Vascular dementia - acquired memory impairment and intellectual abilities of a person due to cerebrovascular disease. With a lack of oxygen, the brain cells responsible for behavior and perception die, changing the patient beyond recognition. Most often, signs of dementia appear in the elderly, and you need to clearly understand that she is not directly a disease.
Types and causes of vascular dementia
The International Classification of Diseases( Revision 10) assigned SD code F01 and identified the following types:
- With acute origin( F01.0).Behavioral disorders occur quickly, in the period 1-3 months after the first or subsequent strokes. It can be a consequence of hemorrhage, cerebrovascular thrombosis or embolism.
- Multi-infarction( F01.1).Most of them are cortical. Signs appear within 3-6 months, gradually, usually, this process is followed by ischemic episodes. In this case, heart attacks seem to accumulate in certain parts of the brain.
- Subcortical( F01.2).Doctors call it subcortical. In this type of violation, for the most part, the deep sections of white matter are affected.
- Mixed cortical and subcortical( F01.3).
- Unspecified( F01.9).
- Another( F01.8).This includes dementia after a stroke.
However, it is impossible to talk about a clear division into cortical( cortical) and subcortical, because in later stages SD affects all parts of the brain.
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Stages of vascular dementia
Dementia precedes 3 stages:
- Emergence of risk factors for development. For example, predisposition to vascular diseases.
- Ischemic injury in the initial stage. At this stage, cerebral lesions can be diagnosed, however, they do not appear externally. In this case, leukoareosis and "silent" infarctions are observed.
- The onset of the symptomatic stage. It is difficult to diagnose at this stage, since the lesions are small and have little effect on the behavior and perception of the patient. Identify violations can only be on neuropsychological testing.
The history of the development of vascular dementia includes several stages and proceeds as follows:
- The initial stage of or the appearance of mild cognitive impairment of vascular genesis.
- Clinical diagnosis of diabetes. At this stage, signs of dementia are already expressed clearly, the patient behaves either aggressively or apathetically, dips in the memory appear.
- Severe or severe diabetes. The patient needs constant supervision and is completely dependent on others.
- Lethal outcome. Basically, death does not occur because of dementia( with rare exceptions like accidents), but as a consequence of a heart attack or stroke.
Symptoms of vascular dementia
Since dementia is not a single disease, but a syndrome that affects the behavior of a person in different ways, it is difficult to indicate the exact changes that accompany it.
But it can be said about the symptoms that arise in most cases, as well as the most basic symptoms.
According to statistics, the most frequent symptoms of vascular dementia are:
- Epileptic seizures( 20-34% depending on the disease).
- Disturbances of walking( 30-95%).This includes instability, light lameness, shuffling steps and similar signs.
- Violations of urination( almost 90%).
- Deterioration of cognitive functions, for example, memory, orientation, attention( in 100%).
- Reduction of physical functions, without impairment of motor skills( 100%).
Symptoms at the initial stage are typical for many diseases, therefore they are not easily distinguishable.
- The appearance of neurosis-like disorders( lethargy, apathy, irritability);
- Absence and inattention.
- The emergence of insomnia, nightmares and other sleep disorders.
- Out-of-home orientation violations.
- Emotional instability, sharp mood swings.
At this stage, the symptoms become noticeable and easily diagnosed:
- Mood swings become more severe. Appears aggressiveness, followed by deep apathy.
- Short-term dips in memory.
- Violations of orientation within the home.
- Difficulties in communication due to forgetfulness of even frequently used words and unwillingness to make contact.
- Violation of physical functions, for example, the vestibular apparatus, and, as a consequence, the need for self-care.
At the last stage all the previous symptoms acquire an extreme degree:
- Loss in space and time. Delirium and hallucinations.
- Dips in memory. This applies to close relatives, events that occurred a few minutes ago.
- Unreasonable aggression.
- Difficulties of movement, including the inability to get out of bed.
- The need for constant self-care.
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In addition to the main symptomatology, there are signs that you can more accurately determine the disease.
For vascular dementia it is:
- Short recovery of cognitive functions. The reasons for this effect are not fully understood. Most often occurs with intellectual loads. The patient's condition can improve almost to the normal level, but vascular dementia itself will not go away anywhere.
- Smooth development. It is the smooth and slow development of diabetes prevents it from diagnosing, especially in the elderly. Relatives of patients often admit that they noticed minor changes, but paid attention to them when it was already late.
After a single stroke, the behavior of a patient with dementia may not change at all until the middle stage. Acute development of diabetes takes in only 20-38% of cases.
- Previous symptoms of cavitary or trauma surgery, as well as aortocoronary bypass.
In patients, especially the elderly, new vascular lesions appear:
- After cerebral angiography in 15-26% of cases.
- After operations on carotid arteries in 17-54%.
- After cardiac surgery and other cardiosurgical interventions, 31-48%.
Diagnosis of vascular dementia
Diagnosis of diabetes is performed by a physician based on the aforementioned signs and symptoms.
For the diagnosis can be used:
- Working group criteria NINDS-AIREN
- International classification of diseases in the 10th revision.
- ADDTC Criteria.
- Criteria for DSM-IV.
- Ischemic scale of Khachinsky.
It all depends on the training of a specialist and the theories he follows. In fact, they differ slightly, but at the middle and heavy stage they practically repeat each other.
During the diagnosis, CT and MRI( magnetic resonance imaging) can be used to identify:
- multiple infarcts;
- lacunar cysts;
- white matter damage.
Treatment of vascular dementia
Cure for vascular dementia is most often impossible, since brain changes are irreversible. But it is possible to overcome changes that are not functional( they do not affect physical and mental abilities).
The need for treatment is clearly indicated by a graph showing the effect of therapy:
It should be noted that the type of therapy can be prescribed only by a doctor. Measures taken independently can worsen a patient's condition and literally bring him to the grave.if you prefer any specific method of treatment, before using it, discuss the matter with your specialist.
Treat dementia as a disease is mistaken, as dementia is a syndrome involving several versatile symptoms. The easiest way to treat dementia is still healthy, trying to prevent dementia.
But, in spite of this, several therapies that use in aggregate are distinguished:
- Folk remedies.
The effectiveness of this method has not been fully proven. However, some drugs have been carefully studied and it has been possible to confirm the improvement in the condition of patients with dementia.
For this, it is used in small doses:
The rest of the medicines are aimed at partially eliminating the symptoms of the patient.
So, to improve cognitive( intellectual) abilities the doctor can prescribe:
- cholinesterase inhibitors;
In cases of depressive conditions and post-stroke anxiety, antidepressants may be prescribed. And when there is an acute psychosis of antipsychotics.
If the patient has been diagnosed with post-stroke mania( and it is confirmed that her cause is dementia), serious medications will be required, for example:
- valproic acid;
Prophylaxis and prognosis in vascular dementia
Prevention of vascular dementia is the prevention of cardiovascular disease. But often it happens that a person learned about this possibility too late, when dementia reached the middle stage.
In any case, this is not a reason to refuse preventive measures, because in most cases, patients become better with such recommendations:
- Refusal from alcohol and tobacco smoking.
- Refuse from fatty foods.
- Daily exercise. You do not need to make a bodybuilder from the grandmother, but she can also allocate 2 times for 5-10 minutes for an easy warm-up.
- Daily intellectual load. This includes solving crossword puzzles, reading, exercises for memory development and the like.
- Control of blood pressure and cholesterol.
The effectiveness of folk remedies is also not proven, however, in rare cases, patients can become better with some of them, for example:
- Turmeric. You can add to the dishes as a seasoning.
- Devyasila. Decoction of Irish moss and flaxseed. Take 1 tbsp.spoon each and boil in 0.5 liters of water for 20 minutes.
- A preparation from a gingko biloba plant.
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Lifetime in vascular dementia
Because the development of vascular dementia is more complex than in other species, life expectancy depends on the measures taken and the stage at which dementia was detected. But unfortunately, it does not exceed 5-6 years with rare exceptions.
Preventing vascular dementia is easier than curing, because there is no universal medicine for dementia. And although life expectancy with diabetes is low, in your power to improve the quality of life of the patient, not only with the help of medication and timely diagnosis.
Patients with dementia are very important to communicate with loved ones.
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