Dementia is atherosclerotic, senile. Atherosclerotic dementia (clinical tomographic study) Atherosclerotic dementia

In some cases, dementia develops from multiple causes. A classic example of such a pathology is senile (senile) mixed dementia.

Functional and anatomical types of dementia

1. Cortical dementia is a predominant lesion of the cerebral cortex. This type is most typical for Alzheimer's disease, alcoholic dementia, and Pick's disease.

2. Subcortical dementia. With this type of pathology, the subcortical structures are primarily affected, which causes neurological symptoms. A typical example is Parkinson's disease with predominant damage to the neurons of the substantia nigra of the midbrain, and specific motor disorders: tremor, general muscle stiffness (“doll gait”, mask-like face, etc.).

3. Cortical-subcortical dementia is a mixed type of lesion, characteristic of pathology caused by vascular disorders.

4. Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system. Steadily progressing dementia is accompanied by severe and varied neurological symptoms.

Forms of dementia

Lacunarnaya

Total

Basic classification of presenile and senile dementias

1. Alzheimer's (atrophic) type of dementia, which is based on primary degenerative processes in nerve cells.

2. Vascular type of dementia, in which degeneration of the central nervous system develops secondarily, as a result of severe circulatory disorders in the vessels of the brain.

3. Mixed type, which is characterized by both mechanisms of disease development.

Clinical course and prognosis

Severity (stage) of dementia

Mild degree

Moderate degree

Severe dementia

Diagnostics

1. Signs of memory impairment - both long-term and short-term (subjective data from a survey of the patient and his relatives are supplemented by an objective study).

2. The presence of at least one of the following disorders characteristic of organic dementia:

• signs of decreased ability for abstract thinking (according to objective research);
• symptoms of decreased criticality of perception (discovered when making real plans for the next period of life in relation to oneself and others);
• triple A syndrome:

• aphasia – various types of disorders of already formed speech;
• apraxia (literally “inactivity”) – difficulties in performing purposeful actions while maintaining the ability to move;
• Agnosia – various disturbances of perception while maintaining consciousness and sensitivity. For example, the patient hears sounds, but does not understand the speech addressed to him (auditory-verbal agnosia), or ignores a part of the body (does not wash or put on one foot - somatoagnosia), or does not recognize certain objects or faces of people with intact vision (visual agnosia). and so on.;

3. Violation of social interactions in the family and at work.

4. Absence of manifestations of delirious changes in consciousness at the time of diagnosis (there are no signs of hallucinations, the patient is oriented in time, space and his own personality, as far as his condition allows).

5. A certain organic defect (results of special studies in the patient’s medical history).

Differential diagnosis of organic dementia

Concept of dementia in Alzheimer's disease

Risk factors for developing the disease

• age (the most dangerous limit is 80 years);
• the presence of relatives suffering from Alzheimer's disease (the risk increases many times if the relatives develop the pathology before the age of 65);
• hypertonic disease;
• atherosclerosis;
• diabetes;
• obesity;
• sedentary lifestyle;
• diseases occurring with chronic hypoxia (respiratory failure, severe anemia, etc.);
• traumatic brain injuries;
• low level of education;
• lack of active intellectual activity throughout life;
• female.

First signs

Characteristics of the advanced stage of progressive dementia of the Alzheimer's type

These signs are called senile (senile) personality restructuring. In the future, against their background, a very specific type of Alzheimer’s dementia may develop. delirium of damage: the patient accuses relatives and neighbors of constantly robbing him, wishing for his death, etc.

• sexual incontinence;
• gluttony with a special penchant for sweets;
• craving for vagrancy;
• fussy, disorderly activity (walking from corner to corner, shifting things, etc.).

At the stage of severe dementia, the delusional system disintegrates, and behavioral disorders disappear due to extreme weakness of mental activity. Patients plunge into complete apathy and do not experience hunger or thirst. Movement disorders soon develop, so that patients cannot walk or chew food normally. Death occurs from complications due to complete immobility, or from concomitant diseases.

Diagnosis of Alzheimer's type dementia

Treatment

• homeopathic remedy ginkgo biloba extract;
• nootropics (piracetam, cerebrolysin);
• drugs that improve blood circulation in the vessels of the brain (nicergoline);
• stimulator of dopamine receptors in the central nervous system (piribedil);
• phosphatidylcholine (part of acetylcholine, a neurotransmitter of the central nervous system, therefore improves the functioning of neurons in the cerebral cortex);
• actovegin (improves the utilization of oxygen and glucose by brain cells, and thereby increases their energy potential).

At the stage of advanced manifestations, drugs from the group of acetylcholinesterase inhibitors (donepezil, etc.) are prescribed. Clinical studies have shown that the use of this type of medication significantly improves the social adaptation of patients and reduces the burden on caregivers.

Forecast

Vascular dementia

Dementia due to cerebral vascular lesions

1. Hemorrhagic stroke (vascular rupture).

2. Ischemic stroke (blockage of a vessel with cessation or deterioration of blood circulation in a certain area).

What disease can cause vascular type dementia?

Risk factors

• hypertension, or symptomatic arterial hypertension;
• increased levels of lipids in blood plasma;
• systemic atherosclerosis;
• smoking;
• cardiac pathologies (coronary heart disease, arrhythmias, heart valve damage);
• sedentary lifestyle;
• overweight;
• diabetes;
• tendency to thrombosis;
• systemic vasculitis (vascular diseases).

Symptoms and course of senile vascular dementia

1. Pseudobulbar syndrome, which includes impaired articulation (dysarthria), changes in voice timbre (dysphonia), less often - impaired swallowing (dysphagia), forced laughter and crying.

2. Gait disturbances (shuffling, mincing gait, “skier’s gait”, etc.).

3. Decreased motor activity, so-called “vascular parkinsonism” (poor facial expressions and gestures, slowness of movements).

Treatment

Senile dementia with Lewy bodies

• orthostatic hypotension (a sharp decrease in blood pressure when moving from a horizontal to a vertical position);
• fainting;
• arrhythmias;
• disruption of the digestive tract with a tendency to constipation;
• urinary retention, etc.

Treatment for senile dementia with Lewy bodies is similar to treatment for dementia of the Alzheimer's type.

Alcoholic dementia

Epileptic dementia

How to prevent dementia - video

Answers to the most popular questions about causes, symptoms and

Are dementia and dementia the same thing? How does dementia occur in children? What is the difference between childhood dementia and mental retardation?

Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?

What is mixed dementia? Does it always lead to disability? How to treat mixed dementia?

Treatment of mixed dementia is aimed at stabilizing the process, and therefore includes combating vascular disorders and mitigating the developed symptoms of dementia. Therapy, as a rule, is carried out with the same drugs and according to the same regimens as for vascular dementia.

Among my relatives there were patients with senile dementia. How likely am I to develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

1. Prevention and timely treatment of diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus).

2. Dosed physical activity.

3. Constantly engaged in intellectual activity (you can make crosswords, solve puzzles, etc.).

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How to prevent vascular dementia?

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%. 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.

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 to engage in 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 not able to simultaneously keep several objects in their field of vision, they 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.

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; symptoms characteristic of an organic personality disorder may be observed. The more pronounced the dementia, the more pronounced the personality disorders will manifest themselves.

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 hypochondria, and 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 after the onset of stroke;
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 and 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 correction of their actions by relatives or medical personnel;
• the severe degree is characterized by a pronounced disruption of the daily life of 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.

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.

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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 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 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. 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

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 cry 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 the large-scale death of its 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 increasing 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. Diseases associated with chronic hypoxia.

The symptoms of Alzheimer's type dementia are generally identical to those 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 is a self-developing pathology that belongs 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 for a lawyer, because a person who is potentially incompetent due to mental health cannot account for his actions and, therefore, should not consent to an examination, which should 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 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 can be problematic to distinguish them from the symptoms of other diseases and to distinguish them from many other age-related changes. 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. Salvation from cerebral vascular damage is a healthy lifestyle, proper nutrition, and ensuring that the brain functions well into 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, the sweetest and kindest person, has turned into an aggressive and angry person (she fights, throws her fists and wants 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.

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%. 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.

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 to engage in 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 not able to simultaneously keep several objects in their field of vision, they 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.

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; symptoms characteristic of an organic personality disorder may be observed. The more pronounced the dementia, the more pronounced the personality disorders will manifest themselves.

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 hypochondria, and 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 after the onset of stroke;
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 and 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 correction of their actions by relatives or medical personnel;
• the severe degree is characterized by a pronounced disruption of the daily life of 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.

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.

Stop! Dementia!

Man is a rational being, and in this he differs from animals. This determines his, if you like, human life. Exactly with the definition in the XYII century by Rene Descartes: “Cogito ergo sum.” Or, in Russian translation, “I think, therefore I exist.”

Our body is a shell for the brain, which is designed to provide the most favorable conditions for its functions, the most important of which is associated with the mind, thinking, and cognition. Cognitive, in other words, activity. How well it is able to implement its most important function depends on the state of the brain and its membrane.

Necessary conditions for effective cognitive activity

These conditions are obvious and follow from the well-known proverb, which means a healthy body and soul. The conditions do not require special discussion. They are achieved by a healthy lifestyle. The problem is, however, that a healthy lifestyle can only be achieved.

From chronic fatigue to emotional burnout

Life in the modern world is a marathon of psycho-emotional overload. And also problems with physical health, a series of infections, primarily viral ones, which are not recognized. Cytomegalovirus, herpetic, adenovirus... The result is chronic fatigue syndrome. Best case scenario. Because chronic unresolved distress leads to a more severe syndrome - emotional burnout. Whether you are overcome by oppressive fatigue, emotional devastation or oversaturation, it doesn’t matter. And also memory and attention disorders, anxiety depressive disorders, aggressive reactions, outbursts of anger, decreased professional achievements with severe feelings of loss of competence and success in one’s activities. If these are all modalities of the most important (cognitive) function, what do you think of this function? It's worth thinking about.

“No matter where you throw it,” there’s disease everywhere

More severe, progressive cognitive impairment occurs with diseases of the brain and the covering for the brain - our body. We are talking about somatic diseases, which are countless. The most important of them:

• atherosclerosis with damage to cerebral vessels;
• arterial hypertension, especially with disturbances in the daily periodicity of blood pressure (the so-called non dipper);
• cerebral stroke, again associated with atherosclerosis and arterial hypertension;
• diabetic antipathies.

• toxic and metabolic brain damage
• post-traumatic brain damage
• Alzheimer's disease
• Parkinson's disease
• chronic heart failure
• chronic liver failure
• chronic renal failure
• chronic endocrine insufficiency
• hearing impairment; visual impairment

These diseases are congenital and acquired

Congenital ones appear at an earlier age, and acquired ones - more often in adulthood. Accordingly, cognitive impairments arise earlier in the former, and later in the latter. Focusing on progressive vascular diseases of the brain, it is important to emphasize that the vast majority of them occur in the elderly and senile age. But this age also means a variety of other somatic diseases, a decrease in physical and social activity and simply, excuse my frankness, old age.

Most common cause of cognitive impairment

Vascular lesions of the brain are the most common cause of cognitive impairment, so it makes sense to dwell on them in more detail.

The following main clinical forms of vascular lesions are distinguished:

• Atherosclerotic encephalopathy.
• Subcortical arteriosclerotic encephalopathy.
• Multi-infarction condition.
• Mixed forms (combinations of the first and second, second and third).

Atherosclerotic encephalopathy

The reason follows from the name. Its morphological basis is predominantly superficial (granular atrophy of the cortex) foci of incomplete necrosis and small infarctions. Small and medium deep cortical-subcortical infarctions are possible. The clinical picture consists of a moderate decrease in cognitive functions, rarely reaching the level of dementia, with a predominance of moderately expressed focal disturbances of cortical functions (aphasia, alexia, agraphia, acalculia, apraxia, spatial agnosia).

Subcortical arteriosclerotic encephalopathy

This form of vascular encephalopathy is also called Binswanger disease, subacute arteriosclerotic Binswanger encephalopathy, chronic progressive subcortical encephalopathy, arteriosclerotic leukoencephalopathy.

In contrast to atherosclerotic encephalopathy, in 98% of cases its cause is long-term arterial hypertension with sharp fluctuations and disturbances in the daily periodicity of blood pressure in the absence of changes in the main arteries of the head. Other possible but rare causes are amyloid angiopathy and hereditary cerebral autosomal dominant angiopathy with subcortical infarcts and leukoencephalopathy, manifesting at a relatively young age.

The morphological basis is the defeat of small perforating arteries of the white matter with a diameter of up to 150 microns with hypertrophy, hyalinosis and sclerosis of the walls, with narrowing or complete closure of the lumen. There are signs of a combination of diffuse damage to the white matter (spongiosis, foci of incomplete necrosis, myelin disintegration, foci of encephalolysis) with small lacunar infarcts in the white matter, subcortical ganglia and pons.

The density of white matter decreases, especially around the anterior and, less commonly, posterior horns of the lateral ventricles - the phenomenon of "leukoaraosis". Multiple small post-infarction cysts are formed after lacunar (mostly clinically silent) infarctions in the white matter and subcortical nodes. Enlargement of the ventricles of the brain is also characteristic. The clinical picture is dominated by progressive cognitive impairment, impaired walking function and pelvic disorders. In the end, dementia and complete helplessness of the patient develop.

Multi-infarction condition

The cause of the multi-infarction condition, as well as subcortical arteriosclerotic encephalopathy, in most cases is arterial hypertension. Much less commonly, the cause is microembolization from thrombi of the left atrium (with atrial fibrillation) and disintegrating atherosclerotic plaques, as well as narrowing of the lumen of intracerebral arteries as a result of atherosclerotic stenosis, angiopathy and coagulopathy against the background of antiphospholipid syndrome, vasculitis, erythremia at a young age.

The morphological basis is multiple, predominantly lacunar, small infarctions with arteriosclerosis of vessels with a diameter of up to 500 microns in the white matter, subcortical nodes, internal capsule, and pons. The clinical picture is dominated by cognitive impairment, rarely reaching the level of dementia, pseudobulbar, subcortical, cerebellar syndromes, and transient paresis of the limbs. In subcortical arteriosclerotic encephalopathy, clinical symptoms develop gradually, and in a multi-infarction state, they develop stepwise, corresponding to microstrokes that unfold sequentially over time.

The importance of localization of vascular lesions

The clinical picture is determined not only by the form, but also by the localization of vascular lesions. One of the most striking it turns out to be with vertebrobasilar insufficiency. The causes of vertebrobasilar insufficiency include atherosclerotic stenosis, deformation, congenital hypoplasia of the vertebral arteries, their compression along the path in the bone canal, etc.

Characteristic signs of vertebrobasilar insufficiency:

• frequent paroxysmal dizziness, accompanied by nausea and sometimes vomiting;
• unsteadiness of gait;
• occipital headaches;
• hearing loss, tinnitus;
• decreased memory for current events;
• attacks of “foggy” vision, the appearance of “spots”, “zigzags” in the field of vision;
• sudden falls against the background of preserved consciousness (“drop attacks”).

In old age, the most common is cochleovestibular syndrome with dizziness, unsteadiness, hearing loss, tinnitus and decreased memory for current events. We take note - any vascular lesions entail cognitive impairment.

If you experience these symptoms, we recommend making an appointment with your doctor. Timely consultation will prevent negative consequences for your health. Phone number for registration:

To... "nearby"

It is impossible to embrace the immensity. Therefore, in order to better understand the essence of brain dysfunction in the whole variety of somatic diseases, we will focus our attention on cerebrovascular insufficiency (dyscirculatory, vascular encephalopathy, angioencephalopathy).

At its core, as can be seen from the definition, is a progressive deterioration in the blood supply to the brain. Clinical symptoms of cerebrovascular insufficiency look like this:

• increase in cognitive impairment: decrease in memory, attention, intelligence with outcome in dementia;
• emotional impoverishment, loss of interest in life and narrowing of interests;
• static disturbances, destabilization of tempo, rhythm and coordination of movements, increased tendency to fall;
• development of a shuffling, mincing gait with small steps, up to the loss of the ability to walk;
• subcortical parkinson-like syndrome, in some cases with slowness of movements, poor facial expressions and a slight increase in tone of the extrapyramidal type;
• pseudobulbar disorders of varying severity with dysarthria, dysphagia, violent laughter and crying, positive symptoms of oral automatism;
• sometimes mild and moderate paresis of the limbs;
• gradual development of disorders of control over the function of the pelvic organs;
• social maladaptation, narrowing of the circle of interests and spontaneity in old age.

It is based on cognitive impairment that cerebrovascular insufficiency is divided into the following three stages or degrees of severity:

• decreased working memory, increased mental fatigue, frequent headaches, irritability, moderate disturbances of mnestic activity, decreased performance while maintaining social and everyday activity;
• worsening memory impairment with a decrease in attention and performance, an increase in intellectual and emotional disorders, the possible appearance of mild subcortical and pseudo-subcortical disorders, gait disturbances;
• dementia of varying degrees with social maladaptation and personality degradation, pseudo-bulbar and subcortical disorders, gait disorders, pelvic disorders.

Did you notice?! In cerebrovascular insufficiency, cognitive impairment is the “head of everything.” And yet, dementia is just a stone’s throw away.

Dementia as it is

Dementia (translated as feeble-mindedness) is understood as severe impairment of cognitive functions with a sharp decrease in memory, intelligence and the ability to abstract thinking, emotional impoverishment, personal degradation, reduction or collapse of professional, social and everyday activities. Dementia can be global or focal.

Global dementia is a disorder of all types of mental activity with loss of criticality and personality degradation. Focal dementia - preservation of personality and criticality, but a decrease in intellectual abilities and memory.

Main signs of dementia:

impairment of short-term and long-term memory;

presence of at least one of the following signs:

• violation of abstract thinking - inability to find similarities and differences between similar words, difficulties in defining words, concepts, misunderstanding of the meaning of proverbs and sayings, inability to solve simple semantic and arithmetic problems, etc.;
• violation of higher cortical functions - aphasia, apraxia, agnosia, constructive-spatial apraktoagnosia;
• impaired judgment - inability to make a purposeful plan, contact with other people, family;
• personal changes - change or sharpening of premorbid traits, neglect of appearance, apathy, narrowing of interests;
• difficulty in normal social life and inability to work.

Levels of dementia and social activity:

• easy - maintaining the ability to live independently;
• moderate - some degree of care required;
• severe - the patient is completely helpless in everyday life.

Important note: dementia is diagnosed only when there is a combination of intellectual-mnestic disorders and signs of decline or collapse in professional, social and everyday activities. Take note, dementia is not all lost. Especially when we diagnose it in a timely manner. Simply because “he who diagnoses cures.”

Vascular and atrophic dementia

Brain lesions, it was agreed, may have a vascular origin, or may be associated with a pathological process in the brain itself, as, for example, in Alzheimer's disease. Therefore, the entire variety of lesions, which often intersect in everyday life, are conventionally classified into vascular and atrophic. As if vascular lesions do not lead to atrophic changes in the brain. In accordance with this, dementia is also classified into vascular and atrophic. Differentiation is carried out using the Khachinsky scale.

To do this, the patient is determined for signs of dementia and the total number of points is calculated in accordance with the scale. The criterion for atrophic dementia is the sum of points does not exceed 4, vascular - more than 7. The scale is a scale, but vascular dementia, like atrophic dementia, must also be confirmed by computer x-ray (CT) or magnetic resonance imaging (MRI).

The scourge of the elderly

Dementia is the scourge of the elderly. After 55 years, its incidence reaches 8%, and after 80 years - already 45%. The main causes of it at this age: Alzheimer's disease, dementia with Lewy bodies, vascular dementia. I would like to note on my own behalf that even if Alzheimer’s disease and dementia with Lewy bodies are present, it must be against the background of atherosclerotic encephalopathy. Simply because by this age, atherosclerosis cannot be avoided, for sure, by no one.

Alzheimer's disease is based on the accumulation of insoluble pathological amyloid in the brain parenchyma and perivascular spaces with a neurotoxic effect, the final result of which is the death of brain neurons. The most pronounced degenerative changes are determined in the mediobasal regions of the frontal lobes, the hippocampus, and the association zones of the temporal and parietal lobes of the brain. Dementia with Lewy bodies is genetically, neurochemically and pathomorphologically almost Alzheimer's disease. It is distinguished only by the presence of symptoms of parkinsonism and the early development of neuropsychiatric disorders with repeated visual hallucinations. Diagnosis of Alzheimer's disease and dementia with Lewy bodies, as well as vascular encephalopathies, is based on confirmation of dementia with verification by tomographic methods of the absence of signs of focal brain damage.

Caring for people with dementia is associated with significant financial costs. It places a heavy social, economic and emotional burden on both the patient and society. And the earlier it is diagnosed and more effectively treated, the less this burden.

Treat the patient, not the disease

This advice was given to us by the father of medicine, Hippocrates, so we don’t do anything differently. In recommendations to the patient and medical interventions, the first ones are always measures to harmonize lifestyle with a possible increase in physical activity, planning work and rest, giving up bad habits, and a diet balanced in terms of quality and caloric content of food products. In particular, with regard to restrictions on table salt, refined carbohydrates and animal fats. An important place belongs to sanatorium-resort treatment. Statins are recommended for patients with atherosclerosis. For arterial hypertension, angiotensin-converting enzyme inhibitors, beta-adrenergic receptor blockers, retard forms of calcium channel blockers, diuretics, and other drugs are prescribed. In case of atherosclerosis, it is important to achieve the recommended levels of blood lipids, and in case of arterial hypertension, normal blood pressure numbers with the restoration of its daily frequency. At a high risk of thromboembolic complications (atrial fibrillation, etc.), acetylsalicylic acid, thienopyridines, low molecular weight dextrans and anticoagulants are used.

For vascular encephalopathy and Alzheimer's disease, this therapy is supplemented with antioxidants, choline alphascerate - a donor for the biosynthesis of acetylcholine in the presynaptic membranes of cholinergic neurons involved in cognitive functions, analogues of the ACTH fragment without hormonal properties, but with a neuroprotective effect, and other drugs that improve cerebral circulation.

If vascular disorders are based on anatomical causes associated with atherosclerotic plaque, stenosis, or other formations, surgical interventions are recommended. However, medical interventions are not limited to this. Because the most important thing is not said - the indispensable need, if not restoration, then improvement of the cognitive functions of the brain. Whenever cognitive impairment is diagnosed, nootropic drugs (nootropics) are used. Nootropics increase the energy metabolism of the brain, have neurotrophic, neuroprotective and neurotransmitter effects, improve memory, attention and learning ability.

The multicomponent action of these drugs, which regulate many metabolic, neurotransmitter and other changes in the body, expands compensatory capabilities and increases the brain’s resistance to harmful influences. Recently, new generations of drugs with combined nootropic, vasoactive, polyneurotransmitter, neuroprotective, antioxidant and other positive effects have appeared on the pharmaceutical market. With their use, it is possible to achieve not only an improvement in cognitive functions, but also a significant increase in the duration and quality of life of patients.

These drugs are especially indicated for transient ischemic attacks, for prevention and in the recovery period after acute cerebrovascular accident, cerebral stroke, and in all cases of diabetic angioencephalopathy. They are used for toxic, post-traumatic, post-radiation, dysmetabolic and other forms of encephalopathies.

They are indicated for Parkinson's disease, all forms of dementia, migraine, vestibular disorders, hearing impairment of vascular origin, ischemic damage to the optic nerve, and many other similar conditions. They are used to correct mental retardation in children and to enhance mental activity in old age.

Such drugs with combined nootropic, vasoactive and other positive effects are used for urgent and planned inpatient and outpatient therapy in pediatric, adult and geriatric clinics. Equally, neurological, psychiatric and therapeutic. They, and this is important to remember, are excellent helpers for chronic fatigue syndromes and emotional burnout, in general in all cases of mental stress, when there is a need to improve memory, attention and concentration.

Most important function

The most important human function is cognitive. It is not for nothing that he is called Homo sapiens - a reasonable person. This function tends to be developed, maintained and, of course, restored in a timely manner or, at least, improved if it is not possible to restore completely. The only correct approach here is a systematic approach, in which drugs with nootropic, vasoactive, polyneurotransmitter, neuroprotective, and antioxidant effects are required. It is especially pleasant when the entire range of these effects can be achieved by taking one drug, and not a whole mountain of tablets. And not only in illness, but, when required, in health too.

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Vascular form of dementia

The term “dementia” in medicine defines a person’s dementia, memory loss, loss of practical skills and knowledge. Vessels are certainly involved in the pathogenetic mechanism of damage in various brain diseases. They are considered to be the “culprits” for disturbances in the functional state of neurons (the cells that make up the medulla).

Vascular dementia is one of the unfavorable progressive consequences and outcomes of diseases of the arteries and veins, which are responsible for supplying neurons with oxygen and nutrients, supporting the necessary metabolism and energy balance in them.

Differences from mental retardation

The diagnosis of “mental retardation or mental retardation” existing in psychiatry must be distinguished from the changes caused by vascular dementia. With oligophrenia, personality development is suspended under the influence of pathology, the mind of an adult remains at the stage of childhood, and intelligence never reaches the required level.

Most often, mental retardation does not progress, but appears as a result of a hereditary or acquired disease. In this case, the consequences of stroke and other vascular pathology do not play a significant role. Mental changes are detected in childhood.

Common signs may be:

• speech disorders;
• emotional disturbances;
• inappropriate behavior.

Causes

Most often, the vascular form of dementia occurs under the influence of acute or chronic ischemia of the cerebral cortex and some subcortical nuclei. Here, neurons responsible for human cognitive abilities, called cognitive functions in psychiatry, are affected.

Other areas can cause paralysis, paresis, vestibular disorders, loss of hearing or vision, respiratory and cardiac problems, but do not affect the intellect.

Neuron death occurs when:

• strokes and cerebral infarctions;
• insufficient blood supply to the brain as a result of chronic cardiac pathology, if the contractile capabilities of the heart sharply decrease;
• chronic ischemic arterial disease caused by the development of atherosclerosis, hypertension or hypotension.

The rate of development of vascular dementia is influenced by:

• chronic nicotine intoxication from smoking;
• elderly and senile age;
• alcohol abuse;
• previous head injuries;
• presence of diabetes mellitus;
• tumor diseases;
• systemic autoimmune vascular diseases;
• previous infectious vasculitis;
• hereditary predisposition.

The most common cause of dementia in young people is addictions. In psychiatry, this behavior is called addictive. A person experiences a pathological attraction to certain actions. This includes alcoholism and drug addiction. Trying to solve their problems in this way, people approach the state of dementia.

Video about what vascular dementia is and its causes:

These factors accelerate the loss of cognitive functions. But there are reasons that delay the development of dementia and allow you to maintain intelligence even in old age. These include:

• development of learning skills through continuous education, reading;
• presence of creative abilities and active continuation of work;
• physical support through exercise;
• diet with limited animal fats, but with a sufficient amount of liquid, vitamins from vegetables and fruits.

The greater mental ability of persons of the same age with higher education and constant training of the intellect by studying foreign languages ​​has been proven.

Solving crosswords is related to training thinking and memory

Scientists explain this phenomenon by the rational use of additional brain reserves.

What types of dementia exist and the location of the vascular form

In the vast majority of cases (up to 80%), dementia occurs in old age and is of a vascular nature. Since the main factor damaging the arteries is lipoid plaques, this type is regarded as atherosclerotic dementia. In fact, it has the same ischemic mechanism of origin. Another name is senile insanity.

Depending on the clinic, there are 3 types of dementia.

Mild - implies professional degradation, decreased social activity. Patients experience:

• loss of attention to family and friends;
• loss of the need to communicate;
• decreased interest in new information, external living conditions;
• giving up a hobby.

At the same time, self-care skills are preserved, behavior within one’s home environment remains adequate.

Moderate - patients lose the ability to use simple household appliances (gas stove, telephone, remote control, door lock). Such a person requires constant monitoring. He can do his homework only with the help of others. Skills in personal hygiene and self-care remain.

Severe - the patient does not understand his situation at all, responds inadequately to requests, and needs constant assistance with feeding, dressing, and hygiene procedures.

Depending on the predominant location of the lesion in the brain structure, the following forms are distinguished:

• cortical - the pathological focus is localized in the cortical centers of the brain, examples are lobar degeneration (or frontotemporal), dementia in alcoholic encephalopathy, Alzheimer's disease;
• subcortical - subcortical structures are affected, this type includes dementia with multiple foci of infarction in the white matter, progressive paralysis with supranuclear localization, parkinsonism;
• cortical-subcortical (mixed) - includes different levels of vascular lesions, cortical-basal degeneration;
• multifocal - characterized by multiple centers of pathology.

Hippocampus - a structure responsible for memory

What anatomical changes in the brain are found in dementia

According to the pathogenetic mechanism of development, 3 types of vascular dementia are distinguished:

• microangiopathic - the main factors affecting cerebral vessels in hypertension, angiopathy;
• macroangiopathic - characterized by vascular thrombosis, severe atherosclerosis, embolism with gradual narrowing of the channel, the development of stroke;
• mixed - violations are of a varied, unsystematic type.

The anatomical substrate of dementia is:

• medullary infarctions;
• ischemic and hemorrhagic strokes;
• hemorrhages under the dura (subdural);
• formation of lacunae.

Depending on the size of the lesion, swelling of the surrounding tissues occurs, compression of nearby nerve centers, changes in the structure of the brain (hemispheres, brain stem, ventricles), and obstruction of the outflow of cerebrospinal fluid.

In the neurons of the affected area, metabolism is disrupted and energy synthesis stops. As under-oxidized substances accumulate, irreversible conditions are created. Brain cells die. The cortical centers are the most sensitive. The state of the psyche depends on them.

Initial manifestations of dementia

Before manifestations of mental disability, the patient’s psyche goes through the stages of atherosclerotic neurasthenia and encephalopathy. Signs of neurasthenia accumulate over the years. Most common symptoms:

Patients remain critical of themselves and their well-being. More and more people are thinking about health.

Some people experience severe apathy, depression, leading to cases of suicide

Characterized by hypertrophy of personality traits. If previously a person was prone to boasting or enthusiasm, now internal inhibition ceases to restrain his impulses. He may cry in the wrong place, or “explode” due to previously unnoticed circumstances.

At the same time, forgetfulness of names, surnames, dates, and numbers appears. At the same time, the human intellect does not suffer.

Atherosclerotic neurasthenia often occurs in two forms:

• hypochondriacal - an obsessive fear for one’s health (phobia), fear of stroke, heart attack, and cancer develops;
• hysterical - accompanied by violent emotional reactions in front of the “spectators”.

The next stage of development of vascular dementia is considered to be atherosclerotic encephalopathy. Psychiatrists distinguish 2 forms:

• with predominant damage to the subcortical centers - expressed by symptoms of parkinsonism, tremors of the hands, head, intelligence is completely preserved;
• partial dementia syndrome - accompanies strokes and is accompanied by a decrease in intelligence.

It can be difficult for clinicians to determine the moment of transition from the neurasthenic stage to the encephalopathic stage

Signs of increasing mental changes are:

• loss of ability to concentrate;
• memory loss;
• disorders in the emotional sphere.

Previously calm and sociable people become intolerant at work and at home:

• are often rude;
• do not tolerate objections;
• insult others;
• suspiciousness and suspiciousness appears;
• attack children and family members with fists;
• They are cynical about other people's troubles.

Memory disorder is characterized by a loss of connection with recent events while well-preserved memories of the past.

A change in attention manifests itself in the inability to fully listen to the interlocutor. Patients either impolitely interrupt the narrator, or stop listening and talk about another topic. If it is necessary to delve into the problem, patients suddenly fall asleep.

Typical symptoms of the disease

Mental changes are regarded as symptoms of vascular dementia if, according to the anamnesis, the patient has suffered strokes or heart attacks, has been previously examined and there is chronic insufficiency of blood supply to the brain. Manifestations can be associated with the ischemic zone.

Damage to the midbrain is characterized by:

• disturbances of consciousness, hallucinations are possible;
• confused, unclear speech;
• drowsiness, isolation, apathy.

When the lesion is located in the hippocampus area, memory loss for recent events is observed.

When neurons in the frontal lobes die, a person becomes inadequate, becomes stuck on one action, and endlessly repeats a phrase he has heard.

Damage to the subcortical centers is characterized by:

• impaired ability to pay attention to conversations, activities, or thoughts;
• loss of the ability to count and plan events;
• lack of analytical activity, inability to evaluate incoming information.

Common symptoms of dementia include:

• altered gait (shuffling with small steps);
• impaired pelvic functions to retain urine and feces;
• seizures of epilepsy (previously classified as an atherosclerotic form of epilepsy) - usually caused by anxiety, intestinal fullness and overeating, and sexual excesses.

Individuals who have had a long history of alcoholism in the past may experience attacks of delirium with vivid hallucinations and delusional ideas.

In psychiatry, all symptoms are considered depending on the functions of the brain.

Cognitive impairments include:

• memory disorder - in addition to the nature already described, false memories are possible, facts are transferred by the patient to another time or are completely fictitious;
• attention disorder - manifested by the inability to switch from one issue to another.

Loss of higher cortical functions manifests itself in:

• aphasia - the patient cannot find the right words, combine them into a phrase to express his thoughts;
• apraxia - skills acquired throughout life (movements, everyday life) are lost;
• Agnosia - different types of disturbances of sensations, hearing, vision with preserved consciousness.

Disorientation is observed especially in the early stages of dementia. The patient can easily get lost in a previously familiar environment. Does not perceive the time spent.

A disorder of the thinking function is expressed in the absence of logic and the ability to abstract, the pace of thinking slows down sharply

A decrease in criticism towards oneself and the world around is accompanied by an invented subjective assessment of events.

Clinical manifestations of vascular dementia may periodically weaken. Partial recovery is facilitated by the development of collateral circulation due to auxiliary vessels.

Personality changes

At the stage of atherosclerotic encephalopathy, a person loses his former personal qualities. This manifests itself in:

• loss of the former sense of humor, aggressive behavior in response to a joke;
• the inability to explain to him the figurative meaning of the phrase;
• misunderstanding of related phrases (for example, “father’s brother” and “brother’s father”);
• lack of ability to critically assess the situation.

There may be cases of the formation of ridiculous paranoid theories, rationalization proposals, and inventions. Patients are prone to litigiousness and complaints to all authorities. One of the common forms of vascular dementia in men is delusions of jealousy, and in women - complaints of theft.

Worsening dementia can lead to the development of:

• pathological stinginess and laziness;
• pronounced conservatism;
• loss of a critical attitude towards oneself;
• violation of moral standards;
• uncleanliness;
• vagrancy;
• collecting trash.

Hypochondriacal atherosclerotic neurasthenia forces the patient to purchase and take many medications out of fear for his health

Total dementia syndrome

The term “total dementia” in psychiatry refers to gross forms of changes in the cognitive activity of the brain. These include:

• impaired abstract thinking;
• severely lost memory;
• complete loss of concentration;
• changes in the patient’s personality regarding compliance with moral standards (bashfulness, sense of duty, politeness disappear).

This form of dementia is more characterized by vascular and atrophic changes in the nuclei in the frontal lobes of the brain.

Diagnostics

To make a diagnosis, a psychiatrist conducts an interview with the patient to determine the lost functions of brain structures. More objective methods are developed special tests-questionnaires, which make it possible to study mental disorders using scoring responses.

To confirm the vascular mechanism of dementia, the following are prescribed:

• magnetic resonance and computed tomography of the head;
• Doppler examination of the vessels of the neck and brain.

Treatment and prevention

Considering the vascular origin of mental disorders, in atherosclerotic dementia the main direction of therapy is considered to be the maximum possible improvement of blood circulation in the brain.

Symptoms of dementia are subject to symptomatic correction.

Treatment for vascular dementia includes:

• a diet with mandatory avoidance of spicy and fatty foods, consumption of dairy products, cooked meat, vegetables and fruits;
• feasible physical exercises for arms and legs;
• vasodilators of the ACE inhibitor class;
• monitoring blood pressure and periodically taking diuretics is necessary to prevent hypertensive crises;
• thrombolytics such as TromboAssa, Cardiomagnyl, Aspirin group;
• you can independently take light sedatives in the form of herbal tinctures of valerian, motherwort, the drug Novopassit includes a useful combination of plants;
• stronger sedatives and anticonvulsants are prescribed only by a psychiatrist, the dosage and duration of use are agreed upon in advance;
• a group of nootropics (Cerebrolysin, Mexidol, Cortex, Piracetam, Nootropil) is used to support brain cells and provide them with additional energy.

Walking in the fresh air and sleeping in a ventilated room helps improve the patient's condition. Daily water procedures (showers, baths, rubbing) activate brain activity.

At the initial stage of atherosclerotic neurasthenia, psychotherapy has a good result. It is important for the doctor to be careful in his statements. The patient needs to be convinced that his fears are groundless and told about the reasons for his poor health. Patients in the stage of encephalopathy should be kept from strong excitement and overexertion.

Prevention of dementia begins immediately after strokes. Hospitalization of a patient in a rehabilitation department or referral to a sanatorium allows you to select the most appropriate options and give specific recommendations to relatives.

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 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 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. 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

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 cry 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 the large-scale death of its 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 increasing 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. Diseases associated with chronic hypoxia.

The symptoms of Alzheimer's type dementia are generally identical to those 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 is a self-developing pathology that belongs 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 for a lawyer, because a person who is potentially incompetent due to mental health cannot account for his actions and, therefore, should not consent to an examination, which should 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 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 can be problematic to distinguish them from the symptoms of other diseases and to distinguish them from many other age-related changes. 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. Salvation from cerebral vascular damage is a healthy lifestyle, proper nutrition, and ensuring that the brain functions well into 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, the sweetest and kindest person, has turned into an aggressive and angry person (she fights, throws her fists and wants 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.

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

As a manuscript UDC 616.895.8-093

SUKIASYAN Samvel Grantovich

ATHEROSCLEROTIC DEMENTIA (CLINICAL TOMOGRAPHIC STUDY)

Moscow-1987

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)

SCIENTIFIC ADVISER -

Doctor of Medical Sciences V.A. Kontsevoy

SCIENTIFIC CONSULTANT -

Doctor of Medical Sciences S.B. Vavilov

OFFICIAL OPPOINTERS:

Doctor of Medical Sciences S.I. Gavrilova
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

Scientific Secretary
specialized council
Candidate of Medical Sciences T.M. Loseva

GENERAL DESCRIPTION OF WORK

Relevance of the work.

The study of cerebral atherosclerosis and atherosclerotic dementia, despite the numerous studies conducted, remains one of the most relevant in gerontopsychiatry today. The central aspects of this problem, which determined its development, were clinical, psychopathological and morphological approaches to its study.
In recent 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 increasing interest in the problem of atherosclerotic dementia is also due to the development and introduction into medical practice of 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 studies focused on the tomographic characteristics of dementia, while its clinical aspects were not sufficiently taken into account.
Finally, the importance of studying atherosclerotic dementia is dictated by the new therapeutic possibilities that have emerged in recent years in the treatment and prevention of vascular diseases of the brain and strokes (vascular drugs with predominantly cerebral action, nootropic drugs, etc.).
Thus, the problem of atherosclerotic dementia is currently acquiring great relevance both in theoretical and practical terms.

Purpose of the study.

The purpose of this work is to establish clinical and morphological (tomographic) relationships in cerebral atherosclerosis, which occurs with the formation of dementia; assessment of their significance for understanding the pathogenesis of atherosclerotic dementia and its diagnosis; development of principles of differentiated therapy.

Research objectives.

In accordance with the stated purpose of the work, the following tasks were set:
I. Development of a clinical-psychopathological taxonomy of atherosclerotic dementia, adequate for establishing clinical-morphological relationships.
2. Study of the clinical dynamics of cerebral atherosclerosis, which occurs 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.

Scientific novelty of the work.

For the first time in Russian psychiatry, a clinical and psychopathological study of atherosclerotic dementia was carried out with the simultaneous use of the CT method. A taxonomy of atherosclerotic dementia has been developed, highlighting its clinical and psychopathological types, taking into account brain CT data. Tomographic signs of morphological changes in the brain characteristic of atherosclerotic dementia are described. Sets of such signs that are preferable for various types of dementia have been identified.

Practical significance of the work.

Tomographic changes in the brain in atherosclerotic dementia, which are essential for its nosological diagnosis, have been identified. The principles of differentiated pharmacotherapy for atherosclerotic dementia in late age have been developed. The work was implemented in IND No. 10 of the Proletarsky district of Moscow.

Publication of research results.

Based on the research materials, 4 works have been published, a list of which is given at the end of the abstract. The results of the study were reported at the symposium “Gemineurin - clinical, pharmacokinetic aspects and mechanisms of action” (1985) and at the conference of the Scientific Research Institute of Clinical Psychiatry of the All-Russian Research Center of Clinical Psychiatry of the USSR Academy of Medical Sciences (1987).

Scope and structure of work.

The dissertation consists of an introduction, 5 chapters (Literature review; Research methods and general characteristics of clinical material; Clinical aspects of atherosclerotic dementia; Computed tomographic study of clinical material; Therapy of patients with atherosclerotic dementia), conclusions and conclusions. The literature index contains 220 bibliographic references (112 works by domestic and 108 works by foreign authors).

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 nature of the psychopathological manifestations of dementia, its structure and the depth of the disorders were studied using clinical and psychopathological methods. 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 of anatomical formations corresponding to the given planes of study”, 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 an expansion of the cerebrospinal fluid spaces of the brain, which are respectively 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. The average age was 66.85±1.3 years. 32 patients were aged 50-69 years and 29 were aged 70 years or older.
In 49 patients, cerebral atherosclerosis was combined with arterial hypertension. In the age group of 70 years and older, arterial hypertension was detected less frequently (18 observations, 62.1%, than in the age group 50-69 years (31 observations, 96.6%). Along with arterial hypertension, other types of hypertension were detected in 41 patients -matic pathology (chronic bronchitis, pneumosclerosis, diabetes mellitus, etc.) The frequency of somatic pathology increased with
increasing age of patients. At the age of 50-69 years it was 46.9%, and at the age of 70 years and older it was 89.7%. The neurological status of all patients revealed signs of chronic cerebrovascular insufficiency and residual effects of previous cerebral hemodynamic disorders.
In 49 patients, along with symptoms of dementia, psychotic disorders of exogenous-organic and endoform types were observed of varying degrees of severity.
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.

RESEARCH RESULTS

A clinical and psychopathological study of the characteristics of atherosclerotic dementia showed that in all patients, along with the disorders characteristic of organic dementia (intellectual-mnestic and emotional-volitional, etc.), signs specific to atherosclerotic dementia were also revealed. Three cardinal signs were identified that determine the nosological specificity of atherosclerotic dementia - asthenia, rigidity and fluctuations in the condition of patients.
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, systematics 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 a background of 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 the identified clinical types of dementia and the degree of severity largely reflects both general age patterns and the presence or absence of arterial hypertension.
The amnestic type of atherosclerotic dementia was significantly correlated with the later age of patients (70 years and older). It was more often formed in hypertensive forms of cerebral atherosclerosis. Meanwhile, the development of pseudoparalytic type of dementia was observed mainly at the age of 50-69 years in the presence of arterial hypertension. The torpid type of dementia, like the pseudoparalytic type, formed at the age of 50-69 years (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 the age of 50-69 years 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 at the age of 50-69 years 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), analeptics (sulfocamphocaine, 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 30-60 mg/day, propazine 50 mg/day). Heminevrin (300-600 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. ). If the structure of hallucinatory-delusional psychoses contains depressive disorders with anxiety-hypochondriacal
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 (propazine 25-75 mg/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 restorative” drugs; 4) Treatment of productive psychotic disorders must be carried out with minimally acceptable doses and short courses. The selection of optimal doses of drugs and the duration of the course of treatment is carried out based on individual tolerability of the drugs .
conclusions
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 of 50-69 years, 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 detected.
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.

LIST OF WORKS PUBLISHED ON THE TOPIC OF THE DISSERTATION

1. Computed tomography in psychiatry / Review of foreign
studies of recent years /. // Journal. neuropathol. and a psychiatrist. - 1986. - T. 86, v.1. - P. 132-135 (co-authored 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. (in collaboration 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).

Senile dementia in the elderly is often due to extracerebral causes. Atherosclerotic dementia develops in older people against the background of pathologies of the cardiovascular and other systems that are already present in them. The signs of this disease are characterized by a decrease in all mnestic functions - memory, attention, imagination and thinking. In severe cases, people with similar clinical symptoms become patients in psychiatric hospitals, because they are no longer able to care for themselves and pose a certain threat to others.

The disease progresses over many years. Therefore, it is unlikely that it will be possible to completely eliminate the symptoms. But it is possible to make life easier for the patient if the cause of dementia is determined in time.

Etiology and pathogenesis

The main etiological factor in the occurrence of dementia in older people is atherosclerosis. This term combines the process of accumulation in the bloodstream of triglycerides, cholesterol, low and very low density lipoproteins and other toxic metabolic molecules. When all these substances accumulate in the blood, they begin to penetrate through the damaged endothelium into the intima of large and small vessels. The arteries and veins of the brain are also susceptible to triglycerides, lipoprotein fractions and “bad” cholesterol. Therefore, these substances often clog the lumen of the cerebral vessels, thus blocking the inflow and outflow of blood saturated with oxygen or removing withdrawal products.

Signs of the disease

With atherosclerosis of cerebral vessels, the following clinical symptoms are observed:

• Memory impairment. The patient remembers current events worse, but remembers perfectly what happened to him in childhood. This indicates that with atherosclerotic changes in the choroid plexuses of the brain, short-term memory suffers predominantly.
• Attention regression. People with cholesterol plaques in the brain find it difficult to concentrate on any thought or activity. Their attention is scattered, they have difficulty switching from one thought to another.
• Thinking disorder. Patients with established atherosclerotic lesions often experience false memories and cunning conclusions that have no basis. It seems to them that everything around has a secret subtext. Sometimes such patients begin to be haunted by paranoid phobias.
• Dizziness. This symptom often accompanies mnestic disorders. It appears when atherosclerotic plaques grow in the vascular walls of the vestibular apparatus.
• Noise or ringing in the ears. Symptoms make themselves felt when cholesterol accumulations appear and progress under the endothelium of the arteries and veins of the middle ear.
• Flickering of flies before the eyes or the appearance of luminous artifacts in the field of vision.

Types of dysfunction

Atherosclerotic lesions of the choroid plexuses of the brain are divided as follows:

• According to the localization of the outbreak.
  • Cortical. Atherosclerotic lesions are concentrated in the gray matter of the brain.
  • Subcortical. With this type of cholesterol metabolism disorder, plaques appear in the vessels of the white matter.
  • Mixed or cortical-subcortical.
  • . With it, multiple foci of atherosclerotic lesions form in the brain.
• According to syndromic manifestations.
  • Lacunarnaya. With it, memory suffers more. The remaining mnestic functions remain relatively intact.
  • Total. This is the most severe form of dementia, in which memory, thinking and attention are irreversibly impaired.

Diagnosis of the disorder

In order to make a diagnosis of atherosclerotic dementia, a number of psychological tests, neurological tests, laboratory and instrumental tests are performed:

• Ophthalmological examination. It is performed using ophthalmoscopy. The patient is examined for the condition of the fundus of the eye to identify edematous changes or atherosclerotic inclusions.
• Psychological tests to determine levels of attention, memory and thinking. The classic thing is to draw a clock with hands on certain numbers. Patients with severe vascular lesions often not only falsely indicate the time, but also have difficulty depicting the clock instruments themselves.
• Blood chemistry. With its help, the level of low and very low density lipoproteins, triglycerides and cholesterol is determined in the bloodstream. In parallel, liver transaminases are examined.
• Dopplerography of the vessels of the neck and head. This is an ultrasound vascular examination that allows you to determine the location and degree of occlusion of arteries or veins. If there are characteristic symptoms, Doppler sonography is performed on other parts of the body.
• CT and MRI. These high-precision techniques make it possible to exclude a possible diagnosis of cancer in order to clarify treatment. If the tumor is confirmed, the patient is transferred to another department.