Atherosclerotic dementia. Clinic of mental disorders in cerebral atherosclerosis

As a person ages, failures begin to occur in all systems and organs. There are also deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, due to mental disorders, behavior changes, causeless depression appears, emotionality decreases, and the person begins to gradually degrade.

Dementia usually develops in older people. It affects several psychological processes: speech, memory, thinking, attention. Already at the initial stage of vascular dementia, the resulting disorders are quite significant, which affects the patient’s quality of life. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave their professional career, and they simply cannot do without the constant supervision of family members.

General characteristics of the disease

Acquired cognitive impairments that negatively affect a patient's daily activities and behavior are called dementia.

The disease can have several degrees of severity depending on social adaptation patient:

1. Mild degree of dementia - the patient experiences a degradation of professional skills, his social activity decreases, and interest in favorite activities and entertainment weakens significantly. At the same time, the patient does not lose orientation in the surrounding space and can take care of himself independently.
2. Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on his own. front door. This degree of severity is often colloquially referred to as “senile insanity.” The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

There can be two forms of dementia: total and lacunar(dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). A typical variant of lacunar dementia can be considered in the initial stage.

The form of total dementia is characterized by absolute personal degradation. The patient is exposed to intellectual and cognitive disorders, the emotional-volitional sphere of life changes radically (there is no sense of shame, duty, vital interests and spiritual values ​​disappear).

From a medical point of view, there is the following classification of types of dementia:

• Dementia of the atrophic type (Alzheimer's disease, Pick's disease) usually occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.
• Vascular dementia (atherosclerosis, hypertension) - develops due to circulatory pathologies in the cerebral vascular system.
• Dementia of mixed type - the mechanism of their development is similar to both atrophic and vascular dementia.

Dementia often develops due to pathologies leading to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as a severe complication of the disease. In addition, conditions such as skull trauma, brain tumors, alcoholism, etc. can be causes of dementia.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, causeless aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal disintegration, are relevant.

Vascular dementia

This type of disease is associated with impaired cognitive function due to abnormal blood flow in the brain. Vascular dementia is characterized by a long development pathological processes. The patient practically does not notice that he is developing brain dementia. Due to disturbances in blood flow, certain brain centers begin to experience pain, which causes the death of brain cells. A large number of such cells leads to brain dysfunction, which manifests itself as dementia.

Causes

Stroke is one of the root causes of vascular dementia. Both, and, which distinguish a stroke, deprive brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are at particularly high risk of developing dementia.

It can also cause dementia. Because of low blood pressure the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can be caused by ischemia, arrhythmia, diabetes, infectious and autoimmune vasculitis, etc.

As mentioned above, often the cause of such dementia can be. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing impairments in cognitive activity. This dementia differs from other dementias in the stepwise progression of the clinical picture, when episodic improvements and deteriorations in the patient’s condition periodically replace each other. Atherosclerotic dementia is also characterized by dizziness, speech and visual abnormalities, and slow psychomotor skills.

Signs

Typically, a doctor diagnoses vascular dementia in cases where disruptions in cognitive functions begin to appear after an experience or a stroke. A harbinger of the development of dementia is also considered to be weakening of attention. Patients complain that they cannot concentrate on a certain object or concentrate. Characteristic symptoms Dementia is considered to be changes in gait (mincing, wobbly, “skiing”, unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - too alarm signal. Even at the beginning of the disease, the patient experiences some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia at the initial stages, the patient is given special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

By the way, with vascular type of dementia memory deviations are not particularly pronounced, which cannot be said about the emotional sphere of activity. According to statistics, about a third of patients with vascular dementia are in depressed state. All patients are subject to frequent mood swings. They can laugh until they cry, and suddenly suddenly begin to sob bitterly. Patients often suffer from hallucinations, epileptic seizures, show apathy towards the world around them, preferring sleep to wakefulness. In addition to the above, symptoms of vascular dementia include impoverishment of gestures and facial movements, i.e., motor activity is impaired. Patients experience urinary disturbances. Characteristic feature a patient suffering from dementia is also sloppiness.

Treatment

There is no standard, template method for treating dementia. Each case is considered by a specialist separately. It's connected with a huge amount pathogenetic mechanisms preceding the disease. It should be noted that dementia is completely incurable, so the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia too, is carried out with the help of drugs that have a positive effect on brain tissue, improving their metabolism. Also, dementia therapy involves treating directly the diseases that led to its development.

To improve cognitive processes (Cerebrolysin) and nootropic drugs. If the patient is subject to severe forms of depression, then, along with the main treatment of dementia, he is prescribed antidepressants. To prevent cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

Do not forget about: giving up smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that Demented people often develop such an unpleasant trait as sloppiness Therefore, relatives need to provide proper care for the patient. If household members cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, should be discussed with those who have already encountered similar problems on a forum dedicated to vascular dementia.

Video: vascular dementia in the program “Live Healthy!”

Senile (senile) dementia

Many, observing elderly household members, often notice changes in their condition associated with character, intolerance and forgetfulness. From somewhere an irresistible stubbornness appears, and it becomes impossible to convince such people of anything. This is due to brain atrophy due to large-scale death of brain cells due to age, i.e., senile dementia begins to develop.

Signs

First, an elderly person begins minor memory impairments– the patient forgets recent events, but remembers what happened in his youth. As the disease progresses, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have virtually no psychotic states, which makes life much easier for both the patient and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis, accompanied by either sleep inversion. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful tenderness to righteous anger, i.e. A global form of the disease is developing. Psychosis can be triggered by changes in blood pressure (hypotension, hypertension), changes in blood levels (diabetes), etc. Therefore, it is important to protect elderly people with dementia from all kinds of chronic and viral diseases.

Treatment

Healthcare professionals do not recommend treating dementia at home, regardless of the severity and type of disease. Today there are many boarding houses and sanatoriums, the main focus of which is the maintenance of just such patients, where, in addition to proper care, treatment of the disease will be carried out. The issue is certainly controversial, since in the comfort of home it is much easier for the patient to endure dementia.

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their effect is manifested in an increase in the ability of the patient’s nervous system to adapt to the resulting physical and mental stress.

Nootropic drugs are used as mandatory drugs for the treatment of dementia of any type, which significantly improve cognitive abilities and have a restorative effect on memory. In addition, modern drug therapy often uses tranquilizers to relieve anxiety and fear.

Since the onset of the disease is associated with serious memory impairment, some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have a calming and hypnotic effect.

Video: Cognitive training for people with dementia

Alzheimer's type dementia

This is perhaps the most common type of dementia today. It refers to organic dementia(a group of dementive syndromes developing against the background of organic changes in the brain, such as cerebrovascular diseases, cranial brain injuries, senile or syphilitic psychoses). In addition, this disease is quite closely intertwined with types of dementia with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms with them. Often even doctors confuse these pathologies.

Most significant factors, provoking the development of dementia:

1. Old age (75-80 years);
2. Female;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes;
6. Atherosclerosis;
7. Obesity;
8. Related diseases.

The symptoms of Alzheimer's type dementia are generally identical to the symptoms of vascular and senile dementia. These are memory impairments; first, recent events are forgotten, and then facts from life in the distant past. As the disease progresses, emotional and volitional disturbances appear: conflict, grumpiness, egocentrism, suspicion (senile personality restructuring). Untidyness is also present among the many symptoms of dementia syndrome.

Then the patient develops delusions of “damage,” when he begins to blame others for stealing something from him or wanting to kill him, etc. The patient develops a craving for gluttony and vagrancy. At the severe stage, the patient is consumed by complete apathy, he practically does not walk, does not talk, does not feel thirst or hunger.

Since this dementia refers to total dementia, the treatment is complex, covering therapy accompanying pathologies. This type of dementia is classified as progressive, it leads to disability and then death of the patient. As a rule, no more than a decade passes from the onset of the disease to death.

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

Quite a rare disease occurring, as a rule, against the background of schizophrenia. For him, the typical picture is a paucity of interests; the patient cannot highlight the main point, or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient constantly expresses himself in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to long-term alcohol-toxic effects on the brain (over 1.5-2 decades). In addition, factors such as liver lesions and disorders play an important role in the development mechanism. vascular system. According to research, at the last stage of alcoholism, the patient experiences pathological changes in the brain area that are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia may regress if the patient completely abstains from alcoholic beverages.

Frontotemporal dementia

This presenile dementia, often called Pick's disease, involves the presence of degenerative abnormalities that affect the temporal and frontal lobes of the brain. In half of cases, frontotemporal dementia develops due to a genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decency and sexual promiscuity, bulimia and urinary incontinence.

Drugs such as Memantine (Akatinol) have proven effective in the treatment of such dementia. Such patients live no more than ten years, dying from immobility or the parallel development of genitourinary and pulmonary infections.

Dementia in children

We looked at types of dementia that exclusively affect the adult population. But there are pathologies that develop mainly in children (Lafora disease, Niemann-Pick disease, etc.).

Childhood dementias are conventionally divided into:

Dementia in children may be a sign of certain mental pathology, for example, schizophrenia or mental retardation. Symptoms appear early: the child suddenly loses the ability to remember anything, and his mental abilities decrease.

Therapy for childhood dementia is based on curing the disease that triggered the onset of dementia., as well as on general flow pathology. In any case, the treatment of dementia is carried out with the help of the exchange of cellular substances.

With any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it’s not his fault that he sometimes does inappropriate things, it’s the illness that does it. We ourselves need to think about preventive measures so that the disease does not strike us in the future. To do this, you should move more, communicate, read, and engage in self-education. Walks before bedtime and active rest, refusal bad habits- this is the key to old age without dementia.

Develops in vascular diseases, Alzheimer's disease, trauma, brain tumors, alcoholism, drug addiction, central nervous system infections and some other diseases. Persistent intellectual disorders, affective disorders and decreased volitional qualities are observed. The diagnosis is established based on clinical criteria and instrumental studies (CT, MRI of the brain). Treatment is carried out taking into account the etiological form of dementia.

Dementia

Dementia is a persistent disorder of higher nervous activity, accompanied by a loss of acquired knowledge and skills and a decrease in learning ability. There are currently more than 35 million people suffering from dementia worldwide. The prevalence of the disease increases with age. According to statistics, severe dementia is detected in 5%, mild – in 16% of people over 65 years of age. Doctors assume that the number of patients will increase in the future. This is due to increased life expectancy and improved quality medical care, which makes it possible to prevent death even in cases of severe injuries and diseases of the brain.

In most cases, acquired dementia is irreversible, so the most important task of doctors is timely diagnosis and treatment of diseases that can cause dementia, as well as stabilization of the pathological process in patients with acquired acquired dementia. Treatment of dementia is carried out by specialists in the field of psychiatry in collaboration with neurologists, cardiologists, endocrinologists and doctors of other specialties.

Causes of dementia

Dementia occurs when there is organic damage to the brain as a result of injury or disease. Currently there are more than 200 pathological conditions that can provoke the development of dementia. The most common cause of acquired dementia is Alzheimer's disease, accounting for 60-70% of the total number of dementia cases. In second place (about 20%) are vascular dementias caused by hypertension, atherosclerosis and other similar diseases. In patients suffering from senile dementia, several diseases that provoke acquired dementia are often detected at once.

In young and middle age, dementia can be observed with alcoholism, drug addiction, traumatic brain injury, benign or malignant neoplasms. In some patients, acquired dementia is detected when infectious diseases: AIDS, neurosyphilis, chronic meningitis or viral encephalitis. Sometimes dementia develops due to severe diseases of the internal organs, endocrine pathology and autoimmune diseases.

Classification of dementia

Taking into account the predominant damage to certain areas of the brain, four types of dementia are distinguished:

• Cortical dementia. The cerebral cortex is predominantly affected. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
• Subcortical dementia. Subcortical structures suffer. Accompanied by neurological disorders (trembling limbs, muscle stiffness, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease and white matter hemorrhages.
• Cortical-subcortical dementia. Both the cortex and subcortical structures are affected. Observed in vascular pathology.
• Multifocal dementia. Multiple areas of necrosis and degeneration form in various parts of the central nervous system. Neurological disorders are very diverse and depend on the location of the lesions.

Depending on the extent of the lesion, two forms of dementia are distinguished: total and lacunar. With lacunar dementia, the structures responsible for certain types of intellectual activity suffer. Leading role in clinical picture Short-term memory disorders usually play a role. Patients forget where they are, what they planned to do, what they agreed on just a few minutes ago. Criticism of one’s condition is preserved, emotional and volitional disturbances are weakly expressed. Signs of asthenia may be detected: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including in the early stages of Alzheimer's disease.

With total dementia, there is a gradual disintegration of the personality. Intelligence decreases, learning abilities are lost, and the emotional-volitional sphere suffers. The circle of interests narrows, shame disappears, and previous moral and moral norms become insignificant. Total dementia develops with space-occupying formations and circulatory disorders in the frontal lobes.

The high prevalence of dementia in the elderly led to the creation of a classification of senile dementias:

• Atrophic (Alzheimer's) type - provoked by primary degeneration of brain neurons.
• Vascular type - damage to nerve cells occurs secondary, due to disturbances in the blood supply to the brain due to vascular pathology.
• Mixed type - mixed dementia - is a combination of atrophic and vascular dementia.

Symptoms of dementia

The clinical manifestations of dementia are determined by the cause of acquired dementia and the size and location of the affected area. Taking into account the severity of symptoms and the patient’s ability to socially adapt, three stages of dementia are distinguished. With mild dementia, the patient remains critical of what is happening and of his own condition. He retains the ability to self-service (can do laundry, cook, clean, wash dishes).

With moderate dementia, criticism of one's condition is partially impaired. When communicating with the patient, a clear decrease in intelligence is noticeable. The patient has difficulty caring for himself, has difficulty using household appliances and mechanisms: cannot answer the phone call, open or close the door. Care and supervision required. Severe dementia is accompanied by a complete collapse of personality. The patient cannot dress, wash, eat, or go to the toilet. Constant monitoring is required.

Clinical variants of dementia

Alzheimer's disease was described in 1906 by the German psychiatrist Alois Alzheimer. Until 1977, this diagnosis was made only in cases of dementia praecox (at the age of 18 years), and when symptoms appeared after the age of 65 years, senile dementia was diagnosed. It was then found that the pathogenesis and clinical manifestations of the disease are the same regardless of age. Currently, the diagnosis of Alzheimer's disease is made regardless of the time of onset of the first clinical signs acquired dementia. Risk factors include age, the presence of relatives suffering from this disease, atherosclerosis, hypertension, excess weight, diabetes, low motor activity, chronic hypoxia, traumatic brain injury and lack of mental activity throughout life. Women get sick more often than men.

The first symptom is a pronounced impairment of short-term memory while maintaining criticism of one’s own condition. Subsequently, memory disorders worsen, and a “movement back in time” is observed - the patient first forgets recent events, then what happened in the past. The patient ceases to recognize his children, mistakes them for long-dead relatives, does not know what he did this morning, but can talk in detail about the events of his childhood, as if they had happened quite recently. Confabulations may occur in place of lost memories. Criticism of one's condition decreases.

In the advanced stage of Alzheimer's disease, the clinical picture is complemented by emotional and volitional disorders. Patients become grouchy and quarrelsome, often demonstrate dissatisfaction with the words and actions of others, and become irritated by every little thing. Subsequently, delirium of damage may occur. Patients claim that loved ones deliberately leave them in dangerous situations, they add poison to food in order to poison them and take over the apartment, they say nasty things about them in order to ruin their reputation and leave them without public protection, etc. Not only family members are involved in the delusional system, but also neighbors, social workers and other people interacting with the sick. Other behavioral disorders may also be detected: vagrancy, intemperance and indiscriminateness in food and sex, senseless disorderly actions (for example, shifting objects from place to place). Speech becomes simplified and impoverished, paraphasia occurs (the use of other words instead of forgotten ones).

At the final stage of Alzheimer's disease, delusions and behavioral disorders are leveled out due to a pronounced decrease in intelligence. Patients become passive and inactive. The need to take fluids and food disappears. Speech is almost completely lost. As the disease worsens, the ability to chew food and walk independently is gradually lost. Due to complete helplessness, patients require constant professional care. Death occurs as a result of typical complications (pneumonia, bedsores, etc.) or progression of concomitant somatic pathology.

The diagnosis of Alzheimer's disease is based on clinical symptoms. Treatment is symptomatic. There are currently no drugs or non-drug treatments that can cure patients with Alzheimer's disease. Dementia progresses steadily and ends with complete collapse of mental functions. The average life expectancy after diagnosis is less than 7 years. The earlier the first symptoms appear, the faster the dementia worsens.

Vascular dementia

There are two types of vascular dementia - those that arose after a stroke and those that developed as a result chronic failure blood supply to the brain. In post-stroke acquired dementia, the clinical picture is usually dominated by focal disorders (speech disorders, paresis and paralysis). Character neurological disorders depends on the location and size of the hemorrhage or area with impaired blood supply, the quality of treatment in the first hours after the stroke and some other factors. In chronic circulatory disorders, symptoms of dementia predominate, and neurological symptoms are quite monotonous and less pronounced.

Most often, vascular dementia occurs with atherosclerosis and hypertension, less often - with severe diabetes mellitus and some rheumatic diseases, even less often - with embolism and thrombosis due to skeletal injuries, increased blood clotting and peripheral venous diseases. The likelihood of developing acquired dementia increases with diseases of the cardiovascular system, smoking and excess weight.

The first sign of the disease is difficulty trying to concentrate, distracted attention, fatigue, some rigidity of mental activity, difficulty planning and decreased ability to analyze. Memory disorders are less severe than in Alzheimer's disease. Some forgetfulness is noted, but when given a “push” in the form of a leading question or offered several answer options, the patient easily recalls the necessary information. Many patients exhibit emotional instability, low mood, depression and subdepression are possible.

Neurological disorders include dysarthria, dysphonia, gait changes (shuffling, decreased step length, “sticking” of the soles to the surface), slowing of movements, impoverishment of gestures and facial expressions. The diagnosis is made on the basis of the clinical picture, ultrasound and MRA of cerebral vessels and other studies. To assess the severity of the underlying pathology and draw up a pathogenetic therapy regimen, patients are referred for consultation to the appropriate specialists: therapist, endocrinologist, cardiologist, phlebologist. Treatment is symptomatic therapy, therapy of the underlying disease. The rate of development of dementia is determined by the characteristics of the leading pathology.

Alcoholic dementia

The cause of alcoholic dementia is long-term (over 15 years or more) abuse of alcoholic beverages. Along with the direct destructive effect of alcohol on brain cells, the development of dementia is caused by impaired activity various organs and systems, gross metabolic disorders and vascular pathology. Alcoholic dementia is characterized by typical personality changes (coarsening, loss of moral values, social degradation) combined with a total decrease in mental abilities (distraction of attention, decreased ability to analyze, plan and abstract thinking, memory disorders).

After completely giving up alcohol and treating alcoholism, it is possible partial restoration however, such cases are very rare. Due to a pronounced pathological craving for alcoholic beverages, decreased volitional qualities and lack of motivation, most patients are unable to stop taking ethanol-containing liquids. The prognosis is unfavorable; the cause of death is usually somatic diseases caused by alcohol consumption. Often such patients die as a result of criminal incidents or accidents.

Diagnosis of dementia

The diagnosis of dementia is made when five mandatory features. The first is memory impairment, which is identified based on a conversation with the patient, special research and interviews with relatives. The second is at least one symptom indicating organic brain damage. These symptoms include the “three A” syndrome: aphasia (speech disorders), apraxia (loss of the ability to perform purposeful actions while maintaining the ability to perform elementary motor acts), agnosia (perceptual disorders, loss of the ability to recognize words, people and objects while maintaining the sense of touch). , hearing and vision); reducing criticism of one’s own condition and the surrounding reality; personality disorders (unreasonable aggressiveness, rudeness, lack of shame).

Third diagnostic sign dementia – a violation of family and social adaptation. The fourth is the absence of symptoms characteristic of delirium (loss of orientation in place and time, visual hallucinations and delusions). Fifth – the presence of an organic defect, confirmed by instrumental studies (CT and MRI of the brain). The diagnosis of dementia is made only if all listed signs for six months or more.

Dementia most often has to be differentiated from depressive pseudodementia and functional pseudodementia resulting from vitamin deficiency. If you suspect depressive disorder the psychiatrist takes into account the severity and nature of affective disorders, the presence or absence of daily mood swings and the feeling of “painful insensibility”. If vitamin deficiency is suspected, the doctor examines the medical history (malnutrition, severe intestinal damage with prolonged diarrhea) and excludes symptoms characteristic of a deficiency of certain vitamins (anemia due to a lack of folic acid, polyneuritis due to a lack of thiamine, etc.).

Prognosis for dementia

The prognosis for dementia is determined by the underlying disease. With acquired dementia resulting from traumatic brain injury or space-occupying processes (tumors, hematomas), the process does not progress. Often there is a partial, less often a complete reduction of symptoms due to compensatory capabilities brain. In the acute period, it is very difficult to predict the degree of recovery; the outcome of extensive damage can be good compensation with preservation of ability to work, and the outcome of minor damage can be severe dementia leading to disability and vice versa.

In dementia caused by progressive diseases, there is a steady worsening of symptoms. Doctors can only slow down the process by adequate treatment main pathology. The main goals of therapy in such cases are maintaining self-care skills and adaptability, prolonging life, providing appropriate care and eliminating unpleasant manifestations of the disease. Death occurs as a result of a serious impairment of vital functions associated with the patient's immobility, his inability to perform basic self-care and the development of complications characteristic of bedridden patients.

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Dementia (dementia): signs, treatment, causes of senile, vascular

As a person ages, failures begin to occur in all systems and organs. There are also deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, due to mental disorders, behavior changes, causeless depression appears, emotionality decreases, and the person begins to gradually degrade.

Dementia usually develops in older people. It affects several psychological processes: speech, memory, thinking, attention. Already at the initial stage of vascular dementia, the resulting disorders are quite significant, which affects the patient’s quality of life. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave their professional career, and they simply cannot do without the constant supervision of family members.

General characteristics of the disease

Acquired cognitive impairments that negatively affect a patient's daily activities and behavior are called dementia.

The disease can have several degrees of severity depending on the social adaptation of the patient:

1. Mild degree of dementia - the patient experiences a degradation of professional skills, his social activity decreases, and interest in favorite activities and entertainment weakens significantly. At the same time, the patient does not lose orientation in the surrounding space and can take care of himself independently.
2. Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on the front door on his own. This degree of severity is often referred to colloquially as “senile insanity.” The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

There can be two forms of dementia: total and lacunar (dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). A typical variant of lacunar dementia can be considered Alzheimer's disease in the early stages.

The form of total dementia is characterized by absolute personal degradation. The patient is exposed to intellectual and cognitive disorders, the emotional-volitional sphere of life changes radically (there is no sense of shame, duty, vital interests and spiritual values ​​disappear).

From a medical point of view, there is the following classification of types of dementia:

• Dementia of the atrophic type (Alzheimer's disease, Pick's disease) usually occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.
• Vascular dementia (atherosclerosis, hypertension) - develops due to circulatory pathologies in the cerebral vascular system.
• Dementia of mixed type - the mechanism of their development is similar to both atrophic and vascular dementia.

Dementia often develops due to pathologies leading to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as a severe complication of the disease. In addition, conditions such as skull trauma, brain tumors, alcoholism, multiple sclerosis etc.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, causeless aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal disintegration, are relevant.

Vascular dementia

Cerebrovascular accident in vascular dementia

This type of disease is associated with impaired cognitive function due to abnormal blood flow in the brain. Vascular dementia is characterized by long-term development of pathological processes. The patient practically does not notice that he is developing brain dementia. Due to impaired blood flow, certain brain centers begin to experience oxygen starvation, causing the death of brain cells. A large number of such cells leads to brain dysfunction, which manifests itself as dementia.

Causes

Stroke is one of the root causes of vascular dementia. Both rupture and thrombosis of blood vessels, which characterize a stroke, deprive brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are at particularly high risk of developing dementia.

Hypotension can also trigger dementia. Due to low blood pressure, the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can also be caused by atherosclerosis, hypertension, ischemia, arrhythmia, diabetes, heart defects, infectious and autoimmune vasculitis, etc.

As mentioned above, cerebral atherosclerosis can often be the cause of such dementia. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing impairments in cognitive activity. This dementia differs from other dementias in the stepwise progression of the clinical picture, when episodic improvements and deteriorations in the patient’s condition periodically replace each other. Atherosclerotic dementia is also characterized by fainting, dizziness, speech and visual abnormalities, and slow psychomotor skills.

Signs

Typically, a doctor diagnoses vascular dementia when disruptions in cognitive function begin to appear after a heart attack or stroke. A harbinger of the development of dementia is also considered to be weakening of attention. Patients complain that they cannot concentrate on a certain object or concentrate. Characteristic symptoms of dementia are changes in gait (mincing, wobbly, “skiing”, unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - also an alarming signal. Even at the beginning of the disease, the patient experiences some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia in the initial stages, the patient is given a special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

By the way, with the vascular type of dementia, memory deviations are not particularly pronounced, which cannot be said about the emotional sphere of activity. According to statistics, about a third of patients with vascular dementia are depressed. All patients are subject to frequent mood swings. They can laugh until they cry, and suddenly suddenly begin to sob bitterly. Patients often suffer from hallucinations, epileptic seizures, show apathy towards the world around them, and prefer sleep to wakefulness. In addition to the above, symptoms of vascular dementia include impoverishment of gestures and facial movements, i.e., motor activity is impaired. Patients experience urinary disturbances. A characteristic feature of a patient suffering from dementia is also sloppiness.

Treatment

There is no standard, template method for treating dementia. Each case is considered by a specialist separately. This is due to a huge number of pathogenetic mechanisms preceding the disease. It should be noted that dementia is completely incurable, so the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia too, is carried out with the help of neuroprotectors that have a positive effect on brain tissue, improving their metabolism. Also, dementia therapy involves treating directly the diseases that led to its development.

Calcium antagonists (Cerebrolysin) and nootropic drugs are used to improve cognitive processes. If the patient is subject to severe forms of depression, then, along with the main treatment of dementia, he is prescribed antidepressants. To prevent cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

Do not forget about the prevention of vascular and heart diseases: quit smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that people with dementia often develop such an unpleasant trait as sloppiness, so relatives need to provide proper care for the patient. If household members cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, should be discussed with those who have already encountered similar problems on a forum dedicated to vascular dementia.

Video: vascular dementia in the program “Live Healthy!”

Senile (senile) dementia

Many, observing elderly household members, often notice changes in their condition associated with character, intolerance and forgetfulness. From somewhere an irresistible stubbornness appears, and it becomes impossible to convince such people of anything. This is due to brain atrophy due to large-scale death of brain cells due to age, i.e., senile dementia begins to develop.

Signs

First, an elderly person begins to experience minor deviations in memory - the patient forgets recent events, but remembers what happened in his youth. As the disease progresses, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have virtually no psychotic states, which makes life much easier for both the patient and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis accompanied by insomnia or sleep inversion. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful tenderness to righteous anger, i.e. A global form of the disease is developing. Psychosis can be triggered by changes in blood pressure (hypotension, hypertension), changes in blood sugar levels (diabetes), etc. Therefore, it is important to protect elderly people with dementia from all kinds of chronic and viral diseases.

Treatment

Health care providers do not recommend treating dementia at home, regardless of the severity and type of disease. Today there are many boarding houses and sanatoriums, the main focus of which is the maintenance of just such patients, where, in addition to proper care, treatment of the disease will be carried out. The issue is certainly controversial, since in the comfort of home it is much easier for the patient to endure dementia.

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their effect is manifested in an increase in the ability of the patient’s nervous system to adapt to the resulting physical and mental stress.

Nootropic drugs are used as mandatory drugs for the treatment of dementia of any type, which significantly improve cognitive abilities and have a restorative effect on memory. In addition, modern drug therapy often uses tranquilizers to relieve anxiety and fear.

Since the onset of the disease is associated with serious memory impairment, you can use some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have a calming and hypnotic effect.

Video: Cognitive training for people with dementia

Alzheimer's type dementia

This is perhaps the most common type of dementia today. It refers to organic dementia (a group of dementive syndromes that develop against the background of organic changes in the brain, such as cerebrovascular diseases, traumatic brain injuries, senile or syphilitic psychoses). In addition, this disease is quite closely intertwined with types of dementia with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms with them. Often even doctors confuse these pathologies.

Pathological process in the brain of a patient with Alzheimer's type dementia

The most significant factors provoking the development of dementia:

1. Old age (75-80 years);
2. Female;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes;
6. Atherosclerosis;
7. Excess of lipids in plasma;
8. Obesity;
9. Connected with chronic hypoxia diseases.

The symptoms of Alzheimer's type dementia are generally identical to the symptoms of vascular and senile dementia. These are memory impairments; first, recent events are forgotten, and then facts from life in the distant past. As the disease progresses, emotional and volitional disturbances appear: conflict, grumpiness, egocentrism, suspicion (senile personality restructuring). Untidyness is also present among the many symptoms of dementia syndrome.

Then the patient develops delusions of “damage,” when he begins to blame others for stealing something from him or wanting to kill him, etc. The patient develops a craving for gluttony and vagrancy. At the severe stage, the patient is consumed by complete apathy, he practically does not walk, does not talk, does not feel thirst or hunger.

Since this dementia refers to total dementia, the treatment is complex, covering the treatment of concomitant pathologies. This type of dementia is classified as progressive, it leads to disability and then death of the patient. As a rule, no more than a decade passes from the onset of the disease to death.

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

A rather rare disease that usually occurs against the background of epilepsy or schizophrenia. For him, the typical picture is a paucity of interests; the patient cannot highlight the main essence or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient constantly expresses himself in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to long-term alcohol-toxic effects on the brain (over 1.5-2 decades). In addition, factors such as liver lesions and disorders of the vascular system play an important role in the development mechanism. According to research, at the last stage of alcoholism, the patient experiences pathological changes in the brain area that are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia can regress if the patient completely abstains from alcoholic beverages.

Frontotemporal dementia

This presenile dementia, often called Pick's disease, involves the presence of degenerative abnormalities that affect the temporal and frontal lobes of the brain. In half of cases, frontotemporal dementia develops due to a genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decency and sexual promiscuity, bulimia and urinary incontinence.

Drugs such as Memantine (Akatinol) have proven effective in the treatment of such dementia. Such patients live no more than ten years, dying from immobility or the parallel development of genitourinary and pulmonary infections.

Dementia in children

We looked at types of dementia that exclusively affect the adult population. But there are pathologies that develop mainly in children (Lafora disease, Niemann-Pick disease, etc.).

Childhood dementias are conventionally divided into:

• Progressive dementia – independently developing pathology, belonging to the category of genetic degenerative defects, vascular lesions and diseases of the central nervous system.
• Residual organic dementia - the development of which is caused by traumatic brain injury, meningitis, and drug poisoning.

Dementia in children may be a sign of a certain mental pathology, for example, schizophrenia or mental retardation. Symptoms appear early: the child suddenly loses the ability to remember anything, and his mental abilities decrease.

Therapy for childhood dementia is based on curing the disease that triggered the onset of dementia, as well as on the general course of the pathology. In any case, dementia is treated with medications that improve cerebral blood flow and cellular metabolism.

With any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it’s not his fault that he sometimes does inappropriate things, it’s the illness that does it. We ourselves should think about preventive measures so that the disease does not affect us in the future. To do this, you should move more, communicate, read, and engage in self-education. Walking before bed and active rest, giving up bad habits - this is the key to old age without dementia.

Video: dementia syndrome

Hello, my grandmother is 82 years old, all the signs of dementia are on her face, anxiety, she forgets that she ate after half an hour, she always tries to get up and walk somewhere, although her legs no longer obey her and she simply crawls out of bed, she can no longer take care of herself, Her son is with her for 24 hours, but her nerves also give in, because there is no peace, especially at night, she doesn’t let her sleep at all, she asks her to drink, then to go to the toilet, and so on all night. The medications prescribed by doctors are of no use, sedatives do not work. Can you recommend something that will help both her and us rest at least at night? Are there sedatives for such patients? I will be glad to hear your answer.

Hello! Dementia is a serious condition that has no cure, and most medications are in fact ineffective. We cannot recommend any medications over the Internet; it is better for you to contact a psychiatrist or neurologist for this. Perhaps the doctor will prescribe something stronger than what has already been prescribed, although there is still no guarantee that the grandmother will become calmer. Unfortunately, such patients are a difficult test for relatives, and medicine is often powerless, so you and your family can only have patience and courage in caring for your sick grandmother.

Hello. My mother-in-law, 63 years old, was diagnosed with atherosclerosis, stage II DEP. Previously, we lived more or less normally. Her husband argued with her because of her character traits, but this was not so often. Now it has become completely impossible to live with her. She drinks expired milk, hides jars of pickles next to her bed, they become moldy, she continues to eat them. The apartment is dirty. She almost never washes her bed linen; she puts her dirty clothes in clumps in a pile and doesn’t wash them. In her room there are moldy cans, smelly things smell of sweat and sourness. Instead of throwing away every broken thing, he keeps it, even pens worth 5-10 rubles without refills. Speaks for others. This is expressed in the words “Yes, he didn’t want to do this,” dragging food home that still has a day or two of expiration date. When we throw out expired soaps, creams, and perfumes into the trash, she pulls them out of the trash and takes them back to her room. Recently it got to the point where she takes the discarded milk out of the trash and puts it in the refrigerator. She cannot prepare food for herself. He lies in his room all day, does nothing and doesn’t want to. Complete apathy towards the world around you and towards yourself. She says that she feels bad and needs to go to the doctors. 1-2 days pass, and she already believes that there is no need to go to the doctors. He speaks for the doctor who made the diagnoses, that he said that there was nothing wrong with her. Although she has changes in the tissues of the liver and kidneys. When I talked to the doctor, he said that she was doing poorly. She eats what she shouldn't. Butter, bread, marinades and fermented milk, meat products, margarine, coffee, smokes. We tell her that she can’t eat this, and in response we hear: “Well, I’m just a little bit.” Without thinking about her actions, she collected loans for a huge amount. Constantly screams about the lack of money, although there is some. She constantly lies, day after day, says one thing, and literally an hour later she says that she didn’t say anything like that. If earlier she could hear movies on her laptop perfectly well, now movies and TV series are screaming throughout the entire apartment. He screams a little, periodically shows aggression and bulges his eyes. He cannot step on his feet normally in the morning and towards night. He oohs and ahhs and steps heavily on them. He takes a dish sponge and washes the floor with it. The entire apartment was recently washed with a rag that was covered in cat urine. And she denied the suffocating smell of urine! She doesn't smell anything at all, even when you put it right in her nose. Denies any facts! What to do? Can this person be deprived of legal capacity? Otherwise, we will have problems with her loans. Became secretive, goes somewhere. He says he’s going to work, but goes along a different road. The sick people themselves. My husband has meningococcemia, he has stage 1 DEP and SPA. I have a pituitary tumor. It's impossible to live like that. We have scandals all day long...

Hello! We sincerely sympathize with you; your family is in a very difficult situation. You describe quite typical behavior for patients with severe DEP; you probably yourself understand that the mother-in-law is not aware of her actions and words, because she is sick, and it is really very difficult with such a family member. You can try to recognize her as incompetent, contact a neurologist or psychiatrist, explain the situation. If the doctor writes an appropriate conclusion, then it will certainly be easier to avoid problems with loans, mother-in-law’s appeals to various authorities, etc., because such patients can be extremely active in their initiatives. Aggression, deceit, and sloppiness are symptoms that are very unpleasant and irritating to others, but nevertheless associated with the disease, and not with the mother-in-law’s desire to ruin your life. It is difficult to give advice on communicating with a sick person, not everyone has the nerves and patience, and if you break down and make trouble, then this is a completely natural phenomenon in the current situation. Unfortunately, encephalopathy of such severity is not treated or cured; the outcome, as a rule, is dementia. On the one hand, contact will become completely impossible, you will need care, like caring for a small child, on the other hand, your life will become easier to some extent, since the mother-in-law’s activity will gradually decrease and it will become easier to control the situation. Try to get the maximum from the doctor in order to somehow protect your family and mother-in-law from her inappropriate actions, and we wish you courage and patience.

Hello! Perhaps you should look not only for a competent neurologist or psychiatrist, but also a lawyer, because a person who is potentially incompetent due to a condition mental health, cannot account for his actions and, therefore, should not give consent to the examination, which must be carried out for medical reasons and with the consent of relatives. A neurologist, therapist or psychiatrist must prescribe drug therapy based on the underlying disease; a sick person cannot be left without treatment, which he is entitled to by law. We wish you a speedy resolution to this difficult situation.

Hello! Vascular dementia begins long before obvious symptoms negative symptoms with minor changes, you are absolutely right that the process began many years ago. Unfortunately, the first signs are non-specific and it is difficult to distinguish them from the symptoms of other diseases, to distinguish them from many others. age-related changes can be problematic. On the other hand, it is not at all necessary that other family members will be affected by significant mental and behavioral changes, because everything is individual, depending on the character of the person and the degree of brain damage. Most elderly people have certain signs of vascular encephalopathy, but for many it is limited to a decrease in memory and intellectual performance, while their character and behavior remain quite adequate. Rescue from cerebral vascular damage - healthy image life, proper nutrition, providing the brain with work until old age. It is no secret that solving crossword puzzles, solving interesting mathematical problems, reading books and other literature trains the brain, helps it adapt to conditions of imperfect blood flow and cope with the progression of age-related changes. And it is absolutely not necessary that a disease like your grandmother’s will overtake everyone else; you are too pessimistic. If other elderly family members already have signs of brain aging, then the listed measures plus taking vascular medications, vitamins, and regular doctor's examinations will help slow down the development of dementia. We wish your family health and patience in caring for your grandmother!

Good afternoon. It doesn't sound rude. It's hard for you. We have the same situation. Grandmother, dearest and kindest person turned into an aggressive evil man(she fights, throws her fists and wishes us all to die), we understand that this is not her fault, she did not ask for such a pain. But it is what it is. We get out of the situation in this way: my grandmother went to a neurologist for an appointment - she was prescribed antidepressants and once a month she went to a paid boarding house for a week. For us this is a week of rest. Relatives of such people need to rest, because it is not uncommon for those caring for such patients to die (due to moral burnout and nervous stress) faster than the patients themselves. Strength and patience to you.

Atherosclerotic dementia

ACADEMY OF MEDICAL SCIENCES USSR ALL-UNION RESEARCH CENTER FOR MENTAL HEALTH

SUKIASYAN Samvel Grantovich

ATHEROSCLEROTIC DEMENTIA (CLINICAL TOMOGRAPHIC STUDY)

dissertations for an academic degree

candidate of medical sciences

The work was carried out at the All-Russian Research Center of the USSR Academy of Medical Sciences

(Acting Director - Corresponding Member of the USSR Academy of Medical Sciences, Professor R.A. Nadzharov)

Doctor of Medical Sciences, Professor M.A. Tsivilko

LEADING INSTITUTION - Moscow Research Institute of Psychiatry of the Ministry of Health of the RSFSR

The defense will take place on November 16, 1987 at 13:00 at a meeting of the specialized council at the All-Russian Scientific Center for the Protection of the USSR Academy of Medical Sciences (council code D 001.30.01) at the address: Moscow, Kashirskoye Shosse, building 34

The dissertation can be found in the library of the All-Russian Research Center for Medical Sciences of the USSR Academy of Medical Sciences.

Candidate of Medical Sciences T.M. Loseva

IN last years interest in the study of atherosclerotic dementia has increased significantly. This, first of all, was facilitated by changes in the demographic situation: an increase in the number of elderly and senile people in the general population, which naturally led to an increase in the number of mentally ill people in this age group, including those with dementia. In view of the fact that the trend toward an aging population continues, the relevance of this problem will increase even more in the near future.

A significant proportion among elderly and senile people are patients with mental disorders of vascular origin, which, according to S.I. Gavrilova (1977), reach 17.4%. Dementia of vascular (atherosclerotic) origin among all types of dementia of late age is detected from 10 to 39% (M.G. Shchirina et al., 1975; Huber G., 1972; Corona R. et al. 1982; Danielczyk W., 1983; Sulkava R. et al., 1985 Etc.).

The increase in interest in the problem of atherosclerotic dementia is also due to the development and implementation of medical practice a new method of instrumental research - the computed tomography (CT) method, which significantly increases the level of diagnosis and allows for a more in-depth study of the natomorphological basis of atherosclerotic dementia.

As is known, since the 70s, the concept of atherosclerotic dementia has become widespread, considering multiple cerebral infarctions as its main pathogenetic factor - the concept of the so-called “multi-infarct dementia” (Hachinski V. et al. 1974; Harrison I. et al., 1979 I etc.), In this regard, clinical and tomographic studies are of great importance. This kind of research was carried out by a number of foreign authors (Ladurner G. et al. I981, 1982, I982, Gross G. et al., 1982; Kohlmeyer K., 1982, etc.). However, their work focused on the tomographic characterization of dementia, while its clinical aspects were not taken into account enough.

Finally, the importance of studying atherosclerotic dementia is dictated by new therapeutic opportunities that have emerged in recent years in the treatment and prevention of vascular diseases of the brain and strokes ( vascular agents predominantly cerebral action, nootropic drugs, etc.).

Thus, the problem of atherosclerotic dementia is currently acquiring great relevance both in theoretical and practical terms.

I. Development of a clinical-psychopathological taxonomy of atherosclerotic dementia, adequate for establishing clinical-morphological relationships.

2. Study of clinical dynamics cerebral atherosclerosis, proceeding with the formation of dementia.

3. Study of structural changes in the brain in atherosclerotic dementia, identified by computed tomography; conducting clinical tomographic correlations.

4. Study of issues of therapy for patients with atherosclerotic dementia.

CHARACTERISTICS OF THE MATERIAL AND RESEARCH METHODS.

When studying the problem of atherosclerotic dementia, a new clinical and tomographic approach was used.

We studied 61 patients with atherosclerotic dementia who were treated at the Research Institute of Clinical Psychiatry of the All-Russian Scientific Center for Healthcare of the USSR Academy of Medical Sciences and the Research Institute of Neurology of the USSR Academy of Medical Sciences. The study included patients whose clinical picture of the disease was characterized by persistent symptoms of dementia, the severity of which ranged from relatively mild to severe forms. Cases were studied where the symptoms of dementia were defined for at least 6 months. Manifestations of somatic pathology and neurological disorders in the studied group of patients were relatively mildly expressed and sufficiently compensated. Patients with cerebral atherosclerosis in the stage of psychophysical insanity were not included in the study.

The character of psychopathological manifestations dementia, its structure and depth of disorders. A complete somatoneurological examination of the patients was carried out (therapeutic, neurological, ophthalmological, etc.).

Computed tomographic examination of the brain

was carried out in the laboratory of computed tomography of the Research Institute of Neurology on the devices CT-I0I0 (EMI, England) and CPT-I000M (USSR). Analysis of brain tomograms, description and qualification of identified changes were carried out by employees of the same laboratory. The methodology for assessing tomograms consisted of “determining the level of the brain slice based on the identification anatomical formations according to given planes of research", identifying tomographic phenomena that provide information about the nature of pathological changes in the brain (N.V. Vereshchagin et al., 1986). Such phenomena include a decrease in the density of brain matter (focal and diffuse) and expansion cerebrospinal fluid spaces of the brain, which respectively represent tomographic signs of previous cerebrovascular accidents and a decrease in brain volume, hydrocephalus.

The obtained clinical and CT data were processed on an EC-1011 computer using a program developed in the laboratory of mathematical analysis of the Scientific Research Institute of Clinical Psychiatry of the All-Russian Scientific Research Institute of Clinical Psychiatry of the USSR Academy of Medical Sciences according to the Pearson criteria.

Among the examined patients there were 46 men and 15 women aged from 50 to 85 years. Average age was 66.85±1.3 years. 32 patients were aged 1 year and 29 were aged 70 years or older.

In 49 patients, cerebral atherosclerosis was combined with arterial hypertension. IN age group In those 70 years and older, arterial hypertension was detected less frequently (18 observations, 62.1% than in the age group (31 observations, 96.6%). Along with arterial hypertension, other types of somatic pathology were also detected in 41 patients (chronic bronchitis, pneumosclerosis, diabetes mellitus, etc.). The frequency of somatic pathology increased with

increasing age of patients. At the age of age it was 46.9%, and at the age of 70 years and older - 89.7%. The neurological status of all patients revealed signs of chronic cerebrovascular insufficiency, residual effects previous disturbances of cerebral hemodynamics.

In 49 patients, along with symptoms of dementia, varying degrees severity psychotic disorders exogenous-organic and endoform types.

The duration of clinical manifestations of cerebral atherosclerosis at the time of the study of patients ranged from 1 year to 33 years. Moreover, in 41 patients it reached 15 years, and in 20 patients - over 15 years. The duration of dementia at the time of the study varied from 6 months to 9 years. In 49 patients, the duration of dementia reached 4 years, in 12 - over 4 years.

Asthenia was manifested by mental and physical weakness, exhaustion and was accompanied by an abundance of “vascular” complaints. Rigidity was characterized by varying degrees of pronounced psychomotor torpidity with stiffness, viscosity, stereotypies, etc. d. Fluctuations in the patients’ condition were manifested by episodes of disorganization of behavior, speech, and thinking, sometimes reaching the degree of confusion. Based on the duration of such disorders, macro- and micro-oscillations were distinguished. The noted signs imparted characteristic severity and dynamism to the clinical manifestations of atherosclerotic dementia.

The typological differentiation of dementia of atherosclerotic origin causes certain difficulties. Analysis of our observations showed that the identification of clinical varieties of dementia on the basis of lacunarity is insufficient, since lacunarity reflects only one of the stages in the development of atherosclerotic dementia, which, as it develops, becomes global in nature. In the present study, taxonomy was carried out on the basis of two principles: syndromic and severity assessment. Based on the syndromological principle of systematization, 4 types of dementia were identified.

The general organic type of atherosclerotic dementia (18 observations, 29.5%) was characterized by a relatively mildly expressed intellectual-mnestic decline, shallow emotional-volitional and personality disorders. The preservation of external forms of behavior, skills, and feelings of illness was noted.

The torpid type of dementia (15 observations, 24.6%) was characterized by a significantly pronounced slowdown in psychomotor activity with relatively mild intellectual-mnestic impairments. A feature of the torpid type of dementia was affective disorders, manifested by short-term bouts of violent crying, rarely laughter against the background of a depressive mood.

The pseudoparalytic type of atherosclerotic dementia (12 observations, 19.7%) was manifested by a pronounced decrease in criticism, personality changes with relatively shallow mnestic disorders. The phenomena of anosognosia, familiarity, tactlessness, and a penchant for flat humor against the background of a carefree, complacent, sometimes euphoric mood attracted attention.

Amnestic type. Amnestic dementia was identified as an independent type of atherosclerotic dementia, despite the fact that memory disorders occurred in any other type of dementia. In these cases, memory impairments sharply dominated in comparison with other disorders that make up the status of the patients and were significantly expressed in their depth. The structure of the amnestic syndrome consisted of elements of fixation amnesia, amnestic disorientation, violations of chronological dating, retro- and anterograde amnesia, amnestic aphasia, etc.

Thus, if the torpid, pseudoparalytic and amnestic types were differentiated on the basis of the accentuation of any one sign in the structure of dementia, then the general organic type was characterized by relatively uniform damage to various aspects of mental activity.

Depending on the severity of clinical disorders (intellectual-mnestic functions, the amount of retained knowledge and skills, adaptation capabilities, etc.), two degrees of severity of dementia were distinguished.

Dementia severity level I (31 observations, 50.8%) included cases with a mild weakening of memory for recent and current events, dates, names, but with sufficient orientation in time and place; an unexpressed decrease in criticism and spontaneity, preservation of many skills, and minor symptoms of psychomotor retardation. Dementia severity level 11 (30 observations, 49.2%) included cases with severe memory loss, disorientation in time and sometimes place, decreased criticism, spontaneity, loss of many skills, etc.

The study of the dynamics of the disease as a whole showed that the formation of dementia in the examined patients occurred against the background of the progressive development of cerebral atherosclerosis. Three variants of the course of the disease were identified: non-stroke, stroke and mixed.

A non-stroke type of disease course was observed in 23 patients (37.8%). It was characterized by a slow increase in pseudoneurasthenic disorders, the subsequent appearance of clear signs of organic personality changes, and then the development of dementia. In the dynamics of the disease, periods of exacerbation and attenuation of clinical manifestations of vascular (atherosclerotic) ) process.

The stroke type of cerebral atherosclerosis was identified in 14 patients (22.9%). In this type of course, dementia developed without a previous period of slowly increasing psychoorganic disorders and quickly formed after an acute cerebrovascular accident.

A mixed type of disease course was established in 24 patients (39.3/0. This type of course included signs characteristic of both non-stroke and stroke types of cerebral atherosclerosis. The disease was characterized by a gradual increase in pseudoneurasthenic and psychoorganic disorders, which were interrupted clinically pronounced disorders of cerebral circulation.

Special attention in the present study was paid to studying the influence of a number of factors, such as age and arterial hypertension, on the clinical manifestations of dementia.

Comparative age analysis of clinical observations, as well as their study depending on the nature of the vascular process

showed that the formation of identified clinical types of dementia and the degree of severity largely reflect both general age patterns and the presence or absence arterial hypertension.

The amnestic type of atherosclerotic dementia was significantly correlated with more late in life patients (70 years and older). It was more often formed when hypertensive forms cerebral atherosclerosis. Meanwhile, the development of the pseudoparalytic type of dementia was observed mainly in older people in the presence of arterial hypertension. The torpid type of dementia, like the pseudoparalytic type, was formed at age (p<0,05), но, в отличие от последнего, он преобладал в случаях, где артериальная гипертония отсутствовала. Развитие общеорганического типа слабоумия наблюдалось одинаково часто и в пожилом, и в старческом возрасте, чаще в случаях без артериальной гипертонии.

Our study, in addition, revealed a number of patterns related to age and the nature of the vascular process (the presence or absence of arterial hypertension). In particular, at older ages and in the presence of arterial hypertension, stroke and mixed variants of the disease dominated, which were characterized by an acute and violent course. With increasing age (70 years and older), a tendency towards a clinically non-stroke type of course was revealed. In these cases, the disease was less acute, retaining the dynamics characteristic of cerebral atherosclerosis, manifested by periods of exacerbation and attenuation of the activity of the vascular process.

A CT study of our group of patients showed that atherosclerotic dementia is characterized by a number of tomographic signs. These include 1) a decrease in the density of the brain substance, which manifests itself in the form of circumscribed foci and/or a diffuse decrease in brain density and 2) an expansion of the cerebrospinal fluid spaces of the brain in the form of a uniform, local or asymmetric expansion of the ventricles and subarachnoid spaces of the brain.

The most significant tomographic signs of atherosclerotic dementia include foci of low density and diffuse decrease in density, which are the result of previous cerebrovascular accidents. Most often (51 observations, 83.6%) foci of low density (infarctions) were detected, which in most cases (36 observations, 70.6%) were multiple (2 or more foci). They were detected on one or both sides with approximately the same frequency. In the majority of patients, there was a predominantly left-hemispheric localization of foci of low density (24 observations, 47.1%), and in 17 patients (33.3%) it was predominantly in the right hemisphere; in 10 cases (19.6%), both the left and right hemispheres were equally often affected. Somewhat more often isolated cortical lesions were observed (26 observations, 51.0%) of the temporal, parietal, frontal and, less frequently, occipital lobes; in 21 patients (41.2%) combined cortical-subcortical lesions were detected.

Another significant tomographic phenomenon detected in atherosclerotic dementia is a diffuse decrease in brain density (encephalopathy). This sign was observed in 24 patients (39.3%) in the deep parts of the brain around the lateral ventricles and in the centra semiovale. In the majority of these cases (17 observations, 70.8%), this diffuse decrease in density was combined with cerebral infarctions.

In the majority of patients with atherosclerotic dementia, in addition, a uniform expansion of the cerebrospinal fluid spaces was often detected. It was noted in 53 patients (86.9%). Most often, the pathology of the cerebrospinal fluid spaces manifested itself as a simultaneous expansion of the subarachnoid spaces of the cerebral hemispheres and ventricles (37 observations, 69.8%). Isolated changes in the volume of the ventricular system and subarachnoid spaces were observed less frequently (16 cases, 30.2%).

Finally, in 23 patients (37.7%), tomograms revealed local asymmetric expansion of the subarachnoid spaces of the cerebral hemispheres - more often in the frontal and temporal lobes, less often in the parietal lobes. Local expansion of the ventricular system was manifested only by changes in the lateral ventricles.

Thus, the vast majority of patients with atherosclerotic dementia (52 observations, 85.3%) were characterized by a combination of various tomographic signs - changes in the density of brain matter and expansion of the cerebrospinal fluid spaces. However, at the same time, there are also cases (8 observations, 13.1%) with isolated changes in brain structures.

As for the specificity of morphological (tomographic) changes in different types of dementia, it should be noted that no separate morphological signs were found that would be typical for each type of dementia. However, a certain combination of them has been identified, preferable for each type of dementia.

The tomographic picture in the general organic type of dementia was characterized by a predominance of single and unilateral foci of low density affecting the left hemisphere in the temporal, parietal and occipital lobes of the brain. Local asymmetric dilatations of the ventricles and subarachnoid spaces of the brain were detected with approximately the same frequency.

In dementia of the torpid type, a predominance of multiple, bilateral foci of reduced density was noted. Such lesions were more often found on the left. A relatively higher frequency of damage to the subcortical areas was revealed, and from the cortical areas, mainly to the temporal and parietal lobes. A common finding was local asymmetry of the ventricular system of the brain.

The tomographic picture of the pseudoparalytic type of dementia was characterized by the dominance of multiple, bilateral foci localized in the cortex of the frontal lobe, less often in the temporal and occipital lobes. Local asymmetric expansion of the subarachnoid spaces of the cerebral hemispheres was also revealed. Thus, torpid and pseudoparalytic types of dementia were characterized by preferential localization of foci of low density in certain brain structures.

The tomogram of patients with the amnestic type of atherosclerotic dementia was characterized by the presence of multiple, bilateral foci of low density, localized predominantly on the right, in the cortex and subcortex of any lobe of the brain. Local asymmetric changes in the ventricular system were often detected.

As for clinical and tomographic relationships depending on the severity of dementia, correlations were established between the severity of dementia and the severity of pathological changes in the brain. When comparing dementia of 1st and 2nd severity according to tomographic signs, a significant increase in cases with foci of reduced density was revealed in more severe forms of dementia; there was a tendency towards an increase in the number of foci of low density, an increase in bilateral lesions of the cerebral hemispheres and a predominant localization of foci in the right hemisphere; simultaneous damage to cortical and subcortical structures; more frequent localization of lesions in the frontal lobes; to the predominance of diffuse changes in brain density.

A study of CT data depending on the variants of the course of cerebral atherosclerosis showed that, despite the difference in the types of course, the tomographic picture was generally identical.

Foci of low density were detected with approximately the same frequency (78.6%, 87.05%, 83.3%), regardless of the course of the disease. This indicated that even patients with a non-stroke type of the disease suffered cerebral circulatory disorders, which, however, did not manifest themselves as vascular episodes, i.e. were clinically “silent”, but led to focal and diffuse brain pathology. Thus, it was found that in the dynamics of cerebral atherosclerosis and the formation of atherosclerotic dementia in the vast majority of cases, the occurrence of cerebral infarctions is of decisive importance.

Particular attention in the study was paid to the study of tomographic signs reflecting some patterns and trends in the clinical manifestations of atherosclerotic dementia. Analysis of CT data in a comparative age aspect showed that at the age of 70 years and older there was a tendency towards an increase in cases of single, unilateral cerebral infarctions, more often localized on the left; at this age, diffuse changes in brain density were detected approximately 2 times less often. The data obtained indicate that the formation of dementia in adulthood occurs with multiple, more pronounced destructive changes in the brain. While at the age of 70 years and older, dementia develops even in the presence of single foci of low density.

Analysis of the relationship between CT data and the nature of the vascular process did not reveal significant differences between cases with and without arterial hypertension. The only exception was some

the predominance of diffuse changes in density in cases with arterial hypertension.

A special section of the work was devoted to the treatment of patients with atherosclerotic dementia. Since dementia of vascular origin, as a rule, develops against the background of generalized atherosclerosis with its inherent hemodynamic and somatoneurological disorders, treatment of such patients was carried out comprehensively in 3 main directions. First of all, a group of drugs was used that influenced the pathogenetic mechanisms of cerebrovascular disorders and manifestations of dementia (acute and transient cerebrovascular accidents, vascular crises, vasospasms, embolisms, etc.), i.e. so-called pathogenetic therapy. Along with it, complex therapy included the use of means aimed at compensating and preventing various somatoneurological complications developing in connection with general atherosclerosis and other diseases (general somatic therapy). Finally, drugs were used that influence productive psychotic disorders in patients with atherosclerotic dementia (syndromological therapy).

At the same time, treatment of patients with dementia of vascular origin is associated with a high risk of complications, especially in older age groups, which naturally required a careful approach to the selection of drugs, selection of doses, and determination of the duration of the course of therapy.

Analysis of the use of drugs made it possible to identify the main groups of drugs and identify from them those that are most effective for treating this group of patients. To influence cerebrovascular disorders and manifestations of dementia, the use of vasoactive and metabolic agents has proven to be most effective. Piracetam (1200) was often used

mg/day), aminalon (500 mg/day), cavinton (15 mg/day), trental (300 mg/day), cinnarizine (75 mg/day), etc. Average doses of drugs used , as a rule, were within the range of acceptable doses for middle-aged and elderly people. In most cases, the duration of therapy was up to 1 month. The group of drugs that have a general somatic effect included antihypertensives (adelfan, clonidine), coronary drugs (chimes, nitrong), analeptic drugs (sulfokamphocaine, cordiamine), glycosides (isolanide, digoxin), vitamins (group B), etc. Doses of these drugs and duration of therapy were determined individually and were within the limits recommended in the literature for people of late age. Various psychotropic drugs have been used to treat productive psychotic disorders. Therapeutic tactics in the treatment of these disorders were determined by the type of leading syndrome.

Treatment of psychoses of exogenous-organic structure was carried out mainly by a combination of cardiotonic drugs with tranquilizers (radedorm 5-10 mg/day, seduxen 10 mg/day). If the latter turned out to be ineffective, “mild” antipsychotics were used (chlorprothixene mg/day, propazine 50 mg/day). Heminevrin (mg at night) had a positive effect in conditions of atherosclerotic confusion.

The treatment tactics for psychoses, the clinical picture of which was determined by disorders of the endoform structure, were determined by the structural features of the syndromes. For the treatment of these psychoses, “mild” antipsychotics were used primarily (Teralen up to 10 mg/day, Sonapax 20 mg/day), which, in the absence of a positive effect, were replaced with stronger antipsychotics (etaperazine 5-8 mg/day. ). In the presence of depressive disorders with anxiety-hypochondriacal disorders in the structure of hallucinatory-delusional psychoses

disorders, small doses of antidepressants (amitriptyline 12.5 mg/day) in combination with antipsychotics (Sonapax 20 mg/day, Eglonil 100 mg/day) were used.

Treatment of psychoses of the most complex structure was carried out taking into account the syndromic features of exogenous-organic and endoform syndromes. Drugs with antipsychotic and sedative effects were used (propazinmg/day, teralen 12.5 mg/day). Sometimes strong antipsychotics were used in small doses (haloperidol 1-2 mg/day).

Thus, our experience in the treatment of productive psychotic disorders against the background of atherosclerotic dementia can be summarized as follows: I) The choice of a specific psychotropic drug must be made taking into account the spectrum of action and severity of the psychotropic activity of the drug, its individual tolerability, and also depending on the syndromic type and degree severity of psychotic disorder; 2) For the treatment of productive psychotic disorders, it is advisable to first use “mild” neuroleptics and thymoleptic drugs with mild psychotropic activity. Only if the latter are ineffective should stronger drugs be used; 3) It is advisable to combine the use of these drugs with the simultaneous administration of metabolic (nootropics), cardiovascular and “general strengthening drugs; 4) Treatment of productive psychotic disorders must be carried out with the minimum acceptable doses and short courses. The selection of optimal doses of drugs and the duration of treatment is based on individual tolerability of the drugs.

1. Based on a comprehensive clinical and tomographic study of 61 patients with atherosclerotic dementia, the effectiveness of this type of research for diagnosis, clinical and psychopathological systematics and the study of clinical and morphological relationships, including various parameters of atherosclerotic dementia was established: syndromic type, severity, course features cerebral atherosclerosis.

2. Atherosclerotic dementia is generally characterized by the following tomographic signs: a) a decrease in the density of the brain substance and b) an expansion of its cerebrospinal fluid spaces (subarachnoid spaces of the cerebral hemispheres and the cerebellum, and the ventricular system).

2.1. A decrease in the density of brain matter is the most pathognomic tomographic sign of atherosclerotic dementia. Most often it is presented in the form of foci of low density (indicating strokes), in most cases the foci are multiple and bilateral; less commonly, the decrease in density is presented as a diffuse decrease in brain density (indicating neurocirculatory encephalopathy), often in the area of ​​the lateral ventricles.

2.2. Expansion of the cerebrospinal fluid spaces of the brain is a common, but not specific sign of atherosclerotic dementia. In most patients, it is characterized by a uniform expansion of the subarachnoid spaces of the cerebral hemispheres and the ventricular system, less often by local asymmetric expansion of these structures.

2.3. Most cases of atherosclerotic dementia are characterized by simultaneous detection of foci on tomograms

reduced density and moderately pronounced symmetrical expansion of the subarachnoid spaces of the cerebral hemispheres and the ventricular system.

3. The main clinical parameters of atherosclerotic dementia, essential for comparison with tomographic data, are the syndromic type of dementia, its severity, age and type of course of the cerebral sclerotic process.

3.1. The main syndromic variants of atherosclerotic dementia, differing in tomographic characteristics, are general organic, torpid, pseudoparalytic and amnestic types. The tomographic picture in the general organic type is characterized by a predominance of single, unilateral foci of low density, localized in the temporal

and parietal lobes of the brain, as well as local asymmetric expansion of the subarachnoid spaces and ventricles; in the torpid type, multiple, often bilateral, predominantly on the left, lesions predominated with a relatively higher frequency of damage to subcortical structures. In the pseudoparalytic type of dementia, relatively frequent damage to the cortex of the frontal lobes of the brain was noted; Multiple, bilateral foci of low density dominated, predominantly on the left. The amnestic type of dementia is characterized by the presence of multiple, bilateral foci, localized predominantly on the left, in any lobe of the brain.

3.2. Clinical and tomographic comparisons, depending on the severity of dementia, showed that the more severe the dementia, the more frequent and significant the pathological changes in the brain (a significant increase in cases of cerebral infarctions in more severe forms of dementia, a tendency towards an increase in their number, towards bilateral

damage to the cortex and subcortex, more frequent presence of diffuse changes in brain density).

3.3. Clinical and tomographic comparisons of atherosclerotic dementia in a comparative age aspect revealed a tendency for the tomographic picture to depend on the age of the patients: in the age period, the tomographic picture of the brain is characterized by relatively less severe vascular destructive changes than in the age period of 70 years and older.

3.4. The type of course of cerebral atherosclerosis is not significant for the tomographic picture of the brain. Each of the identified types of the course of the disease - stroke, non-stroke and mixed - is characterized by similar pathological changes in the brain characteristic of atherosclerotic dementia in general, that is, both foci of reduced density and expansion of the cerebrospinal fluid spaces of the cerebral hemispheres were equally often found.

4. Thus, taking into account CT data of the brain, the development of atherosclerotic dementia is most often associated with the occurrence of cerebral infarctions; however, not all cases are multiple (70.6%). Therefore, the term “multi-infarct dementia” is not advisable to consider as replacing the completely traditional term “atherosclerotic dementia”.

5. For the treatment of patients with atherosclerotic dementia, an integrated approach is important, aimed both at normalizing and compensating for cerebrovascular insufficiency, psychoorganic disorders, and at relieving concomitant somatoneurological and psychotic disorders.

studies of recent years /. // Journal. neuropathol. and psychiatrist.. - T. 86, v.1. - S. (in collaboration with A.V. Medvedev).

2. Computed tomography of the brain in post-stroke atherosclerotic dementia // Neurohumoral mechanisms of aging: materials of the symposium. - Kyiv, 1986. - P. I40-I4I. (co-authored with A.V. Medvedev, S.B. Vavilov).

3. Atherosclerotic dementia (clinical tomography study) // Abstracts of the 2nd Congress of Neuropathologists, Psychiatrists and Neurosurgeons of Armenia. - (accepted for publication), (in collaboration with A.V. Medvedev, S.B. Vavilov).

4. Clinical and tomographic study of atherosclerotic dementia // Journal. neuropathol. and psychiatrist, (accepted for publication in * 12, 1987).

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Vascular dementia (atherosclerotic dementia) is a disorder of cognitive functions, which include memory, intelligence and attention, which develops as a result of damage to the blood vessels of the brain.

Pathology is always, to one degree or another, accompanied by a deterioration in a person’s adaptive capabilities to the social environment.

Who is susceptible

Atherosclerotic dementia is one of the most common pathologies, second only to dementia due to Alzheimer's disease.

Among all forms of acquired dementia, it accounts for 15-20%. The older a person is, the greater the likelihood of developing this disease.

Vascular dementia is more common in men, especially in the cohort of people under 65 years of age.

Types of disease, according to ICD-10:

• vascular dementia with acute onset;
• multi-infarction;
• subcortical;
• mixed (cortical and subcortical), as well as others.

Causes

The most common causes of vascular dementia are atherosclerosis and hyalinosis. Rare causes include inflammatory pathologies leading to vascular damage (rheumatism, syphilis), amyloidosis, and some genetically determined diseases.

Scientists have identified the most significant risk factors that can lead to symptoms of vascular dementia over time. If you detect them in time and try to eliminate them, the risk of cognitive impairment is significantly reduced.

Here is a list of these risk factors that can further lead to cognitive defect:

• high blood pressure (arterial hypertension) or low blood pressure (hypotension);
• smoking;
• elevated blood cholesterol levels (hypercholesterolemia);
• diabetes mellitus type 2 (most often it occurs in adulthood or old age);
• infections (rheumatism, syphilis);
• chronic heart disease (especially those that can lead to atrial fibrillation);
• genetic factors.

If the impact of these factors is not eliminated in a timely manner, then over time, vascular problems develop (atherosclerosis, thrombosis and even thromboembolism), leading to devastating brain damage caused by insufficient blood supply and the development of vascular dementia.

Symptoms of the disease

What symptoms are most often observed? This is general weakness, frequent headaches, dizziness and fainting caused by vascular dysfunction, insomnia, memory impairment, as well as personality disorders.

Diagnosis of vascular dementia is impossible without identifying “core” (sustained) and optional (psychological and behavioral) signs of the disorder.

The main symptoms of vascular dementia include:

• intellectual-mnestic disorders;
• speech disorders;
• problems with concentration;
• inability for purposeful activity and self-control;
• personality disorders.

Intellectual and memory disorders

Memory impairment is a persistent sign of vascular dementia. Characterized by both difficulties with remembering new information and problems with reproducing past events, their temporal sequence, and loss of acquired knowledge and skills. Early memories (about youth, childhood), as well as basic professional skills, are the last to be lost.

Intellectual impairment is characterized by a deterioration in the ability to analyze everyday events, identify the most important ones and predict their further development. People with such disorders adapt very poorly to new living conditions.

Attention disturbances are observed - patients have difficulty switching from one topic to another, the scope of attention is narrowed, patients are unable to simultaneously keep several objects in their field of vision, and can focus only on one thing.

Problems with memory and impaired concentration lead to the fact that patients have difficulty orienting themselves in time and location.

Speech disorders are manifested by the fact that it is difficult for a person to remember the first and last names of people, the names of objects; their speech slows down, becomes viscous, and poor in content.

Vascular dementia in older people can manifest itself as a violation of purposeful mental activity; the patients themselves are not able to plan their actions, it is difficult for them to start doing something on time, and they are practically incapable of self-control.

Personality and emotional changes

In most cases, vascular dementia is accompanied to varying degrees by pronounced emotional and volitional disorders and various kinds of personality changes, and symptoms characteristic of . The more pronounced the dementia, the more pronounced the personality disorders will manifest themselves.

Psychopathization can occur in different ways: some patients become self-centered, others become overly suspicious, and others become excessively anxious or excited. Personality and emotional disturbances characteristic of Alzheimer's disease may also be observed - gloomy and angry mood, emotional callousness, pathological stinginess. Some patients experience a smoothing of their character traits—emotional flattening and decreased activity come to the fore.

The disease does not always proceed linearly, with a gradual increase in symptoms and a deepening of existing signs of the disease. There may be a short-term improvement in a person’s condition or, conversely, a sharp deterioration (decompensation). Most often this is due to fluctuations in regional cerebral blood flow.

Optional symptoms

Optional signs develop in 70-80% of patients.

The most common of them are confusion, delusional disorders, depression, anxiety disorders combined with psychopathic behavior.

Forms of the disease

Depending on which symptoms dominate, several forms of vascular dementia are distinguished:

• amnestic dementia - its distinctive feature is a pronounced weakening of memory for current events with a slight deterioration in memories associated with past events;
• dysmnestic dementia - psychomotor reactions slow down, a slight deterioration in memory and intelligence occurs while maintaining criticism of one’s condition;
• pseudoparalytic - mildly expressed mnestic disturbances, accompanied by a complacent mood, decreased criticism of one’s condition and behavior.

Diagnostic criteria

The diagnosis of vascular dementia, according to ICD 10, is coded as F 01. It is made based on the following criteria:

• the presence of dementia as such must be confirmed;
• The patient has been diagnosed with vascular pathology of the brain;
• There is a relationship between the development of vascular pathology of the brain and the appearance of signs of acquired dementia:

1. dementia occurred within 3 months of stroke onset;
2. sudden or gradual deterioration in cognitive functioning (deterioration of memory, intelligence, etc.).

To confirm brain damage, an MRI or CT scan of the brain is necessary to detect signs of infarctions. If an MRI or CT does not confirm the presence of vascular pathology or lesions, then the diagnosis itself will be unlikely.

Stages

Taking into account the clinical picture of the disease, we can roughly distinguish the following stages of vascular dementia:

1. Initial - patients are concerned about the symptoms of a somatic disease, for example, hypertension. Dizziness, nausea, headaches, dependence of the physical state on weather conditions (meteotropicity), emotional instability, and rapid onset of fatigue may be observed. At this stage there are no cognitive impairments.
2. Actually, a stroke (infarction) of the brain - the symptoms of this stage will depend on which part of the brain is affected. Acute disturbances of consciousness are characteristic, followed by emotional instability.
3. The appearance of a defect in cognitive functions, which can occur suddenly (this is typical of acute vascular dementia), or gradually, stepwise.

Degrees of the disease

Taking into account how independent and active a person is, the following degrees of vascular dementia are distinguished:

• with a mild degree of the disease, despite a minor cognitive defect, patients remain critical of their condition, they maintain personal hygiene, and can live independently;
• with an average degree of the disease, patients can no longer live independently; due to a violation of intellectual-mnestic functions, such people are not able to perform all the necessary actions to maintain a normal standard of living, eat regularly, maintain personal hygiene, such patients need regular monitoring and adjustment of their actions by relatives or medical personnel;
• Severe degrees are characterized by pronounced impairment Everyday life patients, due to existing motor and cognitive impairments, such people require constant care and monitoring.

Forecast

Unfortunately, the prognosis for vascular dementia is not the best. Many patients require constant care and supervision. In addition, this category of patients often develops depression, which further worsens the course of the mental disorder.

Life expectancy with vascular dementia leaves much to be desired. This is due to the fact that the disease is a consequence of another very serious pathology - stroke.

The mortality rate of patients with post-stroke dementia during the first few years after a stroke reaches 20%.

For people who have had a stroke (or even several) and have a cognitive defect, disability with vascular dementia is indicated. Depending on what symptoms come to the fore, how pronounced they are, and also on how independent the person is (or, conversely, needs constant supervision and care), specialists from the medical and social expert commission will determine the degree of disability and his need for social protection.

Therapy for mental disorder

Treatment of vascular dementia must begin with treatment of the underlying vascular disease. Prescribe antihypertensive drugs (lower blood pressure), anticoagulants (thin the blood, thereby preventing the development of blood clots), angioprotectors (drugs that help restore the walls of blood vessels), and vasodilators.

To treat a cognitive defect, vitamins and nootropics (piracetam, lucetam) are prescribed, but careful selection of the dose of these drugs is necessary to avoid the development of steal syndrome, in which, although the cognitive defect decreases, new psychopathological disorders (delusional disorders, convulsive seizures) may appear.

In addition, drugs from the group of acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine), as well as memantine, can be prescribed. These drugs reduce the severity of behavioral disorders, and patients experience improvement in cognitive function.

Vascular dementia is a disease that requires a comprehensive approach. If you promptly maintain a healthy lifestyle, maintain physical activity, avoid harmful addictions, and generally monitor your health, then you can prevent the development of atherosclerotic dementia.

There are vascular diseases that affect not only the functioning of the heart, but also the brain activity of a person. One of the early manifestations of cerebral vascular damage is headache (cephalgia) and memory impairment, which most people perceive as quite ordinary symptoms.

If the pain is eliminated by citramone or analgin, many people take these pills for years without thinking about why the condition does not improve. Memory deterioration is attributed to age-related “sclerosis.” Following this, other, more frightening symptoms may arise that can lead to a person’s disability and completely exclude him from society. A cerebral vascular disease called cerebral atherosclerosis can lead to such consequences.

What kind of cerebrovascular disease is this?

Cerebral atherosclerosis is a cerebral vascular disease in which endocrine-biochemical processes and neuroregulatory mechanisms responsible for cerebral circulation (cerebral perfusion) are disrupted. “Atherosclerosis” in the name of the disease means narrowing or hardening of blood vessels, and the word “cerebral” reflects the location of the lesion - the vessels of the brain.

The disease is chronic and progressive.

When the blood supply to the brain deteriorates, the neurological functions of the body are disrupted and its mental processes are depleted. The result of such disorders can be intellectual-mnestic personality changes and even severe dementia.

What causes this disease, what provokes it? The mechanism of development of cerebral atherosclerosis is based on stenosis of the lumen of the cerebral arteries, due to which the nutrition of brain cells deteriorates and oxygen deficiency (ischemia) occurs.

The cause of stenosis, as a rule, is cholesterol plaques (atheromas) that arise in the intima (inner wall) of the vessel. Sclerotically compacted vessel walls become incapable of stretching, inelastic, and fragile. With a long-term course of stenosing atherosclerosis of the precerebral (located on the surface of the brain) arteries or acute vasospasm, occlusion may develop - complete closure of the lumen, due to which a focus of necrosis of brain tissue (necrosis) will form at the affected area.

ICD code

According to the International Classification of Diseases, 10th revision, cerebral atherosclerosis belongs to class IX “Diseases of the circulatory system” under heading I67 “Other cerebrovascular diseases”. Synonyms of this nosological group are:

• cerebral artery atheroma;
• sclerotic disorders of cerebral circulation;
• sclerosis of cerebral vessels and others.

The ICD-10 code for cerebral atherosclerosis and synonymous pathologies is I67.2.

Symptoms

Headache, often observed in the initial stages of cerebral atherosclerosis, is not a specific symptom of this disease. Cephalgia occurs with many other diseases that are not associated with vascular pathologies. The true signs of cerebral atherosclerosis are very specific. Lack of blood supply provokes variable disorders of the nervous system, which are not always accompanied by pain and vary depending on the stage of the disease.

Atherosclerosis of cerebral arteries

initial stage

It is difficult to diagnose the early stage of cerebral atherosclerosis of cerebral vessels. The gradual development and increase in the symptomatic picture leads to the fact that a person gets used to his condition and sees no reason to see a doctor. You need to be very attentive to your well-being to notice such disorders:

• deterioration in concentration, memory, and reading comprehension;
• the occurrence of strange reactions to certain sounds or tastes;
• disorder of the temperature perception mechanism - the appearance of a feeling of heat or chills in the absence of a real febrile condition;
• deterioration of fine motor skills of the hands (inability to perform work with small objects or with a clear and quick sequence of actions);
• dizziness, occasional deterioration in coordination of movements;
• weakness in the limbs;
• sleep disturbances (difficulty falling asleep, nightmares, frequent awakenings).

It is not uncommon for a person to become hard of hearing in one ear or go blind in one eye. The first transient (transient) ischemic attacks (TIA) appear.

Mental and cognitive disorders

With cerebral atherosclerosis of the 2nd degree (or stage), there is such a deterioration in the patient’s condition, which is more pronounced, this is:

• decreased intelligence;
• weakness (softness, lack of character), if it has not been observed previously;
• progress in the deterioration of RAM - events of the past are remembered more clearly than those that occurred the other day or a few minutes ago;
• further deterioration in concentration, patients do not grasp the meaning of what they read, are not able to remember it, or answer questions.

Against the background of mental disorders, a person becomes dependent on external circumstances, reacts sharply even to minor shocks and tends to invent non-existent problems. For example, he convinces himself that he is sick with some incurable somatic disease, suffers from a fear of dying from cardiac arrest and other mental disorders associated with cerebral atherosclerosis.

Dementia

The third stage of cerebral vascular atherosclerosis is the most unfavorable with regard to the risk of stroke. Its characteristic dementia (senile dementia, “senile dementia”, acquired dementia) is characterized by:

• persistent decrease in cognitive activity;
• loss of previously acquired skills;
• inability to acquire new knowledge;
• complete professional unsuitability of a person.

Obsessive states in patients with dementia sometimes acquire catastrophic proportions and threaten the safety of not only the patient himself, but also the people around him.

According to some data, the incidence of dementia has increased rapidly in recent years and amounts to about 7.7 million registered cases annually.

How to treat?

From the above description of cerebral atherosclerosis it is clear that this is a disease that is quite difficult to treat. The pathological processes occurring in the brain during cerebrovascular disease are mostly irreversible, especially in the later stages. It follows from this that treatment of cerebral (brain vessels) atherosclerosis should begin at early stage.

Treatment usually begins with correction of lifestyle and diet, since bad habits, low physical activity and excess weight are the main risk factors for the development of cerebral atherosclerosis.

The next step is drug therapy, including the use of:

• nootropic agents that increase the resistance of brain cells to aggressive influences and improve blood supply to the brain;
• medications that improve blood circulation and reduce blood viscosity (acetylsalicylic acid);
• medications to maintain blood pressure at a safe level;
• in some cases - sedatives and other psychotropic drugs to stabilize the psycho-emotional background;
• statins and other lipid-lowering drugs that lower blood cholesterol levels;
• vitamins that help regulate the functions of the central nervous system (mainly group B).

In certain situations, surgical treatment is used.

Effective measures to combat cerebral atherosclerosis are physiotherapy (BIMP - traveling pulsed magnetic field), ultraviolet irradiation - ultraviolet irradiation, which improves microcirculation and rheological properties of blood (fluidity), massage of the cervical-collar area, hyperbaric oxygenation procedure (oxygen saturation) and others.

Massage of the cervical-collar area is one of the methods of therapy

Is treatment with folk remedies effective?

It is undesirable to rely on treatment with folk remedies for such a serious disease as cerebral atherosclerosis. Traditional medicine only approves of those remedies that are actually useful for normalizing lipid metabolism and reducing “bad” cholesterol. These are food products, dishes from which are useful to include in the patient’s diet:

• green tea, juices (grape, citrus);
• vegetable oils, walnuts;
• seaweed and other seafood;
• green peas, garlic, onions, cucumbers, carrots, pumpkin, zucchini, melons, cabbage.

Herbal medicine includes infusions of lemon balm, strawberry leaves, and fibrous membranes of grapefruit.

Forecast

Without treatment of cerebral atherosclerosis, the prognosis is poor. Disability and asociality are the most common results of atherosclerotic changes in cerebral vessels. The risk of developing ischemic stroke is extremely high, often fatal. Post-stroke patients rarely return to their usual activities or profession.

With timely prescribed treatment, and most importantly, strict compliance with all instructions, the progress of the disease can be slowed down, and the prognosis improves.

Preventative measures to strengthen blood vessels

You can prevent a dangerous disease called cerebral atherosclerosis if you strengthen blood vessels from a young age. A healthy lifestyle in this case is the main measure to prevent the disease. That means:

• rational and balanced nutrition;
• drinking enough fluid (to improve blood rheology);
• sufficient, age-appropriate physical activity;
• performing special gymnastic exercises;
• constant memory training;
• useful interests, hobbies.

A calm lifestyle, maintaining good spirits, interest and a positive attitude towards others are also important factors in increasing stress resistance, strengthening the central nervous system and preventing vascular pathologies.

Conclusion

1. Cerebral atherosclerosis is a systemic disease caused by the formation of atherosclerotic plaques in the walls of blood vessels in the brain.
2. Depending on the degree of ischemic brain damage (stage), it can occur subclinically or manifest itself as a stroke, mental disorders, or dementia.
3. The main factor in prevention is maintaining a healthy lifestyle.

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