Vascular dementia: symptoms, diagnosis and treatment methods

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Vascular dementia is a disease associated with impaired brain activity. Often the pathology is directly related to a stroke, which leads to damage to the blood vessels of the head. As a result, the patient's cognitive abilities decrease. Thinking becomes illogical, memories begin to disappear, speech becomes meaningless, and the ability to navigate in time and space is lost. The man loses his mind. This process usually lasts 6-8 months. But sometimes an acute form of dementia occurs immediately after a stroke.

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What happens in vascular dementia

Blood circulation in certain areas of the brain can be impaired for various reasons: hemorrhage due to a stroke, thrombosis, blockage or narrowing of vascular passages by atherosclerotic plaques. As a result, many cells are deprived of oxygen supply and are deprived of the ability to fully function. Hypoxia gradually or immediately leads to their death. As a result, the structure of the brain changes and its functions are disrupted, which contributes to the development of vascular dementia.

The degree of dementia depends on the size of the affected area; symptoms can be invisible both to the patient himself and to his environment or, on the contrary, to be very striking: inappropriate behavior, neurosis, impaired orientation in time and space, aggression, increased emotionality.

The consequences of the disease are dangerous. Vascular dementia in older people (the symptoms of which we will list later) is fraught with:

• complete loss of ability to work (the patient cannot receive and transmit information, perceive and assimilate new data, establish cause-and-effect relationships);
• human helplessness (he is not able to take care of himself, cook food, go to the store, forgets the simplest household skills, may get lost);
• psychosis (a person becomes dangerous to others, aggressive, prone to inappropriate actions).

Symptoms of vascular dementia rapidly progress, and as a result, the patient’s personality changes dramatically.

Unfortunately, the disease cannot be cured; changes in the brain are provoked by massive cell death and circulatory disorders, so the affected areas are not restored. Drug therapy in this case is prescribed to maintain blood supply to the brain and eliminate the symptoms of vascular dementia (if possible), which will negatively affect the life of the patient and his loved ones.

Patients with dementia are seen by a psychiatrist and a neurologist.

Reasons that can lead to the development of vascular type dementia:

• arterial hypertension;
• diabetes;
• advanced age;
• mental pathologies;
• serious brain injuries, brain surgery;
• insufficient physical activity;
• bad habits.

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Disease prevention

Preventive measures are aimed at combating risk factors for the development of diseases in adulthood and old age, such as: depression, vascular diseases, hypertension, atherosclerosis, diabetes, obesity, high cholesterol.

It is necessary to eliminate bad habits such as smoking and alcohol abuse, which can trigger the development of early dementia.

Physical education reduces the risk of developing dementia and slows it down, allowing you to maintain skills that are necessary in everyday life, and helps improve the cognitive abilities of people with dementia.

Nutrition helps prevent dementia. Research confirms the fact that the more vegetables and fruits in a person’s diet at a young age, the lower the percentage of developing dementia in the future.

Early dementia is usually difficult to diagnose. Symptoms such as absent-mindedness, forgetfulness, and inability to concentrate can be explained by chronic fatigue and stress, so it is very important to see a doctor if your cognitive abilities are deteriorating.

How to distinguish vascular dementia from Alzheimer's disease

MRI or CT is used as diagnostics; without these studies, it is very difficult to obtain data about the disease and determine its type only by the symptoms that appear. Experts focus on the following indicators:

1. If memory and cognitive impairment are observed after a stroke, a diagnosis of vascular dementia is made.
2. With signs of Alzheimer's syndrome, the pathological process develops slowly but steadily; with vascular dementia, symptoms arise suddenly, sharply, with a gradual course, and sometimes fluctuations in the manifestation of symptoms occur.
3. Often with vascular dementia, signs of focal brain damage, weakness of the limbs (hemiparesis), impaired reflexes of the right and left arms and legs, and the severity of the Babinski reflex appear.
4. Gait disturbance (shuffling, slowness, unsteadiness) is also a symptom of vascular dementia. Patients often complain of dizziness, confusing it with instability.
5. In chronic ischemia, a characteristic symptom of vascular dementia is incontinence. This symptom is observed in almost all patients.

It is noteworthy that one patient may exhibit both symptoms of vascular dementia and signs of Alzheimer's syndrome. Modern scientists have been able to conduct research that has shown that deformation of cerebral vessels becomes the main factor in the development of Alzheimer's syndrome and one of the main reasons for the onset of the neurodegenetic process. In this regard, many forms of dementia are mixed in nature - vascular-degenerative.

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Classification by localization

• Cortical dementia - formation occurs with predominant damage to the cerebral cortex. Examples are Alzheimer's disease and alcoholic encephalopathy. This type is characterized by amnesia, significant cognitive disorders, such as impairment of abstract thinking and calculation, speech disorders, even absence, and inability to recognize faces. The patient does not remember his name and does not recognize his relatives. Movement disorders are not typical.
• Subcortical dementia is a disease that affects subcortical structures. Examples are: dementia in Parkinson's disease, Huntington's disease, toxic dementia, as well as dementia in diseases such as normal pressure hydrocephalus, metabolic encephalopathy, corticobasal degeneration. The disease is characterized by slow thinking, nasal or muffled speech, mild memory impairment - forgetfulness, severe motor impairment, and tremor.
• Cortical-subcortical dementia is formed when the cortex and subcortical structures are damaged, with the presence of two types of symptoms. Typical representatives are: vascular dementia, dementia with Lewy bodies, corticobasal degeneration.
• Multifocal dementia is a rapidly progressing type; the disease is characterized by multiple focal lesions in all parts of the brain. An example is Creutzfeldt-Jakob disease. Characterized by amnesia, perceptual disturbances, speech impairment and loss of practical skills.

Vascular dementia and its symptoms

Dementia manifests itself as a complex of symptoms that vary in accordance with the nature of the disease and its stage. Here are common symptoms of vascular dementia:

• difficulty perceiving information;
• impaired orientation in space and time;
• depression;
• apathy;
• memory impairment;
• epilepsy attacks;
• slurred speech;
• inhibited reactions;
• lack of coordination;
• slow cognitive and psychological functions;
• changes in emotional state;
• difficulties in establishing interpersonal relationships.

1. First stage.

The main clinical symptom of vascular dementia is memory impairment. At the beginning of the development of the disease, the clinic manifests itself in a mild form, it is difficult to recognize due to the fact that even a completely healthy person sometimes observes memory problems (who has not at least once lost a phone in an apartment while holding it in their hands, or not confused salt with sugar, or did not try to open the front door with the garage key).

Next, the so-called fixation memory loss appears, when the patient cannot remember what he said or what happened recently. Similar symptoms appear in the early stages of Alzheimer's disease. For such disorders, the best remedy is keeping a diary: the patient will be able to reproduce the necessary facts by reading personal notes.

There is an exacerbation of some character traits. For example, previously a person could rarely criticize his friends, but in the acute stage he begins to literally mock his loved ones or those around him, not missing the slightest opportunity to point out their wrong actions, and becomes a grumpy cynic. The punctuality inherent in a person in previous periods of life turns into pettiness, and “creative disorder” into a real dump, etc.

The ability to make and execute plans decreases, this becomes very noticeable and is complemented by forgetfulness. Simply put, even having dinner at 18:00 for a patient can be an impossible task.

Mental work is too complex for a patient with vascular dementia; he is simply unable to perceive, summarize and analyze information. A person forgets words, repeats what was said several times, and numerous parasitic phrases appear in speech.

For reference! At the beginning of the development of vascular dementia, disturbances of consciousness are not detected.

The patient becomes irritable, tearful, prone to depression, refuses to communicate, confuses days of the week and dates, names of cities, countries, names of famous people. Can take care of himself, but still needs help from relatives.

In the case of a sudden onset of progression of vascular dementia, epileptic seizures and problems with short-term and long-term memory are characteristic.

2. Middle stage.

As the disease progresses, serious memory impairment begins, some real memories are replaced by fictitious ones, the patient reproduces moments experienced in childhood or other long-standing fragments of life very well, even better than healthy people. Fictions can be similar to reality or look like fantastic nonsense.

Sometimes pseudoreminiscence occurs - the patient's old memories move into the present. For example, a grandmother who can barely make it to another room quickly begins to get ready for school or work. Very often the patient asks to be returned to the place where he grew up or was born, and tries to meet with former friends.

Coordination and spatial orientation are severely affected; the patient should not be allowed to leave the house unaccompanied, otherwise he may get lost.

The patient cannot handle household appliances: cook food, wash clothes, clean the apartment. He is still able to take care of himself, but signs of sloppiness are already noticeable: spitting on the floor, wiping his nose with his sleeves, putting garbage in his pockets, etc.

A person loses interest in previously favorite activities; all his leisure time comes down to watching TV or humming songs he learned earlier. In the middle stage of development of vascular dementia, the patient needs outside help and supervision so that he does not cause harm to himself or others.

3. Severe stage.

The last stage of the disease is characterized by worsening symptoms. The patient speaks little, reacts to almost nothing, becomes stubborn and violent. The degradation of physical abilities begins - the patient moves little, cannot walk or move without the help of loved ones. At this stage, a complete breakdown of personal characteristics occurs - the patient does not recognize his relatives and does not remember who he is.

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Diagnosis of vascular dementia

The diagnosis is made after a psychodiagnostic study, testing according to the Khachinsky scale and the Mini-mental State Examination (MMSE) system.

Three factors support the diagnosis of vascular dementia:

1. Dementia was confirmed by psychodiagnostic testing.
2. There are cerebrovascular diseases identified by Dopplerography of cerebral vessels, ultrasound of the great vessels, CT, and MRI.
3. The first and second factors coincide or are related.

If the patient has any characteristic symptoms, he is prescribed a differential diagnosis for Alzheimer's syndrome. A comprehensive examination is carried out, the stage of the disease is determined and a course of therapy is prescribed.

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What anatomical changes in the brain are found in dementia

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

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

The anatomical substrate of dementia is:

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

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

An important role in the occurrence of pathology is assigned to the basin of the vertebral and carotid arteries. The narrowing of these vessels causes difficulty in the flow of blood into the arteries of the brain.

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

Treatment methods for vascular dementia

• Drug treatment.

So, the symptoms and treatment of vascular dementia in older people. Considering that this is not a specific disease, but a whole set of different symptoms, a differentiated technique is used for patients. With dementia, damage to the cerebral vessels occurs, which causes the destruction of brain cells, so drug therapy prescribed to the patient is aimed at slowing down the pathological process.

Prevention consists of preventing various vascular diseases, which include damage to capillary networks. For these purposes, medications are prescribed that normalize blood pressure - they try to bring it to 120/80 mmHg.

To prevent cerebral infarctions, drugs of the class of disaggregants are used - drugs to reduce platelet aggregation and to suppress the formation of blood clots.

For heart problems, anticoagulants are used, which inhibit the activity of blood clotting processes.

The patient is prescribed calcium antagonists and peptidergics to restore mental abilities.

The treatment method may vary and depends on the condition of the patient, who must be under the supervision of medical professionals. The doctor monitors all the body’s reactions to treatment, the mental and physical condition of the patient, this approach helps to get the maximum effect from therapy.

• Features of psychotherapy.

Psychotherapeutic methods of treating vascular dementia are used as auxiliary measures. Trainings are conducted for the patient’s social adaptation, which improve important abilities:

— thinking;

- memory;

- speech;

- ability to analyze information.

There are different ways to improve your mental abilities:

- group reading of short stories, discussion of what they read, learning poems helps train memory; For the same purposes, a biographical technique is used: the patient looks at photographs and listens to musical compositions of ancient times;

— keeping a diary helps a lot - it serves as training for the mental function, restores discipline and gives you the opportunity to throw out negativity on paper;

— physical training is effective not only for motor functions, but also for psychological functions; a set of special outdoor exercises helps eliminate signs of depression.

• Lifestyle during illness.

The main thing is to eat right! Salty foods and animal fats are excluded - they are harmful. An important factor is quitting smoking and alcohol.

Under no circumstances should the patient be left alone with the disease. An elderly person must be encouraged to engage in activities and communicate with him so that the symptoms of the disease do not progress unimpeded. Outdoor walks, physical activity and body weight control are required.

After dementia passes into a severe phase, all dangerous objects and devices should be removed from the patient. If a patient has a stroke, it is important to monitor their blood pressure.

Dementia does not go away without a trace, but it is possible to slow down the process and help some brain functions recover. Complex therapy should be prescribed, taking into account the manifestation of symptoms and individual characteristics. In addition to medications, you need a diet, an active lifestyle (if possible) and verbal group communication.

Total dementia syndrome

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

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

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