Dementia of the Alzheimer's type, what is this disease, causes of senile dementia, symptoms and treatment

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As a person ages, cholesterol and blood pressure often increase. As a result, blood circulation in vital organs is disrupted. The central nervous system is especially affected; transient ischemia or stroke results in irreversible changes in the cells. This is how vascular dementia occurs, which is a mental illness. Its main cause is disruption of cerebral blood flow in a certain area and destruction of brain cells due to vascular damage. It is most often observed in the elderly, but can sometimes occur at a young age. According to statistics, pathology occurs more often in men than in women.

What is vascular dementia

If we study the data of foreign scientists, this vascular dementia ranks second in frequency of occurrence after dementia due to Alzheimer's disease. There are different indicators in our country and abroad. Dementia caused by vascular abnormalities is most often recorded in Russia, China and Finland, exceeding Alzheimer's disease in frequency. Often there is a combination of two diseases at once, in this case the deviation is called mixed dementia.

This pathology of vascular origin is a serious medical and social problem. As the average life expectancy of people on earth increases, quite a large number of patients who suffer from dementia turn to doctors, and due to this, its prevalence is increasing. Such patients need not only assistance, but also constant care and monitoring. After detection of vascular dementia, there is a shortening of life and a deterioration in the quality of life in patients. The pathology is treated by a psychiatrist, psychotherapist and neurologist. If necessary, therapists, cardiologists, and others are involved

Severity

There are three degrees of severity of pathology:

mild: there is a decrease in short-term memory, emotional instability, inability to remember new things; the person can take care of himself independently and understands the need for treatment;
moderate: self-care becomes difficult; a person begins to forget about basic actions (close the door, turn off the gas), and may get lost on the way to the store; already at this stage the patient requires constant monitoring;
severe: complete loss of the ability to self-care and critical perception of reality, the need for constant care.

Causes of vascular dementia

Before starting treatment for a disease, it is necessary to understand the causes and mechanism of its origin. Vascular dementia occurs as a result of the death of cells in the central nervous system, as they no longer receive nutrients and oxygen. Violation of the blood supply to a certain area is caused by acute and chronic processes, most often the cause is:

stroke;
cerebral infarction;
traumatic brain injury;
internal intoxication;
dismetabolic processes;
brain tumors;
vasculitis;
atherosclerosis of cerebral vessels;
heart disease;
abnormalities in the structure of arterial walls.

Hemorrhagic stroke, which provokes the appearance of vascular dementia, occurs as a result of hypertension, acute intoxication, and inflammation. Blood pours out from the affected wall and permeates the brain tissue. This process occurs quickly and is accompanied by severe symptoms. If cell death occurs simultaneously, the result is vascular dementia with typical intellectual impairments.

Heredity also plays a role. The likelihood of developing vascular dementia is higher in people whose close relatives suffer from atherosclerosis, coronary artery disease and other pathologies that cause impaired blood flow. It has already been proven that the tendency to lipid metabolism disorders with the formation of sclerotic plaques and coronary heart disease are transmitted genetically. If there are also a number of predisposing factors to the development of vascular dementia:

alcoholism, smoking, drug use;
low physical activity;
diabetes;
history of mental disorders.

As practice shows, the disease is often multifactorial in origin. Many patients at the time of its manifestation or in history have bad habits, a sedentary lifestyle, and the deposition of atherosclerotic plaques on the inner walls of the arteries.

Vascular dementia: symptoms and types

To understand the characteristics of the origin, localization and etiology of the disease, there is a certain classification. In clinical practice, the following types of vascular dementia are distinguished:

acutely developing (when a heart attack leads to damage to a functionally significant area of the brain);
multifactorial;
subcortical (subcortical);
mixed;
other types (with hemorrhage, total ischemia, sudden decrease in pressure as a result of cardiac arrest);
dementia, unspecified.

The chronic form of vascular dementia develops gradually, in stages. Initially, the patient has no cognitive impairment, memory is preserved, and cognitive function deteriorates. The second stage is marked by complaints of memory loss. This manifests itself in the search for familiar objects, since the patient cannot understand where he left them and in forgetting the names of well-known people. Social and professional adaptation, as well as a critical attitude towards one’s condition remains normal.

In the third phase of the disease, cognitive impairment begins to occur:

loss of orientation in an unfamiliar place;
inability to retell the text read;
inability to remember the names of the people presented;
motivation for professional and other activities decreases or is completely lost;
deficits in the ability to concentrate are determined by testing;
the critical attitude towards one’s condition decreases.

The fourth stage corresponds to the concept of mild vascular dementia, when clear symptoms of the disorder appear. During this period, a person:

information about current events is lost;
there is some memory deficit;
lack of concentration;
there is an inability to move independently without the risk of getting lost.

Some patients with vascular dementia may retain the ability to navigate time and place and recognize familiar people. However, complex tasks are beyond their capabilities. As a mechanism of psychological defense, there is a lack of a critical attitude towards one’s condition.

With moderate dementia, which corresponds to the fifth stage of the disease, the patient already needs help. In a conversation, he cannot remember his address, phone number, or names of family members. Discoordination in time and space is often observed. However, many important facts are still retained in a person’s memory. He usually knows his name, retains the ability to care for himself, and can cook and eat food.

The transition to the sixth stage marks the symptoms of severe vascular dementia. There is a man with her:

unable to remember spouse's name;
loses the sequence of events in his life;
they don’t understand what month, season, day of the week, date, year it is;
have difficulty counting from one to ten and back;
needs help with daily living.

Particularly characteristic of severe dementia are changes in the patient’s personality and emotional state. Such violations are varied and include:

psychotic disorders (conversations with a reflection in the mirror, accusing loved ones of impostor, etc.);
obsessive rituals (frequently performing the same actions);
anxiety, hyperarousal, unjustified aggression;
inability to make volitional decisions and actions.

Vascular dementia in the last stage manifests itself in a complete loss of the ability to communicate, often the person simply remains silent. Some may speak out, but their speech loses all meaning and logic. The ability to move independently is gradually lost, and urinary incontinence is observed. When assessing the neurological status, increased muscle tone and the appearance of pathological reflexes are noted.

In vascular dementia after a stroke, the nature and severity of the disorders are determined by the affected area.

Advantages of the clinic

The Health Energy Clinic provides qualified medical care in various areas. We offer each patient:

screening diagnostic examinations;
targeted diagnostics using modern equipment and laboratory research;
consultations with experienced specialists who regularly improve their skills, as well as foreign experts;
individual selection of complex treatment;
disease prevention activities;
organization of sanatorium-resort treatment according to indications;
own day hospital for course treatment.

Senile dementia turns the life of a person and his family into a real hell. Do not allow the disease to progress. Sign up your loved ones for an examination at Health Energy and let our specialists choose the most effective treatment.

How is vascular dementia confirmed?

Vascular dementia is accompanied by a decrease in the functions of the brain centers compared to the initial level, before the development of the disease, which leads to disruption of activity in communication and daily activities. In this case, deviations should not be associated with specific somatic problems and neurological deficits.

To establish a diagnosis of vascular dementia, it is necessary to take into account clinical symptoms, anamnesis, examination results, and the nature of the development of the disease. Its mandatory criteria are:

cognitive impairment (memory disorder, lack of purpose, ability to abstract, plan);
instrumentally confirmed fact of cerebral circulation pathology using CT, MRI and deviations in neurological status.

When examined by a neurologist, the following should be present or indicated in the medical history:

paresis of half the body;
decreased tone of the lower facial muscles;
positive Babinski sign;
impaired skin sensitivity;
symptoms of damage to the extrapyramidal zone (if there is a lesion in it);
inability to maintain balance, changes in gait;
dysarthria.

Additional (secondary) signs of vascular dementia are:

isolated cases of impaired range of active movements, coordination, asymmetry of reflexes, and other signs of pyramidal insufficiency;
ataxia and other abnormalities while walking;
history of frequent falls due to postural instability;
changes in frequency of urination, urge without the presence of urological pathology;
speech and swallowing disorders;
depression, emotional instability, lethargy.

To clarify the diagnosis of vascular dementia, a person is consulted by a neurologist, cardiologist and psychiatrist. Sometimes communication with other specialists is required. It is important to differentiate it from Alzheimer's disease, which is accompanied by similar clinical symptoms. To do this, you need to pay attention to objective analysis data. The following signs should be considered in favor of a vascular origin:

began acutely;
accompanied by transient disturbances of cerebral blood flow;
transient neurological disorders or short-term stupefaction were observed;
the dementia clinic began in stages;
the strength and severity of symptoms changed over a short period of time.

If there are also signs of local damage during brain examination, vascular disease and focal neurological symptoms, then it can almost certainly be stated that the patient has vascular dementia.

You should not make a diagnosis yourself, much less give potent drugs. Only a specialist with extensive experience, based on the studies performed, can determine vascular dementia.

Definition

Dementia is a syndrome that includes several individual symptoms leading to decline in brain activity, dementia and memory loss. From this definition it is clear that Alzheimer's disease and dementia are not the same thing. Dementia is characterized by:

degradation of intellectual abilities;
disorders of memory, thinking, perception and analysis of information;
speech dysfunction;
changes in emotional and mental state, loss of control over emotions;
degradation of behavior in society with attacks of aggression;
loss of motivation;
violation of orientation in space and time;
personality changes, etc.

Important! Dementia and Alzheimer's disease are different concepts!

The difference between Alzheimer's and dementia is that the former is a separate disease, and the latter is a manifestation characteristic of it. Dementia can also be simply referred to as dementia that is chronic and progresses over time. Its causes are changes in the brain as a result of exposure to various factors, leading to severe disturbances in its functioning. However, dementia with each pathology has its own distinctive features.

Vascular dementia: treatment in Moscow

Vascular dementia requires immediate treatment as soon as it is detected. It is carried out both on an outpatient basis and in a hospital. Dr. Isaev’s psychiatric clinic uses only certified and proven medications to eliminate the cause and relieve the symptoms of the disease.

Indications for hospitalization of a patient are:

psychopathological deviations that cannot be stopped at home;
a person’s behavior poses a threat to himself and others (aggression, attack, suicide attempts);
complete helplessness of the patient, inability to care for himself;
the need for psychiatric care, without which significant harm to health can be caused.

For this pathology, psychiatric care includes eliminating the influence of the causative factor (vasculitis, hypertension, stroke, atherosclerosis), improving cerebral blood flow and brain cell metabolism. For this diagnosis the following are used:

anticoagulants and antiplatelet agents to improve blood rheology;
antihypertensive drugs for high blood pressure to prevent recurrent stroke;
antioxidants, nootropics (help restore damaged brain cells and reduce their sensitivity to ischemia);
vasoactive drugs and nicotinic acid (expand the vascular bed and increase the flow of oxygen to the tissues of the central nervous system);
cholinesterase inhibitors (act on the pathogenesis of the disease);
statins (reduce cholesterol levels in the blood, prevent the deposition of plaques on the intima of blood vessels);

There are also studies on the use of antidepressants to treat depression in vascular dementia. If psychotic abnormalities appear, the doctor may prescribe antipsychotics and tranquilizers, mood stabilizers, and sleeping pills. Drug treatment of aggression, mental disorders and correction of patient behavior is carried out through the use of small antipsychotics, which are safer for older people. They are given in minimal doses and in short courses.

People with vascular dementia often experience paradoxical reactions to medications. Therefore, during the period of their prescription, constant monitoring of the characteristics of their effect on a person is required, with a change in the drug in the absence of effectiveness or the development of negative symptoms. All drugs that can impair cognitive functions are not used, or are given in a minimal dose for a short course. Drug therapy for this disease is the main one, but it is successfully supplemented with psychotherapy, occupational therapy, and skilled nursing.

Diagnostics

Neurologists and psychiatrists diagnose dementia. The examination includes:

collecting complaints and medical history, determining the approximate time of onset of the disease, the most pronounced signs, as well as concomitant pathology;
detailed neurological examination with assessment of reflexes, motor and sensory function;
general urinalysis, general and biochemical blood tests, tests for hormones, infections, electrolytes, determination of basic blood clotting indicators;
ECG, ultrasound of the heart;
CT or MRI of the brain to detect structural lesions;
Doppler ultrasound of neck and brain vessels;
electroencephalogram (EEG);
neuropsychological tests to assess the state of the psyche and the quality of thinking.

If necessary, a more detailed diagnosis is carried out.

Help from a psychologist for vascular dementia

Help from a psychologist for vascular dementia is a necessary component of effective therapy. Our specialists also work with people who are forced to care for such patients, as they are constantly under adverse influences and experience distress.

There is no such practice in public hospitals, since most often elderly people who have no social significance suffer from dementia. Therefore, municipal institutions are designed primarily to maintain the vital functions of the patient’s body and care, which also leaves much to be desired.

Scientists have proven in numerous studies that in the early stages of the disease, working with a psychologist can effectively maintain a satisfactory state. Typically, the following psychotherapy techniques are best suited for this purpose:

cognitive-behavioural;
interpersonal;
analytical;
psychodynamic.

Such assistance for vascular dementia is necessary for quality treatment. Many people with this disease are capable of active communication with a specialist at an early stage; they want to preserve their identity and understand what is happening to them. Supportive conversations allow them to adapt to their condition and accept it without unnecessary fear and anxiety, which further aggravate the situation. Some experts consider it inappropriate to inform a person about the diagnosis. But according to surveys and studies, most patients would like to have a more complete understanding of their problem and how to solve it.

The use of supportive psychotherapy, as practice shows, has a very positive effect on the quality of life of a person with vascular dementia. Essentially, this technique involves the psychologist providing attention, support and encouragement to the patient. At the same time, methods are used to stimulate brain function and normalize emotional manifestations. The specialist gives advice, convinces, encourages, and, if necessary, retrains the person. The emphasis of the work is on caring and understanding rather than suppression. After proper psychotherapy, you can get the following results:

partial restoration of lost skills and functions;
social and psychological adaptation of the patient;
restoration of the ability to cope with difficulties;
increasing self-esteem and self-confidence;
knowledge of who to turn to for help in difficult times.

Psychological assistance is also necessary for the patient’s relatives who are nearby and care for him. A psychotherapist and psychiatrist explain the nature of the disease and provide basic knowledge about it, so as not to confuse manifestations of bad character with pathological disorders. Many find it difficult to come to terms with the fact that their mother, father, grandmother or grandfather becomes capricious, aggressive, and begins to say unpleasant things to them. The doctor’s task is to help survive such stress and give strength for care and optimal communication with the patient.

To prevent a nervous breakdown, the patient’s relatives need to:

alternate between caring for a loved one and proper rest;
periodically change the environment (mind your own business, go out into nature, communicate with friends);
learn to completely switch your attention from the patient’s problems to positive things (communication with other family members, watching entertaining TV shows, reading books, physical exercise).

The behavior of loved ones is very important for a person with vascular dementia; the duration of the patient’s active life depends on their attitude. Psychological assistance from relatives includes the following:

constantly explain and give advice;
empathize and sympathize;
encourage, teach, give incentive to action;
constantly praise;
increase the patient's self-esteem;
inspire positive thoughts and hope for recovery;
help solve problems;
create a friendly atmosphere in the house.

It is important that relatives of a patient suffering from vascular dementia treat him with understanding. They should see a person in front of them, not a problem. If this principle is followed, then such an attitude will help him strengthen his strength, improve his skills and overcome difficulties, which, in turn, will make the task of his loved ones easier.

Prevention of dementia

When a person approaches 50 years of age, it is useful to engage in dementia prevention. The recommendations below will help you not only reduce your risk of developing dementia, but also help you stay healthy, happy, and vibrant as you age.

Maintain communication with pleasant people. Communicate with loved ones, meet with friends, participate in clubs of interest, etc. Do not be alone for a long time.
Move. Any regular activity that you like and suits will be a plus. It is useful to walk in the fresh air, go swimming, ride a bike.
Eat properly. Avoid any junk food. Eat according to the schedule several times a day in small portions. A Mediterranean diet is recommended. It is useful to include vitamins in your diet.
Never stop learning new things and training your memory. Develop your brain and engage in interesting mental activities.
Give up all bad habits.
Keep calm. Relaxation, meditation, yoga, psychotherapy will help maintain mental and physical health for a long time.
Get treatment. Cure in a timely manner from emerging diseases, especially infectious and vascular ones.

Questions and answers

What are the ways to prevent vascular dementia?

To prevent the formation of vascular dementia, it is useful to take vitamins and substances with antioxidant properties. These include vitamin E, C, and all types of polyunsaturated fatty acids. It is necessary to monitor sufficient levels of B12 and folic acid, and exclude foods high in cholesterol from the menu.

Can dementia be cured?

Vascular dementia cannot be completely cured. But with the right approach to therapy, it is possible to increase the patient’s life and activity.

What are the complications of dementia?

Complications are observed in severe stages of this disease and in the absence of complex therapy. A person completely loses social adaptation and ability to work, and injuries may occur due to ataxia. The main diseases that lead to brain pathology are getting worse - diabetes, hypertension, atherosclerosis.