It is manifested by a progressive weakening of memory, a deterioration in the speed of thinking, pathologies of abstract thinking and speech, spatial orientation, imagination and other elements of the mental-will and mental sphere. The diagnosis is made on the basis of clinical research data and additional diagnostic methods (auscultation of the great vessels of the head, ophthalmoscopy, biochemical analysis of blood, duplex scanning, ultrasound dopplerography).
Causes of illness
By vascular dementia (in ICD-10 – F01.0 – F01.9) it is commonly understood as a decrease in mental and other higher functions of the nervous activity as a result of ischemic or hemorrhagic brain lesions. Such lesions occur in the pathology of the cerebral vessels or in diseases of the cardiovascular system. In each case, the basis of the disease is a pathology of the blood supply (insufficiency or excess), which develops as a result of:
- Ischemic strokes: as a result of atherosclerosis, in case of embolism of large vessels, in the defeat of small and medium-caliber vessels, “dumb” cerebral infarctions, which are not accompanied by signs of acute cerebral circulation disorders.
- Progressive chronic cerebrovascular disorders.
- Systematic minor intracerebral hemorrhages (hemorrhages) in patients with arterial hypertension; spontaneous hemorrhages in the subshell spaces.
- Cardioembolism with cardiac arrhythmias, after heart attacks, with endocarditis.
- Systemic and infectious inflammation of small vessels (vasculitis).
- Genetic diseases, accompanied by pathology of brain vessels.
There are also groups at risk of developing vascular dementia. It:
- age over 60 years;
- patients with hypotension or hypertension;
- persons with severe disorders of the lipid (fat) composition of the blood;
- cardiac pathology (ischemic heart disease – angina pectoris, ischemia attacks, arrhythmia, heart defects, heart attacks);
- low educational level (which implies a weak neural interconnection and low plasticity – the ability of the intact part of the brain to compensate for the functions of the modified areas).
The disease is based on damage to the gray and / or white matter of the brain as a result of metabolic disturbances in neurons (with chronic intoxication, moderate but persistent hypoxia), or due to their direct damage (bleeding, inflammation, acute oxygen starvation). The inability of neurons to perform their functions in certain areas of the brain leads to the “loss” of these sites from work (to varying degrees), which is manifested by certain symptoms, which together form the diagnosis of vascular dementia.
In old age, when neurodegenerative processes are formed (senile “atrophy” of the brain), the presence of vascular pathology aggravates them, accelerating the development of vascular dementia.
Vascular dementia is different from dementia that develops as a result of physiological age-related atrophy, the nature of the disorders of higher mental activity. In atrophic processes, mental and neurological symptoms appear gradually and are more of a natural look for the age, it does not lead a person out of the usual activities and society.
The clinical picture of dementia of the main vessels of the brain is diverse and depends primarily on the nature and localization of the vascular pathology of the brain, its volume, speed of development.
Post-stroke dementia usually develop acutely, for 3-6 months after a vascular catastrophe. The course is either linearly progressive (with the gradual intensification of the existing and the appearance of new symptoms), or stepwise with periods of stabilization (with the periodic formation of new symptoms against the background of those that appeared earlier and remained unchanged after the appearance). Sometimes there is a reverse development of symptoms with an almost complete restoration of functions.
Disorders of the cognitive sphere due to hidden asymptomatic strokes and heart attacks (for example, with hypertension, hypotension) are formed gradually, slowly deteriorating the quality of life of the patient. At the same time, the patient himself may note a violation of memorization, lability of the emotional sphere (mood changes, incomprehensible to the patient himself). Along with intellectual and mental deficiency, common brain and focal symptoms develop: dizziness, epileptic seizures.
Cognitive impairment can affect only certain areas of the mnestic sphere and be limited to them (for example, only memorization and reproduction of information worsens). And they can be combined with various focal neurological manifestations (impaired sense of smell, hearing, skin and other types of sensitivity, etc.). The latter usually occurs with multi-infarction (multifocal) lesions of brain tissue.
Among all the variety of clinical signs, one of the most frequent manifestations is a violation of the brain’s controlling functions – planning, controlling one’s own behavior and cognitive activity. Patients find it difficult to choose a goal, develop the necessary program to achieve it, are unable to dramatically change the nature of the activity, depending on the prevailing circumstances and motivations. As a result, cognitive activity becomes low-impact with full preservation of previously accumulated knowledge and skills. Characteristically, the cognitive activity worsens mainly due to the shortcomings of its organization.
Typical for vascular dementia are also disorders of motor functions without pathology of the musculoskeletal system, combined with impaired memorization and reproduction of information, including motor. Patients are unable to play team sports (they cannot catch the ball, other projectiles), draw or write. They have an uncertain gait, they can often stumble or fall, hardly remember what happened the day before. Knowing the answer to the question asked, they find it difficult to answer it (if you ask leading questions or give hints, you can get the answer). Difficulties with self dressing, eating are observed. There is no sense of direction.
With an exclusively vascular nature of cognitive impairment, the memory remains relatively preserved, except in cases where an acute violation of cerebral circulation affects the areas of the brain that are directly responsible for remembering the new. Basically, there is a moderate degree of lack of reproduction – the patient at the right time can not extract the necessary information from the memory.
The “pure” vascular origin of dementia is observed mainly at a young age (up to 35 years old) after suffering strokes, head injuries, and brain oncology.
Vascular dementia proceeds in three stages. Each has its own characteristics.
The patient himself or his relatives (more often) notice a slight memory impairment, forgetfulness, confusion. There are difficulties in the selection of words during a conversation, in making decisions and handling money.
Mood fluctuates: apathy, sluggishness, anxiety and tendency to depression in everyday life combined with aggressiveness and irritability when interacting with people (or indifference).
Patients demonstrate forgetfulness with respect to names and events, may lose orientation outside housing and at home, have difficulty in communication (understanding and speaking). Self-service is impossible – the toilet, washing, dressing require outside help.
Cooking, purposeful exits to the community (shopping in the store, walking animals, taking out the trash, walking) become impossible, because the patient loses orientation and puts himself in danger. May cross the road in the wrong place, regardless of the presence of cars, etc. The first signs of dementia appear.
The patient is completely dependent on others. Unable to independently eat, carry out the toilet and relieve need, disoriented in space and time. He is not aware of what is happening around him, does not recognize relatives and the caregiver, and may lose the ability to move independently.
In most cases, the factors causing vascular dementia can be completely or partially eliminated (to varying degrees) with adequate therapy. This means that the disease can be prevented or delayed its development. The importance of early detection, recognition and treatment becomes clear. Particularly important is the ability and the desire of the doctor to distinguish the vascular origin of the disease from the age-related decline in cognitive efficiency.
Despite the fact that predominantly elderly people suffer from dementia, it cannot be considered as a condition normal for aging. Normal aging is accompanied by senile “forgetfulness”, deterioration of the recording and reproduction of recently obtained information, a decrease in the ability to concentrate.
Often the main cause of cognitive disorders in old age are hidden and obvious resentment, depression, fear. Identification and elimination (full or partial) of the causes of psychoemotional stress is enough to improve the indicators of mental functions. This should be the first stage in the treatment of dementia of any origin even before prescribing medications.
Therapy of cognitive disorders of vascular origin should begin with the correction of vascular factors, primarily the normalization of blood pressure indicators. For this purpose, lifestyle and diet correction (moderate exercise, elimination of stress, reduction of salt intake, etc.) is carried out.
Conservative treatment involves the use of antihypertensive agents (ACE blockers, beta-blockers, calcium channel antagonists, etc.). Anticholinesterase agents (Neuromidine, Cerebrolysin, Ceraxone), NMDA receptor blockers (Marketing, Neurontin), neuropeptides (Solcoseryl, Context). The scheme and duration of treatment is selected individually depending on the characteristics of a particular case.
Vascular dementia leads to social, everyday and professional maladjustment – the “loss” of a person from the social environment and interpersonal interaction. In the later stages of the disease makes a person incompetent, dependent on others, becoming not only the personal problem of the sick, but also an acute social issue.
In the long term, without treatment, the prognosis is unfavorable – the sick live from the beginning of the 2-3rd stage no more than 5-7 years.
Vascular dementia is a widespread condition in society, including due to the widespread “aging” of the population. It is possible to suspend the development of pathology with timely detection and timely treatment, which makes the awareness of doctors an important factor in the fight against the disease.