Symptoms of vascular dementia. Dementia (dementia): causes, how it develops, types, manifestations, diagnosis, treatment Atherosclerotic dementia signs

Psychotic changes in mental activity in cerebral atherosclerosis can be expressed by the following syndromes. Impaired consciousness is quite common. They can be caused by sudden or acute decompensation of the blood supply to the brain or a severe infectious disease, acute somatic pathology, intoxication and traumatic factors. The most typical sign of impaired consciousness is a stunned state of varying severity. Stunning develops, as a rule, with a severe disruption of cerebral blood supply. Patients are poorly oriented in place, time, look absent-minded, drowsy, indifferent to their surroundings, answer questions even about their own age, number of children, place of residence with great difficulty, slowly, after a long pause or completely incorrectly, move, speak, and think inhibited , they cannot perform the simplest arithmetic tasks; upon exiting the painful state, they remember only individual moments of the period of upset consciousness. A mild degree of stupor, such as obnubilization, is often observed. In this case, patients outwardly behave correctly, answer simple questions adequately, but upon careful examination it turns out that their mental processes are slowed down, their mental abilities are reduced, that they have difficulty assessing certain situations, especially complex ones, and cannot concentrate pay attention to something, notice their inadequacy, complain about heaviness in their head. If cerebral atherosclerosis is accompanied by the development of a stroke, a sudden deep clouding of consciousness occurs, stupor occurs, and then coma, and then the patients, along with complete disorientation, may experience speech and motor agitation, anxiety, fear, and a convulsive state. Sometimes, under the influence of various exogenous factors (infections, intoxication, mental trauma, overheating due to exposure to sunlight or excessive physical therapy), other types of consciousness disorders may develop. The twilight state of consciousness occurs paroxysmally and is characterized by complete disorientation, anxiety, and fear. The patients are excited, their speech is incoherent. Delirious syndrome also manifests itself as disorientation in place and time, anxiety, restlessness, and fear. However, with it, visual hallucinations are less vivid than with delirium delirium, and reflect the home situation. The disturbance of consciousness in this case lasts from several hours to 1-2 weeks. When the process progresses well, patients emerge from a state of disturbed consciousness, usually after a critical sleep. They experience complete or partial amnesia of their experiences. In general, the course of syndromes of impaired consciousness depends on the degree of compensation for impaired functions from the cardiovascular system. In some cases, gradual recovery is observed, in others, especially with a stroke, usually accompanied by neurological disorders (paralysis, agnosia, aphasia, apraxia), postapoplexy dementia develops. Against the background of impaired consciousness, paranoid states may develop. Sometimes they serve as harbingers of a disorder of consciousness or appear in the process of its reverse development. Patients most often express delusional ideas of relationships, persecution, poisoning, physical influence, declaring that they have been bewitched, poisoned, want to kill, that they are being laughed at, whispered behind their back. In some cases, ideas of self-accusation, sinfulness, and hypochondriacal statements occur. Often acute delusional states are accompanied by auditory hallucinations (in the form of knocking, screaming, rustling, voices), which appear sporadically and are often imperative in nature. Sometimes visual and olfactory hallucinations occur. Paranoid states last from several days to 2-3 months. Sometimes they take a protracted course. Severe depressive and depressive-paranoid disorders are somewhat less common. At the same time, mental disorders often develop only after traumatic situations. The disease develops slowly. It develops slowly at first. At first, a melancholy mood, anxiety, hypochondriacal disorders, and insomnia appear. Against the background of an anxious-depressive state, ideas of self-destruction and self-blame arise. With the progressive course of cerebral atherosclerosis, a persistent, irreversible impoverishment of mental functions (state of dementia) gradually develops. In some cases, as a result of apoplexy (apoplexy dementia

) dementia occurs acutely. The most common type is lacunar (partial) dementia. It is manifested by partial memory impairment, increased exhaustion, loss of the ability to understand the figurative meaning of speech, a tendency to affective outbursts and aggressiveness, sometimes to litigiousness, putting forward “one’s own” theories, doctrines, discoveries, unmotivated carelessness and euphoria with disinhibition of drives. In typical cases of vascular dementia (according to ICD-10 - heading F 01), transient ischemic episodes are observed, accompanied by loss of vision, unstable paresis, and short-term loss of consciousness. Dementia usually progresses gradually with each subsequent cerebrovascular episode or series of brain infarctions. In such cases, impairment of memory and thought processes becomes obvious, and focal neurological signs appear. Cognitive processes may be fragmented with partial preservation of cognitive abilities. According to DSM-IV, vascular dementia (in addition to memory impairment) also manifests itself as aphasic, apraxic and agnostic disorders. The ability for integrative and executive functions, social and labor adaptation, planning and organizing upcoming actions is also impaired. Neurological symptoms are also observed: increased tendon reflexes, positive Russolimo, Babinsky reflexes, pseudobullar palsy, gait disturbance. The above-mentioned disorders can be combined with delirium, delusional states, and depressive mood.

65. Affective disorder (manic-depressive psychosis) and cyclothymia. Patterns of the course, clinical variants.

TIR(circular insanity, circular psychosis, cyclophrenia, cyclothymia) is an endogenous disease that occurs in the form of affective phases (depressive, manic, dual, mixed), separated by intermissions (light intervals). Even with multiple relapses and a long-term course of the disease, persistent irreversible residual mental disorders, as well as any significant changes in personality and signs of a defect, are not observed.

Etiopathogenesis of TIR. Hereditary predisposition and constitutional factors play an important role. Most often, people of a cycloid and psychasthenic type fall ill. Dysfunction of the subtubercular region and pathology of the endocrine system are also of certain importance. Women get sick more often than men. The first attacks can occur both during puberty and in old age. In most cases, the disease begins in the 3rd to 5th decade of life. Types of manic-depressive disorders. 1. MDP with manic attacks (bipolar I disorder) is a variant of MDP in which the patient has had at least one manic attack. At the same time, the disease in the form of exclusively manic attacks (without depressive, hypomanic or mixed manic-depressive) is extremely rare.

MDP with hypomanic episodes (bipolar II disorder)- this is a variant of MDP in which there was at least one depressive and one hypomanic episode, but not a single manic or mixed manic-depressive episode. Mania, depression or hypomania can be caused by an organic disease (multiple sclerosis or thyrotoxicosis), drug addiction (use of amphetamines or cocaine), treatment with antidepressants (MAO inhibitors), sympathomimetics (including cold medications), corticosteroids, or the use of electroconvulsive therapy. In these cases, a diagnosis of bipolar disorder not otherwise specified is sometimes made. In some of these patients, manic attacks may alternate with paranoid ones. 3. Cyclothymia is to MDP in much the same way as dysthymia is to unipolar depression. According to some data, cyclothymia is more common among relatives of patients with MDP than among relatives of healthy individuals or patients with unipolar depression. Diagnostic criteria for cyclothymia include frequent episodes of depressed mood (including anhedonia), alternating with episodes in which the behavior or condition meets some criteria for hypomania, for at least two years. These criteria are arbitrary, and the time criterion creates special difficulties. MDP phases. Depressive phases– characterized by the Jaspers triad – low mood, slowing down of thought processes, motor retardation. Low mood is characterized by the experience of melancholy, anxiety and apathy, which intensifies in the morning. The appearance of the patients corresponds to their affective experiences: expression of grief, sadness, Vergout folds. The poverty of facial expressions and speech, everything is assessed in gloomy colors. Ideas of self-accusation and obsession are frequent. Manic phases– can be mild, moderate or severe. At first, patients experience a surge of vigor, their mood improves, and a feeling of mental and physical well-being appears. The surroundings are perceived in rainbow colors, all mental processes proceed easily, with increased productivity. Then the behavior becomes inappropriate.

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

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

Who is susceptible

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

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

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

Types of disease, according to ICD-10:

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

Causes

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

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

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

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

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

Symptoms of the disease

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

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

The main symptoms of vascular dementia include:

• intellectual-mnestic disorders;
• speech disorders;
• problems with concentration;
• inability 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 in remembering new information and problems with reproducing past events, their temporal sequence, and loss of acquired knowledge and skills. Early memories (about youth, childhood), as well as basic professional skills, are the last to be lost.

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

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

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

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

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

Personality and emotional changes

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

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

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

Optional symptoms

Optional signs develop in 70-80% of patients.

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

Forms of the disease

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

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

Diagnostic criteria

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

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

1. dementia occurred within 3 months 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-mnestic functions, such people are not able to perform all the necessary actions to maintain a normal standard of living, eat regularly, maintain personal hygiene, such patients need regular monitoring and adjustment of their actions by relatives or medical personnel;
• 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.

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

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

Therapy for mental disorder

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

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

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

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

In some cases, dementia develops as a result of 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

Light 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 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). etc.;

personal changes (rudeness, irritability, disappearance of shame, sense of duty, unmotivated attacks of aggression, etc.).

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);
• hypertension;
• atherosclerosis;
• diabetes mellitus;
• 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 mellitus;
• 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 that 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 in remembering new information and problems with reproducing past events, their temporal sequence, and loss of acquired knowledge and skills. Early memories (about youth, childhood), as well as basic professional skills, are the last to be lost.

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

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

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

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-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-mnestic functions, such people are not able to perform all the necessary actions to maintain a normal standard of living, eat regularly, maintain personal hygiene, such patients need regular monitoring and adjustment of their actions by relatives or medical personnel;
• 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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Mental illnesses. Schizophrenia. Depression. Manic-depressive psychosis. Oligophrenia. Psychosomatic diseases.

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 independently open the lock on the front door. This degree of severity is often colloquially referred to as “senile insanity.” The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

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

Reasons

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 specific 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 large-scale death of brain cells due to age, i.e., senile dementia begins to develop.

Signs

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

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

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

Treatment

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

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their effect is manifested in 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 gender;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes mellitus;
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 damage 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 way, because there is no peace, especially at night, she doesn’t let her sleep at all, she asks for a 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, which has an expiration date of another day or two. 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 accumulated 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 appeals to various authorities, etc., because such patients can be extremely active in their initiatives. Aggression, deceit, 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 incapacitated due to mental health cannot account for his actions and, therefore, should not give 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, 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 keeping the brain functioning 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.

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

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

Causes of brain damage

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

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

When cerebral vessels are damaged, memory rarely suffers; the symptoms of this disease come to the fore in the patient's motor functions and cognitive disorders. The pathophysiology of vascular dementia is based on a disruption of communication between various parts of the cortex and brain formations, which subsequently leads to the disconnection of its functions.

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

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

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

Stages

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

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

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

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

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

Degrees

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

With a mild degree of this disease, there is a clear limitation of professional activity and social activity, but patients are able to live independently, maintain personal hygiene, and their intelligence is not significantly impaired.

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

In severe cases of this disease, the activity of patients in everyday life is impaired, they must be constantly monitored and controlled, and they are unable to maintain minimal personal hygiene. At this stage of the disease, motor impairment and intelligence are expressed.

Neurological symptoms in vascular dementia have their own characteristics:

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

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

Diagnostics

To diagnose vascular dementia, not only data from the anamnesis, clinical examination and patient complaints are required, but also neuropsychological studies. Neuroimaging of the affected brain structures is carried out using computed tomography and nuclear magnetic resonance.

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

• 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?
• 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?

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is dementia syndrome?

Dementia is a severe disorder of higher nervous activity caused by organic damage to the brain, and is manifested, first of all, by a sharp decrease in mental abilities (hence the name - dementia translated from Latin means feeble-mindedness).

The clinical picture of dementia depends on the cause that caused organic brain damage, on the localization and extent of the defect, as well as on the initial state of the body.

However, all cases of dementia are characterized by pronounced stable disorders of higher intellectual activity (memory deterioration, decreased ability to abstract thinking, creativity and learning), as well as more or less pronounced disturbances of the emotional-volitional sphere, from the accentuation of character traits (the so-called “caricature”) until the complete collapse of personality.

Causes and types of dementia

Since the morphological basis of dementia is severe organic damage to the central nervous system, the cause of this pathology can be any disease that can cause degeneration and death of cells in the cerebral cortex.

First of all, it is necessary to highlight specific types of dementia in which destruction of the cerebral cortex is an independent and leading pathogenetic mechanism of the disease:

• Alzheimer's disease;
• dementia with Lewy bodies;
• Pick's disease, etc.

In other cases, damage to the central nervous system is secondary, and is a complication of the underlying disease (chronic vascular pathology, infection, trauma, intoxication, systemic damage to nervous tissue, etc.).

The most common cause of secondary organic brain damage is vascular disorders, in particular cerebral atherosclerosis and hypertension.

Common causes of dementia also include alcoholism, tumors of the central nervous system, and traumatic brain injury.

Less commonly, dementia is caused by infections - AIDS, viral encephalitis, neurosyphilis, chronic meningitis, etc.

In addition, dementia can develop:

• as a complication of hemodialysis;
• as a complication of severe renal and liver failure;
• for some endocrine pathologies (thyroid disease, Cushing's syndrome, pathology of the parathyroid glands);
• for severe autoimmune diseases (systemic lupus erythematosus, multiple sclerosis).

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

Functional and anatomical types of dementia

Depending on the predominant localization of the organic defect, which has become the morphological substrate of the pathology, four types of dementia are distinguished:
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

Clinically, lacunar and total forms of dementia are distinguished.

Lacunarnaya

Lacunar dementia is characterized by peculiar isolated lesions of the structures responsible for intellectual activity. In this case, as a rule, short-term memory suffers the most, so patients are forced to constantly take notes on paper. Based on its most pronounced symptom, this form of dementia is often called dysmnestic dementia (dysmenia literally means memory impairment).

However, a critical attitude towards one’s condition remains, and the emotional-volitional sphere suffers slightly (most often only asthenic symptoms are expressed - emotional lability, tearfulness, increased sensitivity).

A typical example of lacunar dementia is the initial stages of the most common form of dementia, Alzheimer's disease.

Total

Total dementia is characterized by complete disintegration of the core of personality. In addition to pronounced violations of the intellectual-cognitive sphere, gross changes in emotional-volitional activity are observed - a complete devaluation of all spiritual values ​​occurs, as a result of which vital interests become impoverished, the sense of duty and modesty disappears, and complete social disadaptation occurs.

The morphological substrate of total dementia is damage to the frontal lobes of the cerebral cortex, which often occurs with vascular disorders, atrophic (Pick's disease) and volumetric processes of the corresponding localization (tumors, hematomas, abscesses).

Basic classification of presenile and senile dementias

The likelihood of developing dementia increases with age. So if in adulthood the proportion of patients with dementia is less than 1%, then in the age group after 80 years it reaches 20%. Therefore, the classification of dementias that occur in late life is especially important.

There are three types of dementia that are most common in presenile and senile (presenile and senile) ages:
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

The clinical course and prognosis of dementia depend on the cause that caused the organic defect of the central nervous system.

In cases where the underlying pathology is not prone to development (for example, with post-traumatic dementia), with adequate treatment, significant improvement is possible due to the development of compensatory reactions (other areas of the cerebral cortex take on part of the functions of the affected area).

However, the most common types of dementia - Alzheimer's disease and vascular dementia - have a tendency to progress, therefore, when they talk about treatment, for these diseases we are only talking about slowing down the process, social and personal adaptation of the patient, prolonging his life, relieving unpleasant symptoms, etc. .p.

And finally, in cases where the disease that causes dementia progresses rapidly, the prognosis is extremely unfavorable: the patient’s death occurs several years or even months after the first signs of the disease appear. The cause of death, as a rule, is various concomitant diseases (pneumonia, sepsis), developing against the background of disturbances in the central regulation of all organs and systems of the body.

Severity (stage) of dementia

In accordance with the patient’s social adaptation capabilities, three degrees of dementia are distinguished. In cases where the disease that causes dementia has a steadily progressive course, we often speak of the stage of dementia.

Light degree

With mild dementia, despite significant impairments in the intellectual sphere, the patient remains critical of his own condition. So the patient can easily live independently, performing familiar household activities (cleaning, cooking, etc.).

Moderate degree

With moderate dementia, there are more severe intellectual impairments and a reduced critical perception of the disease. At the same time, patients experience difficulties in using ordinary household appliances (stove, washing machine, TV), as well as telephones, door locks and latches, so in no case should the patient be completely left to his own devices.

Severe dementia

In severe dementia, a complete breakdown of the personality occurs. Such patients often cannot eat on their own, observe basic hygiene rules, etc.

Therefore, in the case of severe dementia, hourly monitoring of the patient is necessary (at home or in a specialized institution).

Diagnostics

To date, clear criteria for diagnosing dementia have been developed:
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 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). etc.;
• personal changes (rudeness, irritability, disappearance of shame, sense of duty, unmotivated attacks of aggression, etc.).

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 (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).

It should be noted that in order to make a reliable diagnosis of dementia, it is necessary that all of the above symptoms be observed for at least 6 months. Otherwise, we can only talk about a presumptive diagnosis.

Differential diagnosis of organic dementia

Differential diagnosis of organic dementia must be carried out, first of all, with depressive pseudodementia. With deep depression, the severity of mental disorders can reach a very high degree and make it difficult for the patient to adapt to everyday life, simulating the social manifestations of organic dementia.

Pseudo-dementia also often develops after severe psychological shock. Some psychologists explain this kind of sharp decline in all cognitive functions (memory, attention, ability to perceive and meaningfully analyze information, speech, etc.) as a defensive reaction to stress.

Another type of pseudodementia is weakening of mental abilities due to metabolic disorders (vitaminosis B12, lack of thiamine, folic acid, pellagra). With timely correction of disorders, signs of dementia are completely eliminated.

Differential diagnosis of organic dementia and functional pseudodementia is quite complex. According to international researchers, about 5% of dementias are completely reversible. Therefore, the only guarantee of a correct diagnosis is long-term observation of the patient.

Alzheimer's type dementia

Concept of dementia in Alzheimer's disease

Dementia of the Alzheimer's type (Alzheimer's disease) received its name from the name of the doctor who first described the pathology clinic in a 56-year-old woman. The doctor was alerted by the early manifestation of signs of senile dementia. A post-mortem examination showed peculiar degenerative changes in the cells of the patient’s cerebral cortex.

Subsequently, this kind of violation was discovered in cases where the disease manifested itself much later. This was a revolution in views on the nature of senile dementia - previously it was believed that senile dementia was a consequence of atherosclerotic damage to the blood vessels of the brain.

Dementia of the Alzheimer's type is today the most common type of senile dementia, and, according to various sources, accounts for 35 to 60% of all cases of organic dementia.

Risk factors for developing the disease

There are the following risk factors for developing dementia of the Alzheimer's type (arranged in descending order of importance):

• 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);
• hypertension;
• atherosclerosis;
• increased levels of lipids in blood plasma;
• 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

It should be noted that degenerative processes in Alzheimer's disease begin years and even decades before the first clinical manifestations. The first signs of Alzheimer's type dementia are very characteristic: patients begin to notice a sharp decline in memory for recent events. At the same time, a critical perception of their condition persists for a long time, so that patients often feel understandable anxiety and confusion, and consult a doctor.

Memory impairment in dementia of the Alzheimer's type is characterized by the so-called Ribot's law: first short-term memory is impaired, then recent events are gradually erased from memory. Memories from distant times (childhood, adolescence) are retained the longest.

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

In the advanced stage of dementia of the Alzheimer's type, memory impairment progresses, so that in some cases only the most significant events are remembered.

Gaps in memory are often replaced by fictitious events (the so-called confabulation– false memories). The criticality of perception of one's own state is gradually lost.

At the advanced stage of progressive dementia, disorders of the emotional-volitional sphere begin to appear. The following disorders are most characteristic of senile dementia of the Alzheimer's type:

• egocentrism;
• grouchiness;
• suspicion;
• conflict.

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.

Other types of disturbances in normal behavior often develop:

• 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

The diagnosis of dementia of the Alzheimer's type is made on the basis of the characteristic clinical picture of the disease, and is always probabilistic. Differential diagnosis between Alzheimer's disease and vascular dementia is quite difficult, so often a final diagnosis can only be made posthumously.

Treatment

Treatment of Alzheimer's type dementia is aimed at stabilizing the process and reducing the severity of existing symptoms. It should be comprehensive and include therapy for diseases that aggravate dementia (hypertension, atherosclerosis, diabetes, obesity).

In the early stages, the following drugs showed a good effect:

• 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

Dementia of the Alzheimer's type is a steadily progressive disease that inevitably leads to severe disability and death of the patient. The process of disease development, from the appearance of the first symptoms to the development of senile insanity, usually takes about 10 years.

The earlier Alzheimer's disease develops, the faster dementia progresses. In patients under 65 years of age (senile dementia or presenile dementia), neurological disorders (apraxia, agnosia, aphasia) develop early.

Vascular dementia

Dementia due to cerebral vascular lesions

Dementia of vascular origin ranks second in prevalence after dementia of the Alzheimer's type, and accounts for about 20% of all types of dementia.

In this case, as a rule, dementia that develops after vascular accidents, such as:
1. Hemorrhagic stroke (vascular rupture).
2. Ischemic stroke (blockage of a vessel with cessation or deterioration of blood circulation in a certain area).

In such cases, massive death of brain cells occurs, and the so-called focal symptoms, depending on the location of the affected area (spastic paralysis, aphasia, agnosia, apraxia, etc.), come to the fore.

So the clinical picture of post-stroke dementia is very heterogeneous, and depends on the degree of damage to the vessel, the area of ​​​​the blood supply to the region of the brain, the compensatory capabilities of the body, as well as on the timeliness and adequacy of medical care provided in case of a vascular accident.

Dementias that occur with chronic circulatory failure develop, as a rule, in old age and demonstrate a more homogeneous clinical picture.

What disease can cause vascular type dementia?

The most common causes of vascular type dementia are hypertension and atherosclerosis - common pathologies characterized by the development of chronic cerebrovascular insufficiency.

The second large group of diseases leading to chronic hypoxia of brain cells is vascular damage in diabetes mellitus (diabetic angiopathy) and systemic vasculitis, as well as congenital disorders of the structure of cerebral vessels.

Acute cerebral circulatory failure can develop due to thrombosis or embolism (blockage) of a vessel, which often occurs with atrial fibrillation, heart defects, and diseases with an increased tendency to thrombus formation.

Risk factors

The most significant risk factors for the development of dementia of vascular origin:

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

Symptoms and course of senile vascular dementia

The first warning signs of vascular dementia are difficulty concentrating. Patients complain of fatigue and have difficulty concentrating for long periods of time. At the same time, it is difficult for them to switch from one type of activity to another.

Another harbinger of developing vascular dementia is slowness of intellectual activity, so for the early diagnosis of cerebral circulatory disorders, tests for the speed of performing simple tasks are used.

Early signs of developed dementia of vascular origin include violations of goal setting - patients complain of difficulties in organizing elementary activities (making plans, etc.).

In addition, already in the early stages, patients experience difficulties in analyzing information: it is difficult for them to identify the main and secondary, to find the common and different between similar concepts.

Unlike dementia of the Alzheimer's type, memory impairment in dementia of vascular origin is not as pronounced. They are associated with difficulties in reproducing perceived and accumulated information, so that the patient easily remembers “forgotten” when asking leading questions, or chooses the correct answer from several alternative ones. At the same time, memory for important events is retained for quite a long time.

For vascular dementia, disturbances in the emotional sphere are specific in the form of a general decrease in background mood, up to the development of depression, which occurs in 25-30% of patients, and pronounced emotional lability, so that patients can cry bitterly, and a minute later move on to quite sincere fun.

Signs of vascular dementia include the presence of characteristic neurological symptoms, such as:
1. Pseudobulbar syndrome, which includes impaired articulation (dysarthria), changes in voice timbre (dysphonia), less commonly, 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).

Vascular dementia, which develops as a result of chronic circulatory failure, usually progresses gradually, so the prognosis largely depends on the cause of the disease (hypertension, systemic atherosclerosis, diabetes mellitus, etc.).

Treatment

Treatment of vascular dementia is primarily aimed at improving cerebral circulation - and, consequently, at stabilizing the process that caused dementia (hypertension, atherosclerosis, diabetes, etc.).

In addition, pathogenetic treatment is standardly prescribed: piracetam, Cerebrolysin, Actovegin, donepezil. The regimens for taking these drugs are the same as for Alzheimer's type dementia.

Senile dementia with Lewy bodies

Senile dementia with Lewy bodies is an atrophic-degenerative process with the accumulation of specific intracellular inclusions – Lewy bodies – in the cortex and subcortical structures of the brain.

The causes and mechanisms of development of senile dementia with Lewy bodies are not fully understood. Just as with Alzheimer's disease, the hereditary factor is of great importance.

According to theoretical data, senile dementia with Lewy bodies ranks second in prevalence, and accounts for about 15-20% of all senile dementias. However, during life such a diagnosis is made relatively rarely. Typically, such patients are misdiagnosed as having vascular dementia or Parkinson's disease with dementia.

The fact is that many symptoms of dementia with Lewy bodies are similar to the listed diseases. Just as with the vascular form, the first symptoms of this pathology are a decrease in the ability to concentrate, slowness and weakness of intellectual activity. Subsequently, depression, decreased motor activity similar to parkinsonism, and walking disorders develop.

At the advanced stage, the clinical picture of dementia with Lewy bodies is in many ways reminiscent of Alzheimer's disease, since delusions of damage, delusions of persecution, and delusions of doubles develop. As the disease progresses, delusional symptoms disappear due to complete exhaustion of mental activity.

However, senile dementia with Lewy bodies has some specific symptoms. It is characterized by so-called small and large fluctuations - sharp, partially reversible disturbances in intellectual activity.

With small fluctuations, patients complain of temporary impairments in the ability to concentrate and perform some task. With large fluctuations, patients note impaired recognition of objects, people, terrain, etc. Often the disorders reach the point of complete spatial disorientation and even confusion.

Another characteristic feature of dementia with Lewy bodies is the presence of visual illusions and hallucinations. Illusions are associated with a violation of orientation in space and intensify at night, when patients often mistake inanimate objects for people.

A specific feature of visual hallucinations in dementia with Lewy bodies is their disappearance when the patient tries to interact with them. Visual hallucinations are often accompanied by auditory hallucinations (speaking hallucinations), but auditory hallucinations do not occur in their pure form.

As a rule, visual hallucinations are accompanied by large fluctuations. Such attacks are often provoked by a general deterioration in the patient’s condition (infectious diseases, fatigue, etc.). When emerging from a large fluctuation, patients partially amnesize what happened, intellectual activity is partially restored, however, as a rule, the state of mental functions becomes worse than the original one.

Another characteristic symptom of dementia with Lewy bodies is sleep behavior disorder: patients can make sudden movements, and even injure themselves or others.

In addition, with this disease, as a rule, a complex of autonomic disorders develops:

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

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

In case of confusion, acetylcholinesterase inhibitors (donepezil, etc.) are prescribed, and in extreme cases, atypical antipsychotics (clozapine). The use of standard antipsychotics is contraindicated due to the possibility of developing severe movement disorders. Non-frightening hallucinations, if adequately criticized, cannot be eliminated with special medications.

To treat the symptoms of parkinsonism, small doses of the drug levodopa are used (being very careful not to cause an attack of hallucinations).

The course of dementia with Lewy bodies is rapidly and steadily progressive, so the prognosis is much more serious than for other types of senile dementia. The period from the appearance of the first signs of dementia to the development of complete insanity usually takes no more than four to five years.

Alcoholic dementia

Alcohol-induced dementia develops as a result of long-term (15-20 years or more) toxic effects of alcohol on the brain. In addition to the direct influence of alcohol, indirect effects (endotoxin poisoning due to alcoholic liver damage, vascular disorders, etc.) take part in the development of organic pathology.

Almost all alcoholics at the stage of development of alcoholic personality degradation (the third, last stage of alcoholism) exhibit atrophic changes in the brain (expansion of the cerebral ventricles and sulci of the cerebral cortex).

Clinically, alcoholic dementia is a diffuse decrease in intellectual abilities (deterioration of memory, concentration, ability for abstract thinking, etc.) against the background of personal degradation (coarsening of the emotional sphere, destruction of social connections, primitivism of thinking, complete loss of value orientations).

At this stage of development of alcohol dependence, it is very difficult to find incentives to encourage the patient to treat the underlying disease. However, in cases where it is possible to achieve complete abstinence for 6-12 months, the signs of alcoholic dementia begin to regress. Moreover, instrumental studies also show some smoothing of the organic defect.

Epileptic dementia

The development of epileptic (concentric) dementia is associated with a severe course of the underlying disease (frequent seizures with transition to status epilepticus). Indirect factors may be involved in the genesis of epileptic dementia (long-term use of antiepileptic drugs, injuries from falls during seizures, hypoxic damage to neurons during status epilepticus, etc.).

Epileptic dementia is characterized by slowness of thought processes, the so-called viscosity of thinking (the patient cannot distinguish the main from the secondary, and gets fixated on describing unnecessary details), decreased memory, and impoverished vocabulary.

A decrease in intellectual abilities occurs against the background of a specific change in personality traits. Such patients are characterized by extreme selfishness, malice, vindictiveness, hypocrisy, quarrelsomeness, suspiciousness, accuracy, even pedantry.

The course of epileptic dementia is steadily progressive. With severe dementia, malice disappears, but hypocrisy and servility remain, and lethargy and indifference to the environment increases.

How to prevent dementia - video

Answers to the most popular questions about causes, symptoms and
dementia treatment

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

The terms “dementia” and “dementia” are often used interchangeably. However, in medicine, dementia is understood as irreversible dementia that has developed in a mature person with normally formed mental abilities. Thus, the term “childhood dementia” is inappropriate, since in children higher nervous activity is at a developmental stage.

The term “mental retardation” or oligophrenia is used to refer to childhood dementia. This name is retained when the patient reaches adulthood, and this is fair, since dementia that occurs in adulthood (for example, post-traumatic dementia) and mental retardation proceed differently. In the first case, we are talking about the degradation of an already formed personality, in the second - about underdevelopment.

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

Sudden untidiness and untidiness are symptoms of disturbances in the emotional-volitional sphere. These signs are very nonspecific, and are found in many pathologies, such as: deep depression, severe asthenia (exhaustion) of the nervous system, psychotic disorders (for example, apathy in schizophrenia), various types of addictions (alcoholism, drug addiction), etc.

At the same time, patients with dementia in the early stages of the disease can be quite independent and neat in their usual everyday environment. Sloppiness can be the first sign of dementia only if the development of dementia is accompanied in the early stages by depression, exhaustion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

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

Mixed dementia is called dementia, the development of which involves both a vascular factor and the mechanism of primary degeneration of brain neurons.

It is believed that circulatory disorders in the blood vessels of the brain can trigger or intensify the primary degenerative processes characteristic of Alzheimer's disease and dementia with Lewy bodies.

Since the development of mixed dementia is caused by two mechanisms at once, the prognosis for this disease is always worse than for the “pure” vascular or degenerative form of the disease.

The mixed form is prone to steady progression, therefore inevitably leading to disability and significantly shortening the patient's life.
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.

Timely and adequate treatment for mixed dementia can significantly prolong the patient’s life and improve its quality.

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?

Senile dementias are diseases with a hereditary predisposition, especially Alzheimer's disease and dementia with Lewy bodies.

The risk of developing the disease increases if senile dementia in relatives developed at a relatively early age (before 60-65 years).

However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of a particular disease, therefore even an extremely unfavorable family history is not a death sentence.

Unfortunately, today there is no consensus on the possibility of specific drug prevention of the development of this pathology.

Since risk factors for the development of senile dementia are known, measures to prevent mental illness are primarily aimed at eliminating them, and include:
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.).
4. Quitting smoking and alcohol.
5. Prevention of obesity.

Before use, you should consult a specialist.