Definition and main causes of vascular dementia. Clinical manifestations and stages of the disease. Basic diagnostic methods and principles of treatment. Drug therapy and prevention. Vascular dementia is a disease that affects the mental and mental health of a person and results from insufficient blood supply to the brain. As a result, mental abilities, the nature of behavior in society, as well as adaptation mechanisms, deteriorate. Such a person completely or partially loses the ability to self-service. It is also worth noting that impaired consciousness in this state is not observed.
Causes of Vascular Dementia
There are many factors that can affect the vascular system of our body. Moreover, each in one way or another has its own effect on her in general. If any of them strengthen or weaken their influence, this will immediately manifest its negative consequences in the form of cerebral hypoxia. In most cases, it is impossible to determine a single cause of the disease. Several of them are identified at once, which at the same time complement and enhance the action of each other. Among the most common causes of vascular dementia are:
- Stroke … It is considered the most important factor. Acute obstruction of the vessel due to blockage by a thrombus or embolus leads to the cessation of oxygen supply to the brain. Within a few seconds, its cells begin to die, which does not reverse development and leads to serious consequences. Tissue hemorrhage in hemorrhagic stroke has the same effect.
- Atherosclerosis … A fairly common disease that affects the vascular network, accompanying the aging process. Accordingly, it is almost always detected in patients with this profile. In this case, a violation of lipid metabolism occurs, as a result of which atherosclerotic plaques are formed on the inner lining of the vessel. Such layers impede the blood flow in every possible way, while having the property of breaking off and migrating through the circulatory system in the form of an embolus.
- Arterial hypertension … Constant increased pressure in combination with other factors greatly impairs the elastic properties of blood vessels and, as a rule, eventually leads to their failure. As a result, normal blood supply is impossible. The constant lack of oxygen negatively affects the metabolism of cells and eventually leads to their death.
- Chronic cerebral ischemia … The development of this pathology is associated with long-term impairment of blood flow in small vessels. Most often this is due to the influence of various diseases of the endocrine system. Among the most common are diabetes mellitus, thyrotoxicosis, and fermentopathy. In this case, impaired capillary tone and changes in blood pressure are also of great importance.
- Cardiovascular insufficiency … The presence of a pumping function allows the heart to stably supply oxygen to all tissues and organs of our body. If it is violated, this process becomes impossible. The myocardium is unable to provide the required cardiac output, as a result of which the normal blood flow in the capillaries of the brain decreases. The presence of such a pathology can cause both gradual harm and lead to the emergence of acute conditions.
- Vasculitis … Inflammation of the vessel membrane can have a wide variety of etiologies. The most common are autoimmune (erythematosis, systemic lupus erythematosus) and infectious (Lyme disease, syphilis of the nervous system) diseases. Lesions of this type have a very aggressive course and require immediate intervention.
- Exercise stress … Naturally, this does not mean dosed training, but excessive activity. Because of this, the tissue demand for oxygen increases, which the body is not able to provide in full. When compensatory mechanisms cease to cope with this, chronic circulatory failure occurs. This applies mainly to athletes and people doing hard physical work.
- Bad habits … The main problem is the effects of nicotine. It is able to exert a stimulating effect on the muscular membrane, forcing it to be in a contracted state for a longer period of time. After a while, this may be reflected in the work of the cardiovascular system.
- Heredity … The presence of such diseases in any of the relatives always puts a person's life at risk. There is a scientifically proven opinion that the transmission of vascular dementia is possible in a number of generations, and men are more susceptible to this inheritance of genes. But this does not mean that such a probability is one hundred percent. There are cases in which the presence of the disease has nothing to do with the family.
Note! Based on the studies conducted, scientists have proven that insufficient intake of folic acid increases the risk of developing this disease threefold.
Classification of the disease "vascular dementia"
Dementia, which occurs during cerebrovascular insufficiency, is acquired and can jeopardize not only health, but also human life at any time. Symptoms that occur with it can accompany many other conditions, and also act as a syndrome of a separate disease.
The problem of this pathology is very relevant in the modern world, because every year the number of cases increases. Also, more and more cases are diagnosed at a young and even childhood age. In this regard, the scope of research was expanded and the following types of vascular dementia were identified:
- Sharp … This type is characterized by the suddenness and rapidity of the onset of symptoms. Most often this is due to the most etiological factor and the changes that it caused. The stronger its action, the sooner and more aggressive the manifestations will be. Such consequences are most often caused by a stroke, mainly hemorrhagic.
- Multifactorial … This type includes most cases of the disease. It is formed due to the influence of several causes of dementia at once. Sometimes this is a cascade mechanism in which one factor provokes the development of another, but still more often it is their general damaging effect on the vascular system of the brain. Dementia occurs in this case gradually over three to six months, and the main symptom is the presence of arterial hypertension.
- Subcortical … It is characterized by dysfunction, the centers of which are laid on the subcortical level. At the same time, the processes of attention and memory suffer. It becomes difficult for a person to remember new information or to abstract from what is happening around. As a result, there is stiffness, apathy, depression. The center of walking is also affected, after which the beginning of any movement is accompanied by awkwardness and lack of stability on the legs.
- Mixed … It is represented by all types of disorders of the central nervous system that only exist. Her clinic is so diverse that only differential diagnostics using the method of exclusion can be distinguished from the rest. It occurs mainly in elderly people and is associated not only with some direct factor, but also with age-related changes in the first place.
- Indefinite … This type of dementia is rare and mainly affects the younger population. Moreover, it can be both adults and children. The violations that arise are not attached to any cause. In such cases, they speak rather of an unexplained etiology of the process than of its absence. At the same time, the disease does not lose its severity and requires immediate treatment.
Stages of vascular dementia in humans
Each case of dementia must be considered purely individually, because the similarity of symptoms does not guarantee the same course and prognosis in the future. The disease is characterized by the presence of certain stages, which, without correct correction, immediately move from the easiest to the most severe.
According to this principle, the following stages of vascular dementia are distinguished:
- The first … It occurs at the very beginning of the disease and is characterized by a paucity of symptoms. A person notices a deterioration in his professional abilities. It takes more time to complete the usual work, it becomes difficult to remember simple things. This entails a decrease in motor and mental activity, rapid fatigue and depression of mood.
- The second … The patient's condition worsens. Deficiency in everyday life is added to the existing violations. A person cannot stay on his own for a long period of time, because he loses basic self-care skills. At first, he cannot remember how to use the TV remote control or microwave oven, and then he forgets what to brush his teeth and eat. Lost orientation in the space of your own house or apartment. Such incoherence affects not only the patient, but also other residents of the house.
- Third … The last stage makes a person completely incapable of independent survival. Any action requires outside help and round-the-clock supervision. In the process, all acquired skills are lost (washing, combing, personal hygiene rules, holding a fork). There is a certain maladjustment to the conditions of the environment and society. The quality of life of such a person is reduced to almost zero and can lead to disability.
The main signs of vascular dementia
The presence of one or another symptom of vascular dementia depends on the type of disease, each of which is characterized by its own set of disorders. Their number grows with the aggravation of the stage of the process and the intensification of the action of the damaging factor. Some of them may appear immediately, while others join after a certain time.
Symptoms of vascular dementia depend on which function of higher nervous activity is affected:
- Memorization … It is accompanied by disorders of both short-term and long-term memory. Information does not linger in the patient's head. In some cases, a violation of the type of confabulation is possible, when events that have occurred a long time ago are transferred in a slightly altered form by a person in time and applied to the present. The more severe the degree of damage, the longer the period of time involved in this process. Last but not least, the names of close people and relatives disappear from memory. Loss of self-orientation is an extreme degree of this disorder.
- Attention … This extremely important feature does not immediately disappear. Initially, a person may not notice any violations. For example, to re-ask information that you have not heard before, or to re-read the previous sentence in the book again. The situation gets worse over time. The patient responds only to a few repetitive stimuli that can lead to action. And after a while, he cannot concentrate at all on anything. Difficulties also appear in switching attention from one activity to another. It becomes impossible to perform two functions at once.
- Speech … Violation of this parameter is closely related to the area of the lesion of the cerebral cortex, namely the frontal lobe. In this case, a condition such as aphasia occurs. It manifests itself in the fact that a person loses the ability to express his thoughts in words due to confusion in phrases. Understanding the speech addressed to himself, he cannot clearly answer it.
- Praxis … The ability to take purposeful actions is also impaired. This applies to professional, household, motor and speech movements. A person gradually loses these skills, forgetting how to perform them. Walking, writing, reading, or simply bending over becomes impossible over time.
- Orientation … Suffers almost in the first place and is a signaling symptom of dementia. Initially, temporal perception becomes a problem, and then spatial perception. The patient cannot name the day of the week and indicate which year is coming. Over time, finding a way out of your own apartment turns out to be problematic. The last stage and alarming signal is the loss of orientation in one's own personality.
- Behavior … As for this property, its changes are long-term and gradual. The main features inherent in a particular personality are strengthened. If before the illness a person was energetic and cheerful, now this will manifest itself in the form of anxiety and fussiness. It is the same with other parameters. People become vulnerable and resentful. Greed and conflict in the environment is manifested. Sexual disinhibition can sometimes be a problem. A signal of a worsening condition is untidiness. A person ceases to observe personal hygiene, not paying attention to the presence of people around.
- Thinking … The function that distinguishes humans from the animal world begins its evolution in the opposite direction. At first, the patient cannot generalize the collected information or solve a simple problem. When communicating with him, a poor speech is noted, devoid of complex verbal turns, which may completely disappear in the future. A severe manifestation is the emergence of delusional ideas. In men, this is mainly associated with excessive jealousy, and in women, it is associated with theft of property or stalking.
- Emotionality … It's about constant mood swings. Such people, first in a day, and then in a few minutes, can manifest their condition in different ways. Crying, which is abruptly replaced by laughter, they themselves cannot explain. There is a tendency to depressive states, unmotivated anger and a feeling of aggression. It is very rare that such mood variability can end up in manic behavior.
Features of the treatment of vascular dementia
Vascular dementia requires special attention to the choice of therapy. It should be aimed primarily at correcting the underlying disease, as well as associated risk factors. Considering that in most cases there are several reasons at once, the effect of drugs for vascular dementia should minimize the harm to each of them.
Etiopathogenetic therapy
Based on the mechanism of development of this disease, we can say that its main cause is arterial hypertension, as a result of which a stroke occurs. Therefore, the main groups of drugs used in this case will be aimed specifically at correcting pressure.
It is most advisable to use the following drugs:
- Angiotensin Converting Enzyme Inhibitors … The most common of them are Captopril, Enalapril, Lisinopril. They realize their effect in combination with diuretics, lowering blood pressure. Due to their pharmacokinetic properties, they are used even in people with diseases of the gastrointestinal tract and pathology of the pancreas. The drugs are well tolerated by patients with diabetes and obesity.
- Calcium channel blockers … Various representatives of this group are used, but the use of Cinnarizine is preferred. The drug realizes its action in the vessels of the brain, lowering blood pressure and improving blood circulation in general. It also has a neuroprotective effect.
Cognitive drugs
Since it is cognitive dysfunction that predominates in clinical manifestations, it is necessary to devote as much time as possible to its correction. Medical therapy is preferred in this case.
To eliminate the violations that have arisen in the treatment of vascular dementia, you need to include the following groups of drugs:
- Improving trophism … These include Cerebrolysin, the properties of which allow it to have a beneficial effect on the nutrition of brain cells. Penetrating through the blood-brain barrier (between blood and tissue), it participates in the regulation of metabolic processes. It also promotes the transmission of nerve impulses along the fibers.
- Nootropic medicines … The main representative is Piracetam. The substance is included in many modern drugs to improve memory, thinking and learning processes. It has several positive effects at once on the metabolism of the neuron and its blood supply.
- Neural peptides … Therapy with these drugs is aimed at accelerating the recovery processes in the cells of the brain. The most commonly used is Solcoseryl, which has a positive effect on the metabolism in neurons and stimulates regeneration.
Methods for preventing vascular dementia
The fight against dementia in modern society must begin at the stage of prevention. It is much easier to prevent such a disease than to cure it. In this case, it is necessary to talk about self-control and self-development as a person.
There are several points by adhering to which you can significantly reduce the risk of developing vascular dementia:
- Blood pressure control … It is necessary to closely monitor its level. This is especially important for the elderly and those at risk for hypertension. Registration of higher numbers requires immediate contact with medical institutions.
- Distribution of physical activity … Dosed loads have a positive effect on the state of the cardiovascular system, train the muscles of the myocardium and increase its adaptive capabilities. You should also avoid excessive activity, which can significantly worsen a person's health.
- Correction of the mental state … It is very important to adhere to maintaining a healthy psyche. Limiting negative emotions, attending various trainings, walking in the fresh air, and even changing jobs can prevent many painful conditions.
How to treat vascular dementia - watch the video:
Diagnosis of vascular dementia is becoming a verdict for many people in modern society. Unfortunately, with many drugs available for medical treatment, the disease often continues to progress to irreversible changes. Therefore, the most effective in this case is prevention, which can prevent this pathology.
