Symptoms of vascular dementia. Vascular dementia - symptoms, treatment and prognosis Mechanism of disease development

Vascular dementia– a syndrome that is characterized by a deterioration in mental abilities and human behavior, which is caused by damage to the blood vessels of the brain. There is a partial or complete collapse of mental functions. This is very dangerous condition, which leads to disability, so it is very important to pay attention to the symptoms as early as possible and begin treatment.

How does this disease develop? When blood vessels are damaged in certain areas of the brain, nerve cells stop receiving oxygen and nutrients that are necessary for their full functioning. Because of this, they begin to die. For some time, the brain copes with this, so the situation does not make itself felt outwardly. But after the potential is depleted, negative changes begin to affect the state of memory, thinking and speech. These cognitive disorders affect a person’s behavior, even his independence decreases.

The prognosis is very poor, especially if the disease progresses rapidly. It also affects the patient’s life expectancy. This shows the importance of timely investigation and treatment. It is important not just to determine the stage, in order to understand how the disease will develop further, it is necessary to slow down this process.

Causes

In many countries it is believed that main reason dementia - Alzheimer's disease, a disease that is associated with the death of nerve cells. It has been established that the signs of this dangerous disease can be caused by problems with blood circulation in the brain. It is in this case that we are talking about dementia of vascular origin.

This disease in its pure form is detected in approximately 15% of all cases of dementia in older people. But there are many patients who have mixed type diseases. They are based precisely on a combination with Alzheimer's disease. There are several reasons for the development of the disease, the ICD 10 code of which is F01.

1. . There is an opinion that the main reason why vascular dementia develops is acute disorders of cerebral circulation, as brain cells that are left without nutrition die. Indeed, a stroke increases the risk of developing dementia several times. Statistics show that during the first year after an attack it develops in approximately 30% of patients. Much depends on the location of the stroke and the size of the affected area. It has been noted that dementia of vascular origin begins to develop if the lesion affects more than 50 ml of the brain. In the event that the disorder affected the core area for cognitive functions, this number may be lower.

1. Chronic cerebral ischemia. According to scientists, the development of dementia does not necessarily have to be preceded by an acute disorder; blockage of small vessels may be sufficient. The cause may not be obvious, in which case dementia is called subcortical. Despite its secrecy, this type of ischemia can be detected using modern methods research.
2. Decreased blood flow to the brain. The background for this is heart failure, reduced volume of circulating blood, and a strong decrease in blood pressure. Due to the weakness of the blood flow, the peripheral areas of the vascular basins do not receive the required amount of blood, so the nerve cells begin to die.

We can conclude that there are two pathogenetic mechanisms due to which vascular dementia develops:

• acute circulatory disorders in the brain;
• chronic lack of blood supply to the brain.

These disorders can occur together, causing clinical picture the disease becomes more obvious.

There are several forms and stages of development of the disease, which is reflected in ICD-10 and affects the diagnosis and, as a consequence, the treatment process. Since this disorder affects the life expectancy of older people due to a poor prognosis, it is important to identify symptoms early and monitor the patient’s treatment.

Today, the problem of vascular dementia is both medical and social. This is due to the fact that as a result of this disease not only becomes worse quality people's lives. Because of it, considerable economic losses occur, since patients need constant monitoring, especially if they have a severe form of such a serious illness.

Often the main burden due to the patient’s disability falls on relatives, who also strongly feel the terrible consequences of the disease. Its duration cannot be predicted, but life expectancy is in any case shorter, which also often brings a lot of pain.

Anyone caring for such a patient should never prescribe any medications on their own. It is important to strictly follow the doctor’s orders and carry out all studies and tests on time.

Symptoms

Symptoms of vascular dementia in older people depend on various factors. Based on certain signs, the form of the disease is revealed.

1. Dementia with acute onset, coded according to ICD-10 F01.0, is characterized by the appearance of cognitive impairment during the first month after the stroke occurred. Typically, the time for the appearance of such signs does not exceed three months after the attack.
2. The development of multi-infarct dementia (ICD-10 code – F01.1) occurs gradually over six months after several ischemic episodes have occurred. With this form of the disease, there is an accumulation of infarcts in the brain parenchyma of the head.
3. The subcortical form is manifested by arterial hypertension. There are symptoms of damage to the deep zones of the white matter of the cerebral hemispheres of the head.

Increasingly, attention has begun to focus on forms of dementia that are not directly related to cerebral infarctions. This is due to the fact that patients are sometimes given an inaccurate diagnosis, after which the wrong treatment is prescribed. It has been noted that sick people are diagnosed with Alzheimer's disease, the treatment of which uses other drugs. In this case, the vascular lesion continues to develop more and more actively.

Even if the exact cause of the patient’s deteriorating condition is subsequently revealed, the prognosis still remains extremely unfavorable, which, first of all, affects life expectancy. Therefore, it is extremely important to conduct thorough research, accurately diagnose, and identify the stage of the disease. To do this, you need to be examined by qualified specialists, and even take tests in a good clinic.

Vascular dementia is characterized by a clinical diversity of disorders. Neuropsychological and neurological syndromes may be combined in patients. The following symptoms are common in patients with dementia:

• slowing down psychological processes;
• narrowing the range of interests;
• decreases in cognitive functions;
• problems with performing household functions and self-care;
• loss of an adequate assessment of one’s health status.

Cognitive disorders primarily include attention and memory disorders. They are observed at the beginning of the development of the disease and continue to actively develop. If you do not take the prescribed medications, the prognosis will be even worse. More than 50% of patients have emotional incontinence, such as weakness or violent crying. Some patients experience depressive disorders.

Signs of the disease are also considered depending on the stage.

1. At the first stage, the person is very irritated and emotionally unstable. Dizziness, headache, insomnia or drowsiness occur.
2. At the second stage, psychopathological symptoms worsen, and anxiety-depressive syndrome develops. Consciousness may be impaired, hallucinations and delusions may occur.
3. At the third stage, memory impairment and cognitive disorders develop even more. At this stage, dementia is greatly activated. Some patients cannot control their appetite, become indifferent, and can lie or sit for hours. Visual or auditory hallucinosis may occur.

Diagnostics

How is vascular dementia diagnosed? In addition to clinical signs, the patient’s mental state is diagnosed, which is carried out using special tests.

Also important are the results of studies such as MRI and CT, which help to detect affected areas of the brain and establish the stage of degenerative processes. All necessary tests are taken, all results are compared with each other and carefully studied.

As a result of the research, a diagnosis is made based on the 10th International Classification of Diseases:

• F01.0 – dementia with acute onset;
• F01.1 – multi-infarct form;
• F01.2 – subcortical dementia;
• F01.3 – mixed cortical and subcortical dementia.

According to ICD-10, other types of disease are designated as F01.8. If the type is not specified, code F01.9 is set. After a diagnosis has been made in accordance with ICD-10, and for this it is necessary to undergo all prescribed studies and tests, treatment is prescribed.

Treatment

Treatment of vascular dementia is complicated because it is impossible to make accurate conclusions about the cause of the disease. Today, a differentiated approach has become common, since dementia is caused by a complex of syndromes.

The drugs prescribed by the doctor are aimed at preventing and slowing down the negative process that occurs in the patient’s brain. Antiplatelet drugs are used to prevent cerebral infarctions. If there are pathological changes in the heart, anticoagulants are used

Peptidergic drugs, nootropics, calcium channel antagonists help improve cognitive functions. It is very important to strictly follow the dosage prescribed by the doctor. You cannot take medications on your own that you have read or heard about somewhere; consultation with specialists is necessary.

If there is the slightest suspicion of dementia, you should immediately take the person to the hospital. There they will conduct research, take tests, make an accurate diagnosis, on the basis of which decisions will be made regarding treatment, prescription of medications, and disability group. Treatment of vascular dementia will improve the quality of life and possibly prolong it.

Diseases of the cerebral vessels threaten the further development of not only strokes and heart attacks, but also changes in the human psyche, characterized by a gradual decrease in his intellectual abilities and opportunities for social adaptation.

Such disorders include vascular dementia - a progressive dementia, which is based on persistent.

Risk factors and causes of development

Most often, this form of dementia occurs as a consequence of vascular accidents - strokes and heart attacks. During a rupture of a cerebral artery thrombosed by a blood clot, blood flows into the brain tissue, causing massive death of nerve cells - neurons.

The likelihood of developing vascular dementia is highest in cases where the neurons of the cortex and some areas of the subcortex of the brain die: these are the parts that are responsible for a person’s cognitive abilities. If hemorrhage occurs in other areas, then no mental disorders are observed: only disturbances in coordination of movements and orientation in space are noted.

Heart failure- another cause of mental disorders in patients. This is explained by a persistent weakening of peripheral blood flow in the arteries of the brain, since diseased heart loses the function of the “pump” that normally supplies blood to the brain.

As a result, the death of neurons also occurs, which inevitably affects the psyche of people suffering from heart failure.

Plays a role in the development of vascular dementia chronic ischemia, when brain tissue is deprived of a full supply of blood and the oxygen it carries. Persistent hypoxia develops, and its consequences are expressed in the death of nerve cells and the further appearance of symptoms of vascular dementia.

Thus, the main reason for the weakening of mental activity is impaired blood circulation in the heart and brain, caused by constantly increased or decreased blood pressure.

There are also factors that can directly or indirectly influence the likelihood of cognitive decline. These include:

• Age (elderly and senile);
• Gender (dementia most often develops in men);
• Bad habits (smoking and excessive drinking);
• Heredity.

Already existing chronic diseases: diabetes, autoimmune and infectious

It is also interesting that people who initially have high level intelligence and well-educated people develop vascular dementia less often than those whose intelligence is low. This is explained by the difference in the reserve capabilities of the brain.

Symptoms

If certain changes appear in the behavior and psyche of patients who have had episodes of strokes or heart attacks in the past, the doctor may suspect that they are beginning to have vascular dementia: its symptoms depend on which area of ​​the brain is affected by the hemorrhage.

If the midbrain is affected, then the symptoms manifest as mesencephalic syndrome:

• Confusion of consciousness up to the appearance of hallucinations;
• Speech disorders;
• Drowsiness.

Such patients become withdrawn, apathetic, and stop taking care of themselves.

Hemorrhages in the hippocampus (the limbic system of the brain, responsible for memory and the emotional sphere) are characterized by memory loss, in which the patient cannot remember recent events, but remembers well what happened a long time ago.

If massive neuronal death affected frontal lobes, apathetic-abulic syndrome develops: the patient loses adequacy.

This is expressed in apathy, fixation on any one action - for example, repeating one phrase spoken by oneself or heard somewhere.

Vascular dementia caused by damage to the subcortical zone can be recognized by the following signs:

• Impaired concentration on thoughts or actions;
• Loss of ability to plan, count;
• Difficulties in analyzing incoming information when the patient cannot determine the main and secondary things.

Besides specific symptoms, indicating damage to one or another area of ​​the brain, there are also general signs of developing dementia:

• Movement disorders (shaky, shuffling gait);
• Urinary incontinence;
• Epileptic seizures.

However, it is worth noting that the symptoms of vascular dementia may periodically weaken: from time to time, the condition of patients improves, and manifestations of mental impairment become minimal. This is due to the compensatory capabilities of the brain zones adjacent to the affected parts: they take over additional load and partially restore cognitive function.

Emotional disorders

Patients are depressed most of the time, so persistent depression and associated disorders in emotional sphere are also among the most striking manifestations of this mental pathology.

Dementia patients experience emotional incontinence - tearfulness, fixation on negative experiences, excessive sentimentality or, conversely, indifference to what is happening around them.

Personality changes in dementia patients

Vascular dementia entails pronounced changes in people’s personality: patients become pathologically stingy, suspicious, and conservative. They have difficulty accepting new things and are not interested in the world around them or the experiences of other people. Often there is a disregard for moral standards, a loss of the ability to properly evaluate one’s own behavior and the behavior of others.

Dementia patients begin to give the impression of lazy, degenerate, selfish people, although before they were completely different.

Diagnostics

Diagnosis of vascular dementia is carried out on the basis of psychodiagnostic studies and neuroimaging methods. Psychodiagnostic measures include tests on the MMSE, Khachinsky and other scales.

Imaging methods used include Doppler, CT and MRI of the brain.

Also appointed biochemical tests blood.

There are three criteria sufficient to make a diagnosis:

1. A history of cerebrovascular disease;
2. Psychodiagnostic data indicating dementia changes;
3. Established connection between the first two criteria.

Treatment of the disease

Dementia of vascular origin is classified by the ICD as mental illness. However, its treatment differs somewhat from standard treatment regimens. mental disorders. This is due to the fact that dementia is based on gross changes in the conditions of blood vessels and the subsequent vascular catastrophes.

The main emphasis here is on the treatment of the dominant pathology (that is, vascular disease of the brain and heart), and dementia manifestations are subject to symptomatic correction.

Thus, normalization plays an important role blood pressure, since both persistently elevated and persistently decreased blood pressure is fraught with the development oxygen starvation in brain tissue.

To prevent recurrent strokes, patients are prescribed perindopril, lisinopril and other drugs of the ACE inhibitor class. It is highly advisable to prescribe them together with diuretics.

Dementia at an early stage requires the use of nootropics and Cerebrolysin. In the later stages, it is advisable to include tranquilizers in the treatment regimen.

The prescription of psychotropic drugs is indicated only for depression, anxiety and insomnia.

Home care consists of monitoring relatives and involving demented patients in performing simple household chores, creating conditions for moderate physical activity, feasible intellectual activity.

Deterioration of cognitive functions after strokes and heart attacks is a serious medical, social and psychological problem, the solution of which requires a lot of effort. It is most reasonable to ensure the prevention of dementia in the early stages of the disease ( hypertension, diabetes mellitus, cardiac pathologies) - then the manifestations of mental disorders can be, if not avoided, then significantly delayed in time.

Dementia or dementia is one of the types of cognitive mental disorders associated with the cognitive sphere of a person. Depending on the severity of dementia symptoms, the disease can be mild, moderate or severe.

With a mild degree of dementia, only the patient’s professional qualities deteriorate and his social activity decreases. A symptom of moderate dementia is loss of ability to use most household items. At the stage of severe dementia, a person is completely maladapted and dependent on others. He is not able to independently cope with the simplest problems of hygiene or food intake.

Depending on the cause of dementia, there are two main types of disease: senile dementia (also known as senile dementia) or vascular dementia.

Senile dementia

Senile or senile dementia is caused by age-related changes in the structure of the brain. Changes gradually occur at the neural level and are provoked by both insufficient blood supply to the brain and other chronic diseases or acute infections. The cause of senile dementia can be metabolic problems, pathologies of the kidneys and adrenal glands, immunodeficiency, malignant neoplasms or neurodegenerative disorders, such as Alzheimer's disease.

Senile dementia is an irreversible disorder that affects all cognitive spheres of the psyche: thinking, memory, speech, attention. The progression of the disease is accompanied by the loss of all acquired skills and abilities. The ability to acquire new knowledge in patients with senile dementia is also sharply limited.

One of the main symptoms of this type of dementia is the stability of the manifestation of signs of dementia, in contrast to delirium, when the patient experiences temporary attacks of disorientation.

As a common definition for senile dementia, the expression “ senility" The disease affects older people over 65 years of age. On average, 5-15% of the world's retirement age population suffers from various manifestations of dementia symptoms.

Vascular dementia develops as a result of cerebrovascular accidents caused by damage to brain tissue. Vascular dementia can lead to most vascular diseases, For example, arterial hypertension, atherosclerosis, cerebral vascular ischemia, etc.

The results of post-mortem studies of the brain structures of patients with vascular dementia suggest that the cause of the disease is often a heart attack. Or rather, not the myocardial infarction itself, but the cyst formed as a result of it. Moreover, the likelihood of developing vascular dementia does not depend on the size of the damaged cerebral artery, but on the total volume of necrotic cerebral arteries.

A symptom of vascular type dementia is a sharp decrease in cerebral circulation and metabolism. If the disease is accompanied by laminar necrosis with the death of neurons and proliferation of glial tissue, serious complications are possible in the form of embolism (blockage of blood vessels) and cardiac arrest.

Risk factors for vascular dementia include various cardiac pathologies, diabetes mellitus, hyperlipidemia ( increased level blood lipids).

Symptoms of vascular dementia are most often diagnosed between the ages of 60 and 75 years. The disease is 1.5 times more common in men and accounts for 50% of all cases of diagnosed dementia.

Common symptoms of different types of dementia

The average duration of the disease is 5 years with gradual increasing changes in the patient’s personality. First obvious symptoms dementia – sharpening of certain character traits of a person, for example, frugality, stubbornness, suspiciousness, etc. A sick person with progressive vascular or senile dementia exhibits conservatism in actions, judgments and has difficulty accepting anything new. His interests are narrowed, his ability to think is deteriorated, and moral standards of behavior are lost.

As the disease progresses, a person may have difficulty recalling recently occurring events. Then orientation in time and space is lost, although behavior, speech, facial expressions and gestures remain unchanged for a long time.

Physical symptoms of dementia: exhaustion, tremor of the hands, changes in gait - develop only at the most severe stage of the disease, along with increasing signs of personality disintegration.

Diagnosis of dementia

A diagnostic sign of dementia is atrophic processes in the brain. Their recognition is carried out using computed tomography brain. With a pronounced decrease in the patient’s cognitive abilities and detected vascular lesions of the brain, making a diagnosis is not difficult.

Much is written in medical journals about additional diagnostic method differentiation of vascular dementia from Alzheimer's disease - the so-called Khachinsky scale. It is a list of 13 symptoms of dementia. A match on 7 points or more indicates the likelihood of vascular dementia; a statement of less than 7 symptoms is characteristic of Alzheimer's disease.

Dementia treatment

There is currently no effective treatment for dementia, especially when it comes to severe senile dementia. However, with proper care of the patient and symptomatic treatment dementia, serious relief of the patient's lot is possible.

The recommended setting for treating dementia is the home environment. Hospitalization and placement of the patient in a psychiatric department is recommended only for severe senile dementia. The desired daily routine, which the patient’s relatives should provide, is maximum activity and simple household chores.

Psychotropic drugs in the treatment of dementia are prescribed only for insomnia or hallucinations. In the early stages of treating dementia, it is advisable to prescribe nootropics, and later tranquilizers and nootropics.

There is no effective prevention of vascular or senile dementia, as well as treatment.

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Vascular dementia is an acquired psychopathological syndrome characterized by a persistent impairment of the patient’s intellectual potential, manifested by deterioration of mnestic function and a pronounced decline in cognitive abilities. This disorder interferes with a person’s normal adaptation in society, complicates everyday life, deprives him of the ability to perform professional duties, limits or completely makes him incapable of independent care.

Unlike other psychopathological disorders, vascular dementia does not reveal any variants of impaired consciousness - the level of consciousness of the individual remains unchanged. Very often, dementia of vascular origin is accompanied by the appearance of a personality defect - a profound change in the fundamental characteristics of the individual, including personal abilities, manifestations of temperament, character traits, direction of interests, and worldview in general.

Intellectual defect in vascular dementia is manifested by a combination of defects in higher mental functions, including disorders of short-term and long-term memory, inability to perform adequately coordinated actions, deterioration in the processes of perceptual categorization, disturbances in speech function, attention, and thinking. A patient with vascular dementia deteriorates the ability to generalize and abstract thinking, and loses the ability to plan. He is not able to conduct analysis and make independent decisions, does not manage his actions and cannot control behavior.

In contrast to congenital mental retardation - mental retardation, intellectual defects in vascular dementia are acquired. Cognitive decline is a direct result vascular pathologies brain. The bloodstreams of the brain, affected by various factors, do not provide the nerve tissues with sufficient oxygen and nutrients. For this reason, there is a gradual death of nerve cells - neurons, which leads to a global disruption of human higher nervous activity.

In the vast majority of cases, vascular dementia has a sudden onset: the patient spontaneously develops impairments in one or more intellectual areas. This variant of dementia is characterized by a stepwise progression of symptoms. On examination, focal neurological defects are recorded.

It is worth noting that the quality of life of a person suffering from vascular dementia is significantly lower in comparison with persons who have been diagnosed with another type of dementia. This can be explained by the presence of severe motor abnormalities and sensory impairments in the structure of the disease. On average, the life expectancy of patients with severe vascular dementia is no more than five years from the moment of diagnosis.

Vascular dementia: causes and mechanism of development

There are many causes of vascular dementia. The main risk factor for development is a person’s age: it has been established that a greater number of patients who were diagnosed with this disease have crossed the sixty-year mark. A higher likelihood of developing vascular type dementia is present in males. Smoking is a provoking element in the development of vascular pathologies. Most often, this type of dementia is determined in representatives of the Negroid and Asian races.

Vascular dementia is more common among people who have low level education, characterized by low intelligence and working in blue-collar professions. At the same time, people engaged in intellectual work are much less likely to experience cognitive impairment, since such people have large intellectual reserves of the brain. Low social activity, lack of meaningful contacts, monotonous boring work, and lack of mental stress provide a more rapid progression of the symptoms of vascular dementia.

The causes and provoking factors for the occurrence of vascular type dementia are:

• arterial hypertension– stable rise blood pressure;
• arterial hypotension– fixation of blood pressure levels below the values ​​corresponding to the age norm for the patient A;
• hyperglycemia– persistent increase in blood glucose levels, causing diabetes mellitus;
• disruptions in lipid metabolism in the body, causing an increase cholesterol levels in the blood and leading to the development of atherosclerosis;
• acute disruptions in blood circulation in the structures of the brain;
• cardiac ischemia;
• heart rhythm disturbances– atrial fibrillation;
• congenital or acquired changes in the structures of the heart.

Despite the variety of provoking factors, doctors call the leading cause of vascular dementia precisely a persistent increase in blood pressure. Hypertension causes abnormal defects in the walls blood vessels brain. The occurrence of microatheromatosis - atherosclerotic lesions of arterioles, becomes the culprit of severe pathological ischemic lesions - lacunar infarctions. The formation of lipohyalinosis - degenerative changes in the walls of small blood vessels in the brain causes a decrease in their elasticity. As a result of the above abnormal processes, a change in the physiological reactivity of blood vessels occurs. Remodeling of the vascular wall causes a structural decrease in the lumen of the vessels due to thickening of their medial layer. As a result, circulatory disorders occur in the structures of the brain, loss of brain tissue occurs, which causes a pronounced deterioration in a person’s intellectual potential.

Vascular dementia: symptoms

With vascular dementia, a rapid onset of development and aggravation of symptoms is possible: the onset of intellectual activity disorders is observed within one month from the moment of acute cerebrovascular accident. For the multi-infarct type of acquired dementia, the symptoms of the disorder arise gradually: Clinical signs the diseases become pronounced after three months after a series of minor episodes of local decrease in blood supply to the brain.

IN last years Doctors record a large number of cases of vascular dementia, the onset of which was not associated with a cerebral ischemic stroke. Differentiating “non-infarct” dementia from dementia of the Alzheimer’s type is of great importance in neurology, since incorrect diagnosis prevents timely adequate treatment, which ultimately leads to rapid progression of vascular defects. It is for this reason that if a patient is suspected of having vascular dementia, it is advisable to conduct detailed studies using modern neuroimaging methods, in particular magnetic resonance imaging.

One of the variants of acquired dementia is subcortical atherosclerotic encephalopathy, also called Binswanger's disease. For of this disease characterized by atrophy of the white matter of the brain, most often caused by arterial hypertension. Binswanger's disease is characterized by symptoms: memory loss, loss of the individual's inherent cognitive abilities, rapid changes in the emotional background. Usually this type Vascular dementia is recorded in individuals aged 55 to 65 years.

Vascular dementia is characterized by a clinical variety of symptoms. In patients, a significant decrease in the speed of all processes of higher nervous activity is recorded. The patient's unpreparedness to change the program of action in accordance with the new requirements of the surrounding world is determined. All ongoing mental processes are unstable.

A person suffering from vascular dementia experiences significant symptoms of cognitive decline. All types of memory suffer. Memory of recent events fades. A person experiences difficulties when it is necessary to reproduce some information. The patient has difficulty remembering words and visual information. He loses the opportunity to acquire new motor skills.

A common symptom of vascular dementia is visual agnosia. Already in the early stages of the disease, a person cannot recognize the faces of others.

Attention function deteriorates. The person experiences significant difficulties in performing everyday duties. He is unable to carry out basic hygiene procedures: brush his teeth, comb his hair, shave. It is difficult for him to dress and put on his shoes on his own. He finds it difficult to prepare food for himself. Impaired ability to carry out counting operations leads to the patient having difficulty making purchases in a store. He can't fill out financial documents.

A dangerous symptom of vascular dementia is impaired orientation in space. It is difficult for a person to navigate in an urban area: he does not know where he is, does not understand in which direction he needs to move. As the disease worsens, disorientation in time occurs. Some patients cease to navigate their own personality.

A common symptom of acquired dementia is speech impairment. The patient finds it difficult to choose words suitable to express his thoughts. He is unable to give the correct names to the objects presented to him. The subject's utterances contain a small number of nouns. Very often with vascular dementia the individual cannot understand the meaning readable text. As the disease progresses, the patient loses the ability to speak in complete, meaningful and complete sentences. His narratives lack logical meaning and the incorrect use of grammatical structures becomes noticeable.

More than 50% of patients diagnosed with vascular dementia experience symptoms of emotional disturbances. A person shows weakness of convictions, fragility of spiritual interests and moral qualities. There is no firmness and decisiveness in actions. Some patients regularly experience violent involuntary crying, which does not correspond to the current situation and the emotions actually experienced. Many patients suffering from vascular dementia are in a state of deep depression with pronounced melancholic symptoms. Mood disorders often occur. Psychotic symptoms may be observed - auditory, visual, tactile hallucinations, illusions - false beliefs that do not correspond to logical reasoning.

In addition to signs of intellectual impairment, neurological symptoms are always recorded in vascular dementia, including:

• pyramidal insufficiency syndrome– disturbances in the sphere of voluntary movements (decreased strength in the limbs, deterioration in the ability to make fine movements, increased muscle tone and increased tendon reflexes);
• hyperkinesis of the subcortical level– torsion dystonia, chorea (erratic, jerky, irregular movements), athetosis (slow tonic spasm of the limbs, face, torso), ballism (large, sweeping, sharp, throwing movements), Rülf’s intentional spasm;
• pseudobulbar syndrome– dysarthria (pronunciation problems due to impaired innervation of the speech apparatus), dysphonia (loss of voice sonority while maintaining the ability to speak in a whisper), dysphagia (swallowing disorder);
• cerebellar syndrome– movement coordination disorders;
• limb paresis– weakness of the leg muscles;
• gait disturbance;
• urinary incontinence;
• paroxysmal states– short-term loss of consciousness, epileptic seizures, syncope (fainting, accompanied by a drop in muscle tone).

Vascular dementia: treatment options

The main step is to confirm the diagnosis of dementia and identify pathological conditions, preceding the disease. Treatment of acquired dementia is aimed at eliminating the pathology underlying cognitive impairment. Medical efforts are focused on eliminating or correcting the patient’s risk factors.

Since the main cause of vascular pathologies is arterial hypertension, treatment is aimed at normalizing blood pressure. Angiotensin-converting enzyme inhibitors are most often used in combination with diuretics. It is also advisable to include in the treatment regimen calcium antagonists and AT1 receptor blockers that act on the renin-angiotensin-aldosterone system.

To exclude the possibility of recurrence of cases of acute cerebrovascular accident, to prevent other problems from of cardio-vascular system, the treatment program for vascular dementia includes antiplatelet agents. For elimination atrial fibrillation Oral anticoagulants are most often used. If a patient has abnormally elevated lipid levels, it is advisable to take stanines - medications that reduce the production of cholesterol in the liver.

Since the leading symptoms of vascular dementia are mnestic disorders and cognitive impairment, the basis of treatment for the disease is drugs that act to improve intellectual functions. Among such drugs are medications of various groups:

• preparations containing Ginkgo Biloba leaf extract, which can reduce vascular tone and improve cerebral blood flow;
• anticholinesterase drugs - substances that inhibit the activity of the enzyme that breaks down acetylcholine;
• medications that regulate the synthesis of one’s own neurotrophic factors;
• nootropic drugs – neurometabolic stimulants that have a specific effect on higher mental functions of the brain;
• neuropeptides – substances that regulate various physiological functions of the body;
• drugs that have a membrane-stabilizing effect;
• NMDA antagonists are anesthetics that inhibit the action of the N-methyl-D-aspartate receptor;
• ascorbic acid, tocopherol, carotenoids, flavonoids that have an antioxidant effect;
• medications containing gamma-aminobutyric acid;
• vasoactive agents of selective action.

The presence of emotional, affective, and psychotic symptoms in patients with vascular dementia may require the inclusion of appropriate medications in the treatment program.

• In the presence of depressive symptoms, treatment with inhibitors is recommended recapture serotonin. In addition to eliminating depressive disorders, the use of antidepressants has a modulating effect on cholinergic functions.
• To eliminate psychomotor agitation, low doses of antipsychotics are used. As a rule, such drugs are taken once in the evening.
• For anxiety and insomnia, it is recommended to prescribe small doses of benzodiazepine tranquilizers. However, treatment with such drugs requires great caution due to the existing risk of increasing memory disorders.

Drug treatment of vascular dementia must be combined with systematic memory and attention training. Regular exercises will help compensate for the existing defect and improve the patient’s intellectual potential.

Vascular dementia- so-called lacunar (partial, dysmnestic) type of dementia. This type of vascular dementia is determined by increasing disturbances in memory and selective reproduction, disturbances in chronological dating and time orientation (with relative preservation of allo- and autopsychic orientation), progressive difficulty and slowdown of all mental processes. It is accompanied by asthenia and a decrease in mental activity, difficulties in verbal communication and finding the right words, a decrease in the level of judgment and criticism with a certain preservation of the consciousness of one’s own insolvency and basic personal attitudes (the core of personality is preserved), a feeling of illness and helplessness, a reduced tearful mood, weakness and “ incontinence of affects." This type of dementia develops mainly due to atherosclerotic processes that manifest themselves between the ages of 50 and 65 years. It is most often formed gradually by intensifying psychoorganic disorders that arose in the early stages of the disease. In some patients, lacunar dementia syndrome occurs more acutely after cerebrovascular accidents (postapoplectic dementia). In such cases, dementia is preceded by a transient amnesic (Korsakoff-like) syndrome.

After acute cerebrovascular accidents (stroke, severe hypertensive crises, subarachnoid hemorrhages), and often after acute vascular psychoses, amnestic dementia syndrome is possible with severe memory impairments such as fixation amnesia, gross disorientation and confabulations. The picture of such amnestic dementia is in some cases reversible to some extent.

Another type of dementia occurring in vascular lesions of the brain, is called "pseudo-paralytic" due to the predominance in the clinical picture of carelessness, euphoria, talkativeness, disinhibition of drives, absence of a sense of illness, a sharp decrease in criticism and level of judgment - with a relatively lesser severity of memory and orientation disorders. The pseudoparalytic type of vascular dementia is usually found in patients under 65 years of age with severe hypertensive encephalopathy or with frontal localization of softening foci.

With severe hypertensive encephalopathy, sometimes there is a rare form of vascular dementia, with workload and stunnedness of patients, adynamia and reduced motor and speech activity, pronounced difficulties in fixating, perceiving and comprehending what is happening - this form of vascular dementia is described as "pseudotumorous". It requires especially careful differentiation from a brain tumor.

Dementia syndromes observed during the manifestation of the vascular process in old age also have certain clinical features. Due to some similarities between the clinical picture of these syndromes and senile dementia, they speak of senile-like type of vascular dementia. As with senile dementia, the initial stage of this type of vascular dementia is characterized by pronounced personality changes, a gloomy or displeased or irritable mood, a distrustful and hostile attitude towards others, individual ideas of attitude and detachment. The clinical picture of dementia is determined by deeper and more diffuse memory impairments (than with dysmnestic dementia), more pronounced disorientation, and elements of “shifting the situation into the past,” and a deeper decline in all types of mental activity.

An independent clinical variant of vascular dementia is Alzheimer's-like form with focal cortical disorders caused by a special localization of the vascular process, resulting from the addition of atherosclerotic changes in the vessels of the cerebral cortex to the senile-atrophic process.

Psychotic syndromes. In direct causal dependence on the vascular process (its nature, course, rate and degree of progression) are acute and subacute psychoses of the exogenous and exogenous-organic type - “arteriosclerotic states of confusion.” These psychoses are distinguished by a number of common clinical properties: 1) syndromes of altered consciousness that arise within these psychoses (exogenous types of reactions), as a rule, are atypical, rudimentary and syndromic incomplete. Manifestations of acute vascular psychoses do not always correspond to the known syndromic types of delirium, amentia, twilight states and others, which has allowed many modern psychiatrists to generally qualify them as “states of confusion”; 2) acute psychotic disorders are quite often short-term, episodic. Their duration often does not exceed several hours. They occur predominantly at night, and during the day patients can be clearly conscious and do not exhibit psychotic disorders. Confusion at night, in particular, recurs frequently; 3) the course of acute vascular psychoses differs significantly from the course of symptomatic psychoses of other etiologies. 4) with a more protracted (subacute) course of vascular psychoses, in addition to syndromes of altered consciousness, there may be observed not accompanied by stupefaction, but also reversible syndromes, which were called transitional or intermediate. In vascular psychoses, almost all types of intermediate syndromes can occur (preceding or following syndromes of altered consciousness): neurotic and affective (asthenic, depressive, anxious-depressive), hallucinatory-paranoid (schizoform) into organic circle syndromes (adynamic, apathetic-abulic , euphoric, expansive-confabulatory, amnesic-Korsakoff-like).

Acute psychotic states are sometimes observed in the prodrome of stroke. Such post-stroke psychoses with confusion, disorientation, delirious agitation, anxiety, individual hallucinatory and delusional disorders usually turn into prolonged asthenodepressive states, but can also transform into various states of dementia through an amnestic intermediate syndrome.

Acute psychotic episodes can occur during exacerbation of the vascular process against the background of various, even stabilized, mental changes (including dementia).

Of all the so-called endoform (protracted) vascular psychoses (as well as in atrophic processes), the most clinically justified is the identification of protracted vascular paranoid psychoses. They are most often observed in men in the form of paranoid delusions of jealousy. The plot of the delusion contains many naked sexual details. Typical storylines: wife cheating with young people, young family members, including son or son-in-law. Delusions of jealousy are usually combined with ideas of damage (the wife feeds rivals better, gives them the patient’s things), a tearfully depressed mood with outbursts of irritability, anger, and aggressiveness.

There is also no doubt that chronic verbal hallucinosis is classified as vascular psychosis. Chronic vascular hallucinosis is defined by polyvocal true verbal hallucinosis. It flows in waves, often at the height of development it becomes scenic (scenes of public condemnation of the patient), usually intensifies in the evening and night hours and has a predominantly threatening content.

TREATMENT, PREVENTION AND ORGANIZATION OF CARE FOR PATIENTS. The main focus should be on the treatment of the underlying vascular disease and the hemodynamic disorders caused by it. Psychotropic drugs are prescribed for general indications, with maximum caution. Preferably drugs with moderate or even relatively weak neuroleptic activity are administered (aminazine, usually no more than 50-75 mg/day, thioridazine - Melleril). Small doses of haloperidol (for hallucinosis), tizercin (for anxiety-delusional states) are used. Particular caution should be taken regarding the combined use of psychotropic drugs. Such combinations are indicated only for short-term use to reduce anxiety and agitation (for example, in the form of a combination of 25-50 mg/day amitriptyline and 20-25 mg melleril or aminazine). A combination of antidepressants or neuroleptics with weak neuroleptic activity and small doses of tranquilizers (seduxen, tazepam) is advisable. In case of pronounced anxiety agitation and vital fear, intravenous drip administration of seduxen is effective. With vascular inferiority of the brain, there is an increased risk of developing side effects of psychotropic drugs - cardiovascular disorders and the early onset of neuroleptic symptoms. Amitriptyline, which is preferable for anxiety and depression due to its sedative effect, is prescribed in doses not exceeding 50-75 mg/day. The use of pyrazidol is recommended.

In the early stages of the development of vascular mental changes, general restoratives and thoughtful regulation of the regimen are indicated. In some cases, a course of treatment with aminalon (Gammalon), piracetam (Nootropil) or Cerebrolysin is useful.

It is also necessary, if possible, to eliminate all hazards that can negatively affect the course of vascular diseases.