Dementia( acquired dementia) - Causes, symptoms and treatment. MF.

Dementia is acquired with age, dementia, loss of brain functions that make a person a person. The person begins to "forget", loses the ability to cognize the world, acquire household and professional skills and loses the knowledge and skills that already exist, eventually disappear all interests, the speed of thought reactions - there is a "disintegration" of mental functions as a result of brain damage. In this case, a person is not even able to realize what is happening to him.

Depending on the affected area of ​​the brain, there is a dementia with a sharp beginning, cortical, subcortical, cortical - subcortical, multifocal.

60% of dementia gives Alzheimer's disease.15 - 20% is dementia in vascular diseases( subcortical dementia).

The causes of dementia

Etiologically significant are arterial hypertension, occluding atherosclerotic lesions of the main vessels, their combination, systemic circulation disorders, arrhythmias, repeated disorders of cerebral circulation, venous discirculation, rheological blood disorders, hereditary angiopathies.

Etiopathogenetic variants of the development of vascular dementia are macroangiopathic, microangiopathic and mixed. In this case, in the brain material there are multi-infarct changes, multiple subcortical lacunar lesions.

Macroangiopathic variant of development: atherosclerosis, thrombosis, embolism lead to occlusion( obstruction, narrowing of the lumen of the vessel) of the cerebral artery - an insult is formed with symptoms corresponding to the affected basin with subsequent vascular dementia.

Microangiopathic variant of development: hypertension, angiopathy leads to the development of hyalinosis of small penetrating subcortical arteries, which leads in one scenario to demyelination of subcortical white matter and the development of leukoencephalopathy, on the other - to lacunar lesion, which as a result may give rise to Binswanger's disease leading todementia.

By 10 - 20% is a dementia at an alcoholism, tumors of a brain, craniocerebral traumas.1% is dementia in Parkinson's disease, Huntington's chorea, Pick's disease, degenerative diseases of the nervous system, metabolic disorders, infectious processes. Degenerative diseases can lead to almost complete decortication.

Diabetes is also a risk factor for dementia.

Criteria for diagnosing vascular dementia:

- dementia, violation of abstract thinking, reduced criticism, inability to plan action plans,
- aphasia( speech function disorder),
- apraxia( impaired ability to perform motor activity despite undisturbed motor functions),
- agnosia( the inability to recognize or identify objects, despite the persistent sensory perception),
- the presence of cerebrovascular disease,
- the interrelation between(dementia developed within 3 months of the stroke),
- early development of walking disorder - frontal dysbasia - the patient "can not walk",
- the presence of moments of instability and unprovoked falls,
- early development of urinary disorders not associated withurological disease,
- personality change, mood,
- violation of social behavior.

According to the degree of social adaptation, ability to self-service and the need for supervision, distinguish between mild, moderate and severe forms of dementia.

Diseases leading to dementia

Alzheimer's disease is classified - with early onset, with late onset and atypical. Alzheimer's disease is the primary neurodegenerative process leading to the death of neurons and the formation of senile( amyloid) plaques in the cells of the cerebral cortex - this is cortical dementia.

There is a genetic cause of the disease. Risk factors are age, family history, severe vascular disease. Alzheimer's disease is total dementia in the elderly and elderly.

Areas affected by Alzheimer's disease .

Gradually the decline of intellectual functions progresses, the understanding of the surrounding world and independent actions in it are disrupted. The first to suffer memory and attention, the orientation in time, the character changes. Man becomes apathetic egoist. New information can not be understood, scattered, forgetful, recounts past memories as new.

With progression, violations of orientation in time, location, myself are increasing. Patients do not recognize relatives, lose their professional and household skills, their speech is broken - the vocabulary is reduced, false memories, meaningless expressions, lose the ability to read and count.

There may be delusions and hallucinations.

In severe cases, patients are completely dependent on outside care and can not exist on their own. There is a complete disintegration of personality. There remain stereotypical meaningless cries and movements within the bed. With MRI - atrophy of brain substance.

Subcortical vascular dementia is characterized by a slowing of information processes, memory and attention disorders, violation of the processes of memorization and retention of new information, violation of abstraction, speech dysfunctions, programming and switching disorders, apathy, depression, disturbance of frontal type walking( walking slows, step shortens,it is difficult to begin walking, unsteadiness during bends, the area of ​​a support increases).

In severe cases - dementia, complete helplessness, violation of pelvic functions. This is Binswanger's disease .Synonyms - subcortical atherosclerotic encephalopathy, hypertensive encephalopathy of binswanger type, atherosclerotic encephalopathy, progressive vascular leukoencephalopathy.

MRI reveals multiple bilateral foci in white matter larger than 2 cm and no cortical lesions.

Peak Disease is a rare, chronic progressive disease of the central nervous system, manifested by atrophy and destruction of the cerebral cortex in the frontal and temporal lobes. The course of the disease is more malignant than Alzheimer's. The symptoms of total dementia, disintegration of speech functions, thinking and perception, aphasia, amnesia, apathy and extrapyramidal disorders increase more rapidly and the "disintegration" of the personality quickly occurs.

A differential diagnosis of dementia is made between Alzheimer's, Pick's, Kreuzfeld's - Jakob's, vascular dementia and secondary dementias associated with somatic diseases and intoxications.

Examination of a patient with dementia

When a referral to a doctor with a cognitive impairment or already with dementia is carried out a comprehensive examination. Often in the initial stages of the disease, the patient himself does not pay attention to changes in his behavior, so attentive relatives and employees, pay attention to the person who became sluggish, began to confuse words and events, replace them with others, and became withdrawn. He needs to see a doctor.

The survey uses psychometric scales( MMSE), neuropsychological examination, examination of the neurologist, therapist, ophthalmologist.

Laboratory diagnostics is necessary to exclude toxic damage, metabolic disease - blood - sugar, lipidogram, electrolytes, creatinine, hepatic tests, thyroid hormones, vitamin levels, syphilis, HIV.

ECG, vascular dopplerography, EEG with mapping, genetic testing, computed tomography and magnetic resonance imaging, functional radioisotope methods - single photon emission computed tomography( estimated regional blood flow - in Alzheimer's disease it is decreased in the parietal temporal region, with dementia with corpusclesLevy - in the occipital lobes) and positron emission tomography( assess the level of glucose metabolism in the brain - in Alzheimer's disease, it is lowered in the parietal-temporalth field, dementia with Lewy bodies - in the parietal - temporal - occipital region and the cerebellum, depression - is not changed, in vascular dementia - patchy).

For the diagnosis of Alzheimer's disease and vascular dementia, the ischemic scale of Khachinsky is used, in which the sudden onset of the disease, step-like course, fluctuations, night confusion, personal safety, depression, somatic complaints, emotional lability, the presence of arterial hypertension, stroke, atherosclerosis,neurological symptoms.

The presence of more than 7 points - a sign of vascular dementia, less than 4 - is likely to diagnose Alzheimer's disease.

Prophylaxis of dementia

Prevention of vascular dementia - prevention of cerebro vascular diseases and their progression. Be sure to treat arterial hypertension, atherosclerosis, reduce lipids, adhere to a diet low in cholesterol, use olive oil, eat condiments from the root of curcuma( curry prevents the spread of amyloid plaques in the brain, due to which dementia develops), a healthy lifestyle, follow-up of the doctor's recommendations after a stroke. It is necessary to force your mind to work - to read, to teach, to retell.

Dementia Treatment

Dementia treatment is an attempt to improve cognitive deficits. Treatment is prescribed by a neurologist and a psychiatrist. Used drugs: donepezil, galantomine, rivastigmine, memantine. Preparations are taken constantly. The courses use neuroprotectors - cerebrolysin, citicoline, semax, glycine, cortexin. Symptomatic may be prescribed antidepressants, tranquilizers, sleeping pills.

In the photo, June Edwards, the diagnosis is Alzheimer's disease. Her son recorded the stages, as there is a loss of reality and the extinction of the individual with dementia.

The doctor neurologist Kobzeva Svetlana Valentinovna.

* Restoveryrol - a compound that is contained in grapes, red wine and peanuts, is able to prevent age-related memory loss. This was found out by researchers from the Institute of Regenerative Medicine. It is known that resveratrol is useful for the cardiovascular system. Specialists have found out: it also positively influences the hippocampus, the brain region associated with memory, learning process and mood. Probably, resveratrol can cope with neurodegenerative diseases, such as Alzheimer's disease.

Resveratrol properties have been described for a long time, for example, it reduces the risk of head and neck cancer. Resveratrol is an antioxidant that promotes the rapid growth of specific cells - histiocytes( they start to multiply faster than cancer cells) so resveratrol is very effective for cancer, but not in combination with alcohol.