senile marasmus is diagnosed in 5-15% of cases.

The main reason The development of dementia is considered to be vascular atherosclerosis. The syndrome in question manifests itself when chronic ischemia GM and heart disease, due to shortage folic acid, at infectious disease. More often doctors diagnose mixed form dementia, which develops for several reasons.

Symptoms of vascular dementia manifest themselves in the form of memory and speech impairment, poor coordination of movements, and delayed thinking. TO accompanying symptoms manifestations acute form experts include the following:

weakened muscle tone of the limbs;
impaired walking;
manifestation of reflexes in the limbs.

On average, the disease develops within 3-5 years. The patient is “lost” in time and space. On last stage There is trembling of the fingers, exhaustion, and speech is interrupted. The patient requires personal care.

Symptoms of vascular dementia manifest themselves taking into account the area of damage to the cerebral cortex:

if affected midbrain, drowsiness, hallucinations, confused and episodic consciousness are observed;
if there is a disorder in the hippocampus, the patient cannot remember and reproduce current information;
when the frontal lobe is damaged, apathetic behavior is observed;
when the subcortical region is damaged, concentration is weakened, the patient does not understand the significance of what is happening.

Stages of pathology

The syndrome in question occurs in 3 stages.

1. On initial stage the symptoms are invisible or only people close to the patient pay attention to them. The patient cannot concentrate, quickly becomes exhausted (mentally), decreases general motivation. At the same time, it changes quickly emotional condition. With mild dementia, the patient is able to independently perform daily household chores.
2. The second stage is moderate dementia, in which more severe symptoms are observed. The patient is not oriented in space. There is a strong personality change. The patient is aggressive and irritable. He neglects household chores. The patient needs help from loved ones.
3. In severe dementia, the patient is completely dependent on the support of others. The patient does not perceive his family and home. He has difficulty swallowing and has problems with bowel movements and urination. At stage 3 dementia, patients require daily care.

However, not all patients develop a severe course of the syndrome. And not every patient needs constant care. Negative development of the disease can be stabilized by seeking help medical care when the first symptoms of vascular dementia appear.

To diagnose dementia, use following methods examinations:

1. To assess the psyche, special tests are carried out.
2. Using MRI and CT, the affected areas of the brain are identified. The doctor determines the degree of dementia.
3. Comparative analysis of the results obtained.

To detect changes, GMs are used modern methods neuroimaging. Multi-infarct dementia appears on tomograms as white or gray matter. In the subcortical form, the doctor identifies white matter, leukoaraiosis and dilation of the lateral ventricles. To determine the severity of leukoaraiosis, CT or MRI in T2 mode is performed.

Therapy methods

Treatment of dementia is carried out under the supervision of a doctor. The patient is prescribed a step-by-step treatment regimen:

taking etiopathogenetic agents;
taking medications that improve cognitive function;
symptomatic treatment;
prevention.

Due to the large number of etiopathogenetic mechanisms, there is no single and standard treatment method of this syndrome. Therapy includes measures that eliminate the symptoms of the main pathology and risk factors. Since hypertension is considered the main risk factor, they take antihypertensive drugs. If the syndrome developed after a stroke, then blood pressure is normal - 120/80 mm Hg. The patient is prescribed ACE inhibitors: Lisinopril, Perindopril and diuretics.

This regimen is suitable for patients with diabetes, obesity and metabolic syndrome. Calcium antagonists can help prevent the development of dementia. To prevent relapses, antiplatelet medications are indicated. First-line drugs include acetylsalicylic acid, Clopidogrel.

If the syndrome is caused by heart disease, then the patient is prescribed oral anticoagulants (Warfarin). Patients with carotid artery stenosis and atherosclerotic plaques are prescribed surgery. For hypercholesterolemia, statins are taken. To improve cognitive functions, Selegiline, antagonists, nootropics, and inhibitors are prescribed.

Vascular dementia is a dementia that is acquired. The disease develops as a result of damage to the vascular network of the brain. A characteristic symptom is developing memory impairment and decreased intellectual abilities sick. Older people are most susceptible to the disease due to age-related changes in the body, in this case they speak of senile dementia.

Dementia develops due to vascular changes in the brain. The most likely causes of the disease:

suffered a stroke;
blood clot formation;
atherosclerosis;
ischemic disease brain;
heart defects;
infectious diseases, vascular neurosyphilis.

Stroke is the most probable cause development of the disease in older people (after 60 years). A stroke occurs as a result of the formation of blood clots that block blood vessels, or due to atherosclerosis. Dementia in this case appears due to oxygen starvation and lack of cell nutrition, which causes the death of some groups of cells.

Cerebral ischemia provokes a decrease in the tone of small vessels, as a result of which the lumen between them narrows significantly, which causes the development of vascular dementia. Ischemia is often observed as a complication of decompensated diabetes mellitus in older age.

The risk group also includes people over the age of 65 whose diet does not have enough folic acid. In this case, the likelihood of developing dementia increases significantly.

Due to heart defects and diseases of cardio-vascular system There is a disruption in the blood supply to certain areas of the brain. This causes oxygen starvation, which results in a violation neural connection and death of neural tissue in the brain.

Thus, when talking about vascular dementia in older age, one should take into account a whole group of factors - atherosclerosis, stroke, chronic diseases and heart defects. The totality of these pathological conditions and processes in the body provokes the development of dementia.

In young people, vascular dementia can result from infection in the brain. The disease often occurs in patients with neurosyphilis.

At-risk groups

The disease often develops against the background of a stroke. A recurrent stroke significantly increases the risk of dementia, but this depends on the amount of tissue affected and the area of the brain affected by the stroke.

To impair intellectual abilities, damage to a small number of neurons is sufficient. Any pathology that affects the cortex and subcortical region of the brain can cause the development of vascular dementia.

If other areas of the brain are affected, mental abilities are not affected, but loss of motor coordination may develop.

Dementia may result from a disorder cerebral circulation, oxygen starvation and lack of nutrition of brain cells. All this is a consequence of ischemia and the presence of diseases of the cardiovascular system.

Patients with diabetes mellitus are also at risk. With constantly elevated sugar levels, the walls of blood vessels become thinner. This leads to disruption of the nutrition of brain cells.

Also, vascular dementia may appear due to constantly elevated concentrations of lipids in the blood.

Senile dementia

The body ages, everything slows down metabolic processes, affecting, among other things, the brain. Age-related changes neuronal cells of the brain develop according to various reasons. Even an infectious disease can become the impetus for the development of pathology.

Senile or senile dementia is a disease of older people. Its development can be provoked the following pathologies and diseases:

obesity;
kidney dysfunction;
pathologies of the adrenal glands;
immunodeficiency;
malignant neoplasms.

The disease causes cognitive changes. This diagnosis is characterized by changes in thinking, memory impairment, problems with speech and concentration. The disease progresses very quickly, and literally after a couple of months the patient loses many skills and abilities, including professional knowledge.

Popularly, progressive age-related dementia is called senile insanity.

Symptoms of dementia

In vascular dementia, symptoms and signs largely depend on the extent of damage to neuronal cells and the location of the damage. Thus, the following symptoms are characteristic of midbrain damage:

confusion (possible hallucinations);
constant drowsiness;
speech problems.

When the limbic system of the brain is damaged, the patient's memory sharply deteriorates. Patients often cannot remember what they ate for breakfast, but they remember events from many years ago clearly and clearly.

When neuronal cells in the frontal lobes of the brain die, the patient's consciousness is impaired. This is clearly evidenced inappropriate behavior patient - the patient can constantly repeat one word or phrase, perform one action, while absolutely not reacting to external stimuli.

Subcortical vascular dementia causes intellectual impairments - loss of the ability to analyze, as well as mathematical abilities, impaired attention, inability to concentrate, loss of professional skills.

Developing dementia is characterized by neurological symptoms - gait disturbances, problems with urination (incontinence), and sudden seizures similar to epileptic ones are often observed.

The disease is accompanied by visible emotional and personality changes. TO emotional disturbances should include persistent depression and apathy, characteristic of patients with dementia. There is also emotional instability, manifested by tearfulness, sentimentality and fixation on something.

Personality changes include the sudden manifestation of traits that were not previously observed in the patient - stinginess, deterioration in behavior, indifference to the problems of others and non-acceptance of outside opinions. The development of dementia makes a person suspicious, greedy and pathologically lazy.

The human brain is distinguished by its ability to compensate for load. Thus, if certain areas of the brain are damaged, their function can be performed by neighboring areas. In dementia, this is manifested by periodic weakening of symptoms. At this time, cognitive functions are partially restored and the patient seems to be on the mend, but this condition does not last long.

Development of the disease

Depending on the location of the cell damage, dementia may have an acute onset. This form develops very rapidly, visible personal and emotional changes become noticeable very quickly. This rapid course of the disease is due to a stroke. After the first stroke, dementia develops within three months, but if the hemorrhage is repeated, mental impairment becomes noticeable a month after the stroke.

When the cerebral cortex is damaged, a multi-infarct form of dementia appears. The disease develops over four to six months and is accompanied by symptoms of ischemia.

As a rule, the disease is not limited to one area of the brain. If left untreated, dementia affects neighboring areas, resulting in mixed symptoms.

Clinical picture

Dementia develops only in the presence of a provoking factor. To develop dementia, you must have a predisposition to vascular diseases. The disease is preceded by ischemic brain damage. This may be asymptomatic.

The development of dementia occurs in several stages. An acute onset of pathology is often noted.

At the initial stage, mild cognitive impairment develops. This stage is characterized by the following symptoms:

sleep disorders;
neurosis;
attention disorder;
sudden change of mood.

Once characteristic symptoms of personality changes or decreased intellectual abilities begin to appear, a diagnosis is made. This clinical stage dementia. As a rule, the patient exhibits pronounced memory impairment, aggressiveness or lack of response to stimuli. Patients are subject to sudden mood swings. Disorientation is often observed even in familiar surroundings. When communicating, the patient feels insecure. He may forget some words or lose the thread of the conversation.

The progression of dementia leads to a severe stage, at which the patient requires constant monitoring by doctors or close relatives, since self-care is difficult or no longer possible.

This stage is characterized by the following symptoms:

loss of orientation;
memory losses;
problems with movement coordination;
aggressiveness.

Patients often have difficulty moving. Many are bedridden due to the inability to stand up on their own.

The last stage of a progressive disease is death. However, dementia itself is not fatal. The death is a consequence of a stroke, which occurs due to disruption of blood supply and nutrition to parts of the brain.

Establishing diagnosis

Diagnosis of the disease is based on the manifestation clinical symptoms for a specific patient.

For precise definition Localization of brain cell damage requires examination. Magnetic resonance imaging is often prescribed for this purpose and computer examination brain

Diagnostic methods are necessary to determine the cause of brain tissue damage - heart attacks, cysts, cell damage. It is also necessary to conduct an electroencephalography of the brain.

Treatment of pathology

When talking about treating dementia, it should be understood that brain damage cannot be restored. Treatment is aimed at minimizing the manifestations of the disease and restoring intellectual abilities.

Drug therapy and treatment are necessary in order to minimize the patient’s risk of stroke. This helps stop the progression of dementia.

Treatment includes:

therapy arterial hypertension;
treatment of atherosclerosis;
getting rid of bad habits and excess weight;
treatment of concomitant diseases;
taking anticoagulants to prevent stroke;
weakening of cognitive disorders.

Normalization of blood pressure should be carried out in such a way as to prevent its decrease and deterioration of blood circulation in the brain. Normalizing brain nutrition is the primary goal of drug treatment.

Therapy for atherosclerosis includes taking statin drugs, as well as following the necessary diet.

It is extremely important to stop smoking and drinking alcohol. These bad habits negatively affect the condition of blood vessels and blood supply to the brain and can cause rapid progression of the disease. An obese patient's weight is adjusted through diet.

Since dementia in older age can develop against the background of chronic diseases, such as diabetes, an important part of therapy is the treatment of concomitant diseases.

To avoid the development of dementia and limitation of the patient’s ability to self-care, it is necessary to carry out appropriate therapy neurological diseases. The drug Ginkgo Biloba is often prescribed to help treat cognitive disorders. As a rule, patients are prescribed various nootropic drugs and their analogues. These medications help improve mental abilities, affecting the metabolic processes of nerve cells. Patients can be prescribed the drug Piracetam - the most effective drug in the treatment of dementia.

To improve the condition of blood vessels, a drug with an antioxidant effect is indicated. On early stage illness, it is important to take the drug to improve blood supply to the brain.

Forecast

For vascular dementia, treatment will not completely eliminate the disease. Brain damage due to stroke is irreversible. Drug therapy can delay the development of dementia. With timely treatment, the patient takes care of himself independently and does not experience difficulties with socialization.

Statistically, dementia leads to fatal outcome five years after the stroke that triggered the development of dementia. Dementia itself is not a fatal disease; death occurs due to a stroke or cerebral infarction. It is not uncommon for patients to die due to accidents. As a rule, this occurs due to the fact that the patient is not aware of his own actions and cannot react to dangers.

The progression of vascular dementia leads to the fact that the patient is unable to care for himself; care for a bedridden patient is carried out by relatives or medical personnel at the relevant institution.

Drug treatment can delay the onset of permanent dementia, but cannot cure it. Preventive measures There are no methods that would allow one to avoid dementia.

Vascular dementia or dementia is an acquired disease that is diagnosed mainly in people over 60 years of age. Although, sometimes it is detected even in young people. According to statistics, men are more susceptible to it than women. The main reason for its development is a violation of cerebral circulation associated with vascular damage in a separate area of the brain.

Types of pathology

Vascular dementia is a disorder of intellectual abilities and memory of an acquired nature. The development of this condition is preceded by circulatory disorders in the brain. If its cells begin to lack oxygen and nutrients, they begin to gradually die.

There are the following types of vascular dementia:

With an acute onset. In this case, the change in behavior occurs suddenly, usually several months after the stroke, embolism or cerebrovascular thrombosis.
Multi-infarction (cortical) occurs gradually (usually over six months) after ischemic disorders.

Subcortical (subcortical) dementia of vascular origin is characterized by damage white matter in the deep layers of the brain.
Mixed (subcortical or cortical).
Vascular dementia of an unspecified nature.

Stages of pathology

There are 3 stages that precede the development of the disease:

The emergence of risk factors. Among them, the patient’s predisposition to the development of vascular pathologies is usually distinguished.
initial stage ischemic lesion. It is impossible to identify symptoms externally at this stage, although some diagnostic methods make it possible to detect changes that have begun in the brain.
The appearance of symptoms. The lesions at this stage are still minor and the patient’s behavior has not changed much. Neuropsychological tests help detect the disorder.

General practitioner Elena Vasilievna Malysheva and cardiologist German Shaevich Gandelman tell more about the disease:

Vascular dementia goes through several stages of development:

The initial stage when the patient can detect minor cognitive changes of vascular origin.
Emergence clinical manifestations. At this stage, the symptoms of dementia are already clearly visible. A person can fall into apathy or, conversely, behave too aggressively. He experiences memory lapses.

Difficult stage. Now the patient needs supervision by others, on whom he is completely dependent.
Death of a patient. Typically, death is not directly related to vascular dementia, but is a consequence of a stroke or heart attack.

Signs of pathology

Dementia in older people does not have one set of symptoms, as each person who develops dementia may behave differently. However, it is possible to identify some signs that will be the same for everyone. Most often, the patient experiences the following symptoms:

Gait disturbance (lameness, body instability when walking, etc.).
The appearance of epileptic seizures.

How to recognize epileptic seizure and neurologist Dmitry Nikolaevich Shubin tells how to help a patient:

Urinary dysfunction.
Deterioration of attention, memory and other cognitive impairment.
Impairment of physical functions.

Also, symptoms depend on the stage of development of the pathology.

initial stage

It is difficult to identify manifestations of vascular dementia at this stage, since such symptoms can be characteristic of many diseases. Among them:

The appearance of apathy, irritability or other neurosis-like disorders.
Emotional instability and frequent change moods.
Depressive state.

Psychiatrist Mikhail Aleksandrovich Tetyushkin talks about the signs and treatment of depression:

Inattention.
Disorientation in space on the street or in an unfamiliar room.
Sleep disorders (frequent nightmares, insomnia, etc.).

Middle stage

Now the symptoms are becoming clearer, and doctors can use them to diagnose vascular dementia:

Sudden mood swings, when apathy suddenly changes into aggressive behavior.
Memory lapses are still only short-term.
Disturbance in home orientation.

Disruption vestibular apparatus or other physical impairments.
Difficulty in communication. A person may forget the names of objects, be unable to carry on a conversation, etc.

Severe stage

At this stage, all the symptoms of vascular dementia become pronounced:

A person cannot navigate in space.
The occurrence of hallucinations or delusions.
The appearance of aggression for no reason.

Memory losses. The patient cannot say what happened a minute ago, does not recognize loved ones, etc.
Difficulty moving or even being unable to get out of bed.
The patient needs round-the-clock supervision by loved ones.

There are signs that are highly likely to indicate the development of pathology:

Slight recovery of cognitive performance. Doctors have not yet been able to figure out what this might be connected with. Usually this is preceded by mental stress. In this case, the patient's condition may return to normal level, however, the pathology itself does not disappear anywhere and after a while, vascular dementia will begin to manifest itself again.
A gradual development that often precludes diagnosis. In most cases, relatives admit that they noticed some changes in the patient, but they focused attention on this only when irreparable changes had occurred. After a stroke, vascular dementia develops only in 20-35% of cases.
Surgical operations or treatment with coronary artery bypass surgery can precede the development of dementia.

Diagnostics

If vascular dementia was identified at the initial stage of development, then timely treatment gives the patient a chance for a full recovery and normal life. If the pathology has already developed, then treatment can slow down this process. For diagnosis, the doctor needs:

Study the history of the development of dementia and the characteristics of the patient’s life.
Monitor regularly arterial pressure.

Neurologist Alexey Valerievich Alekseev tells more about the specifics of diagnosing the disease:

Carrying out psychological testing, which allows us to identify various disorders cognitive nature.
Take it regularly clinical analysis blood and control sugar levels.
Control of cholesterol and lipid levels in the blood.

Instrumental methods for diagnosing vascular dementia include:

Radioisotope examination of the brain.
Magnetic resonance or computed tomography.
Ultrasound of the brain.

Echocardiography - method ultrasound examination, diagnosing morphological and functional changes heart and its valve apparatus

Electroencephalogram.
Angiography.

The results of the studies make it possible to identify vascular dementia and begin its treatment.

Treatment

Vascular dementia is a serious pathology that can lead to disability. Therefore, it is so important to promptly identify the pathology and begin its treatment. The therapeutic course is prescribed individually for each patient and depends on the stage of dementia and the nature of the pathology. In this case, it is necessary to treat those factors that contributed to the onset of the disease ( increased level sugar, high blood pressure, etc.).

Treatment should be based on measures that can restore impaired cerebral circulation and compensate for disorders that have already occurred. Typically the course of treatment includes:

Taking antiplatelet drugs, the effect of which is to prevent platelet aggregation (Aspirin, Ticlopidine).
The use of medications that stimulate cellular metabolism (Piracetam, Nootropil).

Psychotherapist Alexander Vasilievich Galushchak answers questions about the drug piracetam:

Statins (“Atorvastatin”, etc.).
Taking neuroprotectors.
Khavinson peptides.

To the very effective means, used in the treatment of vascular dementia include:

“Cerebrolysin” is a drug that has a pronounced neuroprotective property, leads to the normalization of cellular metabolism, restores cognitive capabilities and has no side effects.
"Cavinton" is an antiplatelet agent that is used to improve blood circulation in the most small vessels brain. Active components medications improve vascular tone and accelerate the breakdown of glucose.
"Revastigmine", "Memantine" - drugs that are used to normalize mental activity person. With regular use, the patient's cognitive abilities improve and concentration is normalized.

The average price in pharmacies for 5 ampoules of 5 ml of Cerebrolysin injection solution is 1000 rubles

If, as a result of vascular dementia, the patient has a sleep disorder, depression, and other psychological disorders, he is prescribed antipsychotics and sedatives, used in psychiatry. In some patients, the use of such medications may cause paradoxical reactions. In this case, the medicine should be discontinued and consult a doctor who can select an analogue.

In addition to drug treatment of vascular dementia, the doctor may prescribe drugs to the patient plant origin(ergot alkaloids, etc.). Additionally, the patient is shown:

Following a special diet based on fresh fruits and vegetables, dairy products, beans, nuts, vegetable oils, seafood, etc.
Occupational therapy.
Continuous skilled patient care.

Herbalists offer their own methods of treating vascular dementia. However, their effectiveness has not yet been scientifically proven. Doctors do not prohibit the use folk remedies, however, they note that they can only be taken together with drug treatment. For this you can use:

Medicine based on gingko biloba.
Elecampane decoction.

Adding turmeric to food.
A decoction of flax seed and Irish moss.

Prevention

The danger of vascular dementia is that the pathology at the initial stage, when it responds well to treatment, is not easy to identify. Therefore, the disease is often detected already when the brain has major changes, and the pathology led to disability. This is why it is so important to prevent the disease. After all, preventing its development turns out to be much easier than treating it later.

Doctors also note several methods for monitoring their condition, which will make it possible to reduce the risk of developing vascular dementia. These include:

Blood pressure control. For older people and those who have a tendency to increase it, it is important to constantly monitor their indicators. If it increases, it is important to immediately seek medical help and begin timely treatment of hypertension.
News active image life, correctly distributing physical activity. Regular exercise has a positive effect on the state of the cardiovascular system, increasing the capabilities of the myocardial muscles. However, it must be taken into account that too much physical activity can worsen the patient’s condition.
Correction mental state. Every person should monitor the state of their psyche. To do this you need to avoid stressful situations and negative emotions, constantly walking on fresh air, undergo psychological training and consultations.

Give up bad habits and eat right, thereby maintaining proper metabolism in the body.
Monitor the level of sex hormones. This is especially true for women.
Engage in the prevention of infection, injury and poisoning of the body with toxic substances.

Forecast

How long do people live with this diagnosis? Life expectancy depends on the stage at which the disease is diagnosed and the correct treatment. However, in most cases, this period does not exceed 5-6 years.

If speak about full recovery, then this was observed only in 15% of patients who managed to start treatment at the very beginning of the development of the pathology. It is almost impossible to predict the exact life expectancy.

If the disease develops slowly, and the victim retains the ability to care for himself, then he can live with dementia for up to 10 or even 20 years. The more complex the situation, the shorter this period. The constant care of loved ones can prolong a patient’s life.

A recurrent stroke or heart attack can worsen the condition. Also, the cause of death can be pneumonia, sepsis and others accompanying pathologies. Negative consequences are depressed and psychological disorders. Therefore, doctors note that in each specific case, the patient’s life expectancy will differ and can range from several months to several years.

Unfortunately, despite the rapid development modern medicine, scientists have still not been able to create a medicine that could effectively fight vascular dementia at any stage of its development. The disease can progress rapidly, causing irreversible processes in the body. Therefore the only in an effective way prevention and regular maintenance are considered medical examination, which will allow us to identify vascular dementia at the initial stage of development and begin its treatment in a timely manner.

Vascular dementia is an acquired dementia, which is characterized by a persistent decline in cognitive activity and partial loss of previously acquired knowledge or skills. With this disease, there is a disintegration of pre-existing mental functions, as a result of vascular damage to the brain.

Unlike other forms of dementia (mental retardation, congenital or acquired in infancy), which are characterized by underdevelopment of mental activity, vascular dementia is a violation of already formed mental functions as a result of damage to the blood vessels of the human brain.

Causes of brain damage

It is important to take into account involutional changes in the brain in older people. The older person's brain responds differently to vascular lesions than the brain of a younger person, hence the coexistence of Alzheimer's disease and vascular dementia.

Vascular dementias account for 15% of the total amount of acquired and congenital dementia. Their prevalence among male and female populations is the same, however, in people aged 65 years and older, symptoms of vascular brain damage are more common in males. Vascular dementia occupies a leading position among vascular diseases brain (after Alzheimer's disease) in countries such as Russia, Finland and Asian countries (China and Japan). Dementia is worldwide social problem, given the growth cardiovascular diseases and the trend toward an aging population. It is one of the most expensive diseases for medicine.

When cerebral vessels are damaged, memory rarely suffers; the symptoms of this disease come to the fore in the patient's motor functions and cognitive disorders. The pathophysiology of vascular dementia is based on a disruption of the connection between various departments cortex and brain formations, leading further to the separation of its functions.

The main etiological factors in the development of vascular dementia are diseases of a vascular or cardiac nature:

Vascular dementia, in essence, is not independent disease, but a syndrome and has a genetic predisposition.

Factors that have a significant impact on development vascular pathology, are hyperlipidemia and diabetes, obesity, alcohol and nicotine intoxication.

Stages

At the first stage of this disease (pseudoneurasthenic), the patient exhibits symptoms of increased irritability, emotional instability, and intolerance towards other people. Many patients complain of headaches and dizziness, sleep disturbances (insomnia at night and drowsiness during the day). Fluctuations in daily blood pressure are possible. The first place in the psychopathological picture of this disease comes asthenic syndrome, with various anxiety and depressive symptoms. Some patients are afraid to stay at home alone, to travel to public transport, fear of the insignificant physical activity. In the first stage of the disease, symptoms of hypochondria predominate in patients, and all internal experiences are overvalued or obsessive.

The second stage of vascular dementia occurs against the background of discirculatory encephalopathy, psychopathological symptoms worsen and anxiety-depressive syndrome increases. Some patients may experience symptoms of impaired consciousness (stunning, delirium, twilight states). At this stage of the disease, patients experience hallucinosis and then delusional states. Patients feel that they are being poisoned and are being persecuted. Such delusional ideas are fragmentary in nature (not systematized). Patients experience disturbances in thinking, memory and attention. Memory impairment in the form of amnesia - first the immediate events in life are forgotten, and then the distant ones.

A characteristic manifestation vascular disorders is weakness. Patients become very emotional and sensitive. They cry for all sorts of minor reasons (after watching a television series), and they easily move from tears to a smile. As the disease progresses, personality traits that were previously compensated for and invisible to others become sharper. Suspicious people develop increased suspicion, thrifty people develop stinginess, and unkind people develop malice. Such changes in a person’s character worsen his adaptation in society and spoil relationships with relatives.

In the third stage of the disease, symptoms of memory impairment intensify and cognitive disorders are noted against their background. Patients in the third stage develop dementia very quickly. Patients experience further personality changes in the form of a narrowing of their range of interests. Some patients experience carelessness with a euphoric mood, there is a loss of sense of proportion, tact, and possible disinhibition of drives. Some patients at this stage of the disease have an uncontrolled appetite, eat well and a lot, but do not remember this. Some patients experience a decrease in activity and initiative, they become indifferent and indifferent to everything that happens, they can sit or lie for hours.

In the third stage of vascular dementia, auditory and visual hallucinosis may occur, and epiliptiform seizures may recur. With the deterioration of the general condition, the neurological symptoms- increase muscle tone, tremor of the limbs and head, impaired statics and coordination of movements, miosis, sluggish reaction of the pupils to light, focal symptoms. At this stage the disease may be severe neurological complications- strokes, with the development of paresis and paralysis, as well as aphasia and apraxia. Vascular dementia can have several course options: vascular dementia with acute onset, multi-infarct dementia and subcortical vascular dementia.

Degrees

The severity of vascular dementia is determined by the patient’s activity and independence.

At mild degree this disease is clearly limited professional activity And social activity, but patients are able to live independently, maintain personal hygiene and their intelligence is not significantly impaired.

With moderate vascular dementia, patients have difficulty living independently, they need some supervision from relatives, and their memory, attention and intelligence are noticeably reduced.

In severe cases of this disease, the activity of patients in Everyday life impaired, they must be constantly monitored and controlled, they are not able to maintain minimal personal hygiene. At this stage the disease is expressed movement disorders and intelligence.

Neurological symptoms in vascular dementia have their own characteristics:

Patients develop pseudobulbar syndrome, it includes a violation of articulation and timbre of the voice. In more in rare cases there may be a violation of the act of swallowing, unnatural laughter and crying;
The patient's gait changes (many older people shuffle, mince, or have a “skier” gait);
“Vascular parkinsonism” - patients have frozen facial expressions, reduced articulation of speech and gestures, and slowed down all movements.

The patient's life expectancy depends on his care and observation. The death of the patient can occur from a convulsive attack or due to the addition of a secondary infection (sepsis, pneumonia, bedsores).

Diagnostics

Diagnosis of vascular dementia requires not only medical history, clinical examination and patient complaints, but also neuropsychological studies. Neuroimaging of the affected brain structures is carried out using computed tomography and nuclear magnetic resonance.

It is necessary to carry out differential diagnosis between depression in old age and vascular dementia. With depression, the patient is usually oriented, knows where to look for help, subjective complaints are more pronounced than the objective state. An elderly patient with depression has feelings of guilt and hopelessness and general state worsens in the morning. At vascular lesions brain in an elderly patient there are no complaints, he is usually disoriented, symptoms are characteristic emotional lability and rapid mood changes, usually a person has a negative attitude and blames others for everything.

Vascular dementia (dementia) is a disease acquired during life, which most often develops in older people after 60 years of age.

As evidenced medical statistics, this disease more often affects men. There are cases of diagnosing pathology in young people. Progressive vascular dementia is the most common of all neurological diseases after.

This is one of the types of dementia, which is distinguished by its vascular origin, that is, damage occurs individual areas in the area of cerebral vessels and.

At the same time, insufficiency of the most important cognitive (cognitive) functions of the brain, which provide the ability to cognition and study of the surrounding world, perceive it as a single whole, and apply this knowledge in the process of life, intensively develops.

Gradually, thinking abilities and the ability to accept right decisions, digestibility deteriorates new information, the decline in intelligence progresses, control over emotions and actions weakens. Accordingly, it becomes impossible to analyze one’s health status and understand the presence of a disease.

Dementia of this type leads not only to the loss of work skills, but also to the gradual loss of the ability to care for oneself.

Mechanism of occurrence and development of the disease

Acute cerebrovascular accidents (,) or chronic failure blood supply to the brain are mechanisms of the pathogenesis of vascular dementia. There have been cases of development senile dementia if both reasons are present. Signs of the disease appear faster and are more pronounced.

Both cerebral circulation disorders and its insufficiency lead to the fact that in certain areas of the brain the cells stop receiving the cells necessary for life. nutrients and oxygen and die.

With a heart attack of a small number of neurons, there are no manifestations of the disease, since living brain cells compensate for their functions. When a large area of the brain is damaged, symptoms of vascular dementia appear. But in cases of even slight damage to the area responsible for cognitive functions, dementia begins to develop and progress.

Main causative factors of the disorder

Medicine calls enough a large number of Reasons why vascular dementia may develop:

acute heart failure;
chronic cerebral ischemia (blockage of small vessels);
vasculitis ( autoimmune diseases, in which the walls of blood vessels are affected).

There are a number of factors contributing to the development of the disease:

old age (60 years and older);
heart disease (with atrial fibrillation, coronary disease, heart defects);
arterial hypertension or hypotension;
diabetes;
heredity;
bad habits;
sedentary lifestyle.

The increasing prevalence of arterial hypertension has made it a leader among all risk factors for the emergence and further development of this type of dementia.

Stages of dementia development

The course and development of vascular dementia is conventionally divided into three stages, which differ in symptoms and their severity:

Easy stage senile dementia is characterized by blurred manifestations of the disease. The patient, as a rule, does not notice them. Sometimes relatives and friends pay attention to changes in his life and behavior. At the same time it becomes noticeable slight decrease intelligence, a dramatic change in mood and emotions may occur. But the patient controls them and controls his actions. He copes with everyday issues independently and does not need outside help.
Moderate Vascular dementia is more pronounced and noticeable manifestations. The patient’s life is complicated by the inability to navigate in space; a personality disorder occurs with behavioral deviations. Signs of aggression appear. Skills and abilities in handling household appliances, devices, communications equipment and the simplest objects are lost. The patient needs outside help.
Coping with severe Dementia is only possible with the constant help of loved ones. At this stage, a deep breakdown of the psyche is expressed. Difficulties arise with eating, control over the processes of urination and bowel movements is lost. The patient is unable to perform simple hygiene procedures, he does not perceive his family and friends. The patient is completely dependent on others.

However, it cannot be said that all cases of vascular dementia develop before serious condition, although most forecasts are not encouraging - life expectancy and quality of life are not encouraging.

Symptoms at each stage

The first symptoms of vascular dementia begin with a noticeable expression of conservatism in the patient’s views, judgments and actions. At the same time, some character traits are aggravated. Excessive distrust or obstinacy, frugality and other changes appear.

Mental activity and memory gradually deteriorate. This is soon accompanied by unclear speech.

In addition, vascular dementia, which appears as a result of damage to certain areas of the brain, is manifested by a variety of symptoms:

Cell death in midbrain characterized by confusion and obscurity. With the further development of the disease, the patient withdraws into himself, loses interest in what is happening around him, in communicating with loved ones. He doesn't care about his appearance, and he stops following him.
Cell damage hippocampus(parts of the brain in the temple area), responsible for long-term storage of information, leads to amnesia. The patient cannot remember events that happened today or recently, although he can reproduce those that happened a long time ago.
in the frontal lobes brain manifests itself in indifference, apathy, laziness, loss of interest in communication. There may be illogical behavior, which is expressed in the monotonous repetition of a phrase or word that has long been known to the patient.
At in the subcortical regions There is significant absent-mindedness of the patient's attention, which makes it impossible to concentrate on one task or subject. He cannot highlight the main thing and determine the secondary in the information received, or analyze it. All his endeavors are unsuccessful.

In addition to cognitive impairment, almost all patients have problems with urination, which often becomes spontaneous.
Emotional disturbances and instability during the course of the disease often lead to depressive states, loss of optimism and self-confidence.

Methods for diagnosing pathology

Timely diagnosis of vascular dementia in initial stages gives a chance for recovery, in more complex cases, a correctly diagnosed and selected treatment will help stop the development of the disease. For this purpose, modern neurologists use the following research:

studying the history of life and illness;
carrying out psychological tests to identify cognitive impairment;
blood pressure control;
clinical blood test;
determination of blood sugar;
determination of lipid content in the blood and the level of cholesterol concentration in it.

Modern instrumental methods diagnostics that determine the degree of damage to the blood vessels of the brain and its tissues:

radioisotope research of the brain;
(determination of blood flow);
angiography (x-ray examination of blood vessels);
echocardiography.

Studying the research results, their analysis and comparison allows us to establish an accurate diagnosis.

Principles of treatment of vascular dementia

Because causal factors Since there are many developments of vascular dementia, its treatment is prescribed in accordance with their prevalence and taking into account the mechanism of development of the disease. Therefore, treatment for each patient is selected individually and adjusted in the process.

Drug treatment is aimed primarily at reducing the risk of occurrence or re-development stroke and other cardiovascular diseases.

This is provided by antiplatelet (antiplatelet) drugs that prevent the possibility of blood clots forming in blood vessels (Aspirin, Trental, Clopidogrel, Ticlopidine). An anticoagulant is also used indirect action Warfarin.

Such drugs are prescribed and used with extreme caution, as they have a number of contraindications.

To improve cognitive functions and slow down the development of their disorders, Pentoxifylline and anticholisterase drugs are used - Donepezil (Aricept), Galantamine (Reminyl). At treatment of mild and moderate dementia, Memantine is used, which prevents the development of brain dysfunction.

Currently, drugs that lower blood cholesterol levels - statins (Simvastatin, Atorvastatin and others) are becoming popular in the treatment of dementia.

Do not lose their relevance (, Pramiracetam, Cerebrolysin), which have a complex effect on brain cells brain and improving its functions.

For patients with hypertension, blood pressure is monitored and medications are prescribed to reduce it. Thus, eliminating one of the serious factors in the development of the disease.

When mental problems antidepressants are prescribed and relieved. Treatment at home is considered the most favorable, especially for mild and moderate stages of the disease.

Prognosis for recovery and life expectancy

Complete recovery was recorded in approximately 15% of patients in the initial stages of the disease. The rest most often die within 4-5 years of detection and treatment of senile dementia or earlier. The life expectancy of each patient with vascular dementia is different and it is difficult to predict.

In the case of a gradual and slow progression of the disease and maintaining the skills of daily life, you can live 10 - 20 years. In severe cases - no more than 10 years. But quality care and daily care from loved ones and relatives can prolong the patient’s life.

Can also lead to death accompanying illnesses, such as pneumonia, general purulent infection.

The general condition of the patient, the rate of progression of the pathology, living conditions and quality of care are decisive in their life expectancy.

Forewarned and forearmed!

A healthy and active lifestyle can protect older people from vascular dementia. complete failure from bad habits, moderate loads, optimism, development of intelligence, .

Treatment of diseases that are risk factors for vascular dementia and preventing their exacerbation is also an important preventive measure.

It is necessary to control blood pressure, blood sugar and cholesterol levels in order to prevent damage to the blood vessels of the brain and the development of senile dementia.

It is worth paying attention to nutrition. It should be varied and balanced, with a sufficient amount of vegetables and fruits, products containing essential vitamins and microelements.

You should not abuse antidepressants and sleeping pills. Lots of communication, travel and new experiences will prevent the onset of dementia.