From this article you will learn:
What is mixed dementia
What are the causes of mixed dementia?
What are the symptoms of mixed dementia?
Can mixed dementia be cured?
What is the prognosis for life with mixed dementia
Recent studies show that more than two million Russian citizens have been diagnosed with dementia. However, this is not the limit. The World Health Organization notes that worldwide the number of people suffering from this disease by 2030 could reach 80 million. The risk group includes mainly the elderly, their disease manifests itself in the form of serious pathologies of the brain, due to which there is a partial or complete loss of a number of abilities, including mental, speech, etc. Therefore, this disease is best known as "senile dementia" . Next, we will tell you what mixed dementia is, what are its causes and is it possible to cure this disease?
What is mixed dementia
Mixed type dementia is based on severe damage to the central nervous system (CNS). That is, this disease can be caused by a disease of any nature and theology, which results in degenerative changes, the death of cells in the gray matter of the brain.
The varieties of this pathology include dementia, in which the disorder of the central nervous system is caused by diseases that occur and manifest themselves. Namely:
Alzheimer's disease;
epilepsy;
In all other situations, the CNS disorder is secondary. In other words, dementia becomes a complication after the underlying illness. The role of the latter can be trauma, infection, a chronic form of vascular disease, etc.
Let's name the most common causes of mixed dementia:
alcoholism, tumor;
damage to the central nervous system;
head injury;
AIDS and viral encephalitis (less often);
neurosyphilis;
chronic form of meningitis.
The term "mixed dementia" means dementia, in the development and manifestation of which there are mechanisms and symptoms of the lesion:
vascular system;
primary disorder;
destruction of neural connections in the brain.
Most often combines the causes and symptoms of dementia provoked by Alzheimer's disease and Lewy bodies.
Causes of mixed dementia
As we have already mentioned, this disease usually develops against the background of a combination of vascular pathology with Alzheimer's disease (AD). True, the medical world knows other scenarios. So, with mixed dementia, three pathological processes can be detected simultaneously, for example, vascular pathology, neurodegeneration, and the consequences of trauma.
However, it should be noted that the most common combination of AD with vascular pathology in mixed dementia has a logical explanation arising from a number of factors. Let's start with the fact that these pathological processes have the same risk factors: overweight, smoking, persistent high blood pressure, diabetes mellitus, hyperlipidemia, atrial fibrillation, physical inactivity, metabolic syndrome and the presence of the apoE4 gene. With the appearance of one of the diseases in the brain, changes occur, on the basis of which favorable soil is formed for the formation of the second. Further, the patient has a rapid development of mixed dementia.
The brain of a healthy person has a certain reserve of cells, due to which it is possible to compensate for the problems associated with the death of some cells due to vascular diseases. As a result, for some time the disease may go unnoticed by the patient, since the brain is still able to work within the normal range. After vascular disease is supplemented by Alzheimer's disease, more severe damage to neurons occurs. But the body is already deprived of a reserve, as a result, decompensation of brain functions is observed in a short time, symptoms of mixed dementia appear.
During the development of AD in the substance of the brain, senile plaques or accumulations of beta-amyloid are deposited on the walls of its vessels. They cause the development of angiopathy, due to which extensive vascular damage occurs quickly when a cerebrovascular disease is attached.
Of course, the likelihood of a person developing mixed dementia is directly related to his age. So, in middle-aged people, dementias caused by one disease are more common. And the elderly are characterized by dementia, provoked by two or more diseases.
To avoid the development of mixed dementia, it is important to understand what factors can lead to it:
Sedentary lifestyle.
Obesity.
Bad habits.
Atherosclerosis, that is, blockage of blood vessels by cholesterol plaques.
Violation of lipid metabolism.
High blood pressure.
Head injury.
Diabetes.
Heredity, in other words, when close relatives were diagnosed with Alzheimer's disease.
The presence of apolipoprotein B, which are plasma proteins and are involved in cholesterol metabolism. The presence of a subspecies of this protein, anoE4, is a genetic factor in Alzheimer's disease.
Heart rhythm disturbances.
Clinical manifestations of mixed dementia
Symptoms of the disease of any form of dementia, including mixed, have some similarities and depend on the stage and degree of the disease. True, it should be understood that in the case of mixed dementia, the presented disorders occur against the background of Alzheimer's disease, vascular pathologies, in other words, strokes, cerebral ischemia, etc.
Communication problems. A person is deprived of the opportunity to formulate a thought, forgets the meaning of words, the goal that he wanted to achieve with his statement.
Violation of abstract thinking. The simplest arithmetic operations, counting money become impossible for the patient.
Memory problems: gradually fails long-term and short-term. So, a person suffering from mixed dementia may not remember what he did that morning. But at the same time, he perfectly remembers details from early childhood: what clothes he wore, how his beloved grandmother's soup smelled, etc. Gradually, a person forgets his own name, does not remember what a knife and fork are for. The result is a breakdown of personality.
Mood swings. Emotional instability is one of the key signs of dementia.
Difficulties doing routine activities. The patient is not able to remember the order in which he performed any household actions for a long time, he cannot repeat the things that he did before without thinking.
Lack of concentration.
Specialists divide dementia of mixed type into three groups according to the degree of the course of the disease: mild, moderate and severe.
In the first case, despite the fact that a person's working capacity is impaired and he needs supervision, the patient can independently serve himself. He retains critical thinking, that is, the patient is aware of his problem, so he can often worry about this.
Also, specific character traits sometimes appear: a generous person turns into a miser, collects things that seem valuable to him in garbage cans. A persistent person, for example, becomes stubborn, as a result, it is not possible to convince him.
With a moderate degree With mixed dementia, a person almost fails to take care of himself, he needs the help of others to use the simplest household appliances, cook food, and clean up. In other words, such patients do not lose only skills related to hygiene, but already look sloppy.
At this stage of the disease, a person cannot critically assess the situation. Speech, thinking work at the level of the simplest phrases, thoughts. Since serious memory impairment has already occurred, such a patient cannot be left alone at home, as he may forget to turn off the water and gas. Memory disorders are actively progressing, while the failures are replaced by fictitious events.
Often, doctors observe a process that is called pseudo-reminiscence: it seems that events that happened a long time ago have just happened. In this case, older people can rush to the first lesson at school, get ready for the wedding, etc.
With a severe degree there is a disintegration of the personality: a person no longer understands speech, is not able to serve himself. Now he needs constant care, best of all in stationary conditions or in a specialized clinic. The patient's need for food and water is significantly reduced. Now, due to the loss of the ability to chew food, he needs to cook pureed dishes. He had already lost control of his bladder action. It is not uncommon for people at this stage of mixed dementia to no longer be able to walk, sit, or swallow. As a result, there is a complete degradation of the motor apparatus, after which death soon occurs.
Diagnosis of mixed dementia
This diagnosis is made on the basis of the anamnesis, clinical picture and the results of additional studies, indicating the course of two pathological processes at once. But we note that according to the results of MRI or CT of the brain, indicating the presence of focal vascular lesions, areas of cerebral atrophy, mixed vascular dementia is not always diagnosed. According to experts, this diagnosis can be considered justified only if the manifestations or dynamics of dementia are not explained by one disease.
As practice shows, the diagnosis of "mixed dementia" is made in three situations. First of all, with the rapid aggravation of cognitive disorders after a stroke in a patient with AD. Also in the case of progressive dementia with signs of damage to the temporoparietal region, if a stroke has recently been suffered, but no symptoms of dementia have been observed before. The latter - with the simultaneous presence of symptoms of dementia in AD and vascular dementia against the background of signs of cerebrovascular disease and neurodegenerative process according to neuroimaging.
When a diagnosis is made, the doctor must take into account that Alzheimer's disease (especially in the early stages) is rather hidden. There are no dramatic manifestations of stroke, visible changes in the appointment of additional studies. About mixed dementia with damage to the vessels of the brain says a characteristic anamnesis, which includes progressive disorders of cognitive functions, memory problems. Also, the possibility of developing mixed dementia in vascular pathology is evidenced by the presence in the family of people suffering or suffering from BA.
Treatment and prognosis for mixed dementia
Unfortunately, this type of senile dementia is difficult to treat because it is accompanied by other disorders. Therefore, the treatment of mixed dementia requires an integrated approach. That is, it is necessary to eliminate the factors that caused vascular pathologies. Therefore, drugs are prescribed that reduce blood pressure, statins, antiplatelet agents, drugs that improve cerebral circulation. And it is also required to slow down the development of Alzheimer's disease - drug therapy is used to stop the development of dementia. This approach is relevant even at the last stage of mixed dementia.
As we have said, people with mixed dementia are often prone to depression. It negatively affects the activity of patients, depresses their condition. It is important that such a state negatively affects, including cognitive processes. To reduce the negative effect, prescribe antidepressants with minimal side effects. They require course treatment.
But the fight against mixed dementia is not only the use of medications, it is important to ensure the person's safety and constant monitoring. To do this, they install video cameras, blockers for gas stoves and electricity, or invite a nurse. In order for the patient to maintain social skills, he can be sent to group psychotherapy, occupational therapy.
It is not easy to talk about prognosis in mixed dementia, as they depend on a number of factors. In a person who becomes ill after 65 years, the disease can last for several years. For a person diagnosed with this problem after age 85, the disease will be rapid and lead to death in just a few months. Disappointing statistics say that in the United States, senile dementia affects every second person who has lived to be 85 years old. Therefore, we repeat, it is difficult to predict anything unambiguously here.
Memory, intelligence and speech, provoked by changes in the molecular exchange between cells in the cerebral cortex, caused by various reasons. And the more pronounced these changes, the more severe the senile dementia, which is called dementia in medicine. At the same time, an elderly person loses not only the existing knowledge, experience, ability to learn, but also his own personality.
About what causes dementia, how many years they live with this diagnosis, and what different types of this pathology look like, we will talk later in the article.
Classification of dementia
Noticing that an elderly person living nearby is changing habits, character and ability to communicate, relatives begin to worry, fearing the worst case scenario - total dementia, which, as a rule, turns out to be a harbinger of the imminent death of a loved one. Is it so? How fast does the brain age?
To understand this, one should determine what kind of dementia one had to face. In medicine, there are different classifications of this pathology. And since it is not an independent disease, then, depending on the underlying problem that caused it, the following types of dementia are divided:
- Atrophic form of the disease (provoked by Alzheimer's or Pick's disease), which occurs against the background of the initial degenerative reactions occurring in the cells of the central nervous system.
- Vascular, caused by atherosclerosis and hypertension. It occurs due to a violation of blood circulation in the brain.
- Mixed type - the development of this pathology has mechanisms similar to both the atrophic appearance and the vascular one.
Causes of dementia
The described problems can begin their destructive effect both as a result of the natural aging process of the body, and as a result of diseases of the internal organs, thyroid diseases, neurological and vascular pathologies (such as ischemia, arterial hypertension, atherosclerosis, etc.).
Intoxication with alcohol or drugs can also push the body to pathological changes. Chronic poisoning with toxic chemical compounds at work also has a destructive effect.
Strokes, tumors, and head injuries can also sever neural connections, leading to dementia.
True, cases have been recorded when the causes of dementia lie not in the process of natural aging or the listed diseases, but in taking medications. In such cases, the process is reversible if the number of such drugs is limited or discontinued.
Dementia due to Alzheimer's disease
Most often, the causes that cause development are hidden in organic damage to those areas of the brain that are responsible for human thinking and memory. And the most common among them is Alzheimer's dementia, that is, dementia resulting from degenerative processes in neurons and the destruction of synaptic connections.
During this disease, amyloid (protein) plaques, as well as neurofibrillary tangles, are formed on the nerve cells of the patient's brain, which ultimately causes the death of these cells. Pathological areas atrophy as a result of these processes, and damage over time captures the entire brain, and this process, alas, is irreversible.
How does Alzheimer's dementia develop?
All with Alzheimer's disease are characterized primarily by an increase in short-term memory impairment, and as they progress, a narrowing of the circle of interests, insufficient resourcefulness, inattention, passivity, slowness of thinking and motor reactions, irritability.
Later, patients show a lack of understanding of the events taking place around them, they can repeat what was said for a long time, treat others inappropriately, and uncritically - to themselves. And over time, they may develop paranoid ideas and hallucinations.
Total dementia in this case is accompanied by muscle rigidity and impaired control of urination and bowel movements. Epileptic seizures may occur.
How long they live with dementia of this type depends on many reasons, and on average it is about 6 years, but the process can last up to 20. Intercurrent (accidental) diseases that have arisen against the background of dementia are usually fatal.
Alzheimer's disease, according to statistics, is the cause of dementia in 70% of recorded cases. But, unfortunately, not only this pathology can push to the beginning of the development of dementia.
Vascular dementia: causes and symptoms
Vascular dementia develops against the background of cerebrovascular accidents. In older people, as already mentioned, it can be provoked by atherosclerosis, hypertension, ischemia of cerebral vessels, arrhythmia, heart defects, pathologies of heart valves or high blood lipids. By the way, in the male part of the population, the predisposition to the vascular form of dementia is one and a half times higher than in women.
At the initial stage of the disease, symptoms are expressed by irritability, increased fatigue, sleep disturbances, lethargy and headaches. At the same time, distraction and depressive experiences become systematic.
In the future, the patient's memory is noticeably impaired. This is expressed in disorientation, as well as in forgetting names, dates, etc.
By the way, how dementia develops, how many years patients with this diagnosis live, directly depends on whether they had a history of stroke. In this case, life expectancy is greatly reduced. Neurological symptoms of this pathology are: hemiparesis, rigidity, speech disorders, swallowing, walking and urination.
Is it possible not to miss the onset of dementia? Signs of the disease
Unfortunately, it is almost impossible to catch the initial stages of the oncoming dementia, since this is a long and slow process that can take 10-15 years. A person's memory of what happened recently is gradually deteriorating, but memories of events that have occurred long ago are retained.
Dementia in the elderly is mainly manifested by a loss of learning ability and intelligence. Patients find it increasingly difficult to navigate in space and time. And soon it turns out that it is already quite difficult for them to choose the right words, and their speech is noticeably impoverished. By the way, no less problems arise in the process of operating with numbers.
Interestingly, some people are able to hide the signs of dementia for a long time, avoiding complex actions (for example, paying with a checkbook). What betrays them is a noticeably reduced interest in reading and any kind of activity. Those who cannot rebuild their lives find themselves in a difficult position, as their ability to perform daily duties decreases - a person now and then forgets about important matters or does them incorrectly.
How does dementia start?
Of course, the development of dementia and life expectancy with this disease depend on many reasons: health status, past illnesses, personal characteristics, attitudes of others, and much more. But if we talk about the signs of the disease in general, then we can highlight some common features of the changes taking place in a person:
- Most often, changes in the character of the patient become especially noticeable. Some of his personality traits are aggravated, for example, thrift develops into stinginess, and perseverance - into stubbornness.
- It is more and more difficult for a person, or rather impossible, to change the established view of events. He develops conservatism.
- Thought processes deteriorate.
- Often, these signs are followed by violations of moral norms of behavior (patients with dementia lose their sense of shame, the concept of duty, their spiritual values and vital interests are leveled).
Over time, noticeable changes in the state of memory and disturbances in temporal and spatial orientation begin. True, the features of behavior, gestures and speech of a particular person remain unchanged for a long time.
Last stage of dementia
As you know, the most rapid extinction of the patient occurs at the last, severe stage of the disease. The development of dementia at this time is characterized by trembling of the fingers, impaired coordination and gait, and exhaustion. The patient's speech becomes abrupt, and information about himself becomes fragmentary.
An elderly person in this state can no longer take care of himself, eat and observe elementary hygiene rules without outside help. In most patients, there is a violation of the process of urination. It can be both stagnant processes and uncontrolled urine output.
The disease shortens the lives of those who have it, due to the fact that in the severe stage of dementia the patient is no longer able to report ailments to the doctor, and in addition, older people most often do not develop fever or leukocytosis as a response to infection. The doctor in this situation has to rely only on his insight and experience, but, unfortunately, any infection that has joined can cause the death of such a patient.
Features of the course of senile dementia
Interestingly, the so-called senile, or senile, dementia in older people sometimes shows a clear dissociation between overt dementia and preserved behaviors. The patient remains unchanged the previous manner of holding, gestures, correct speech, lively intonations. All this often misleads the outsider. He thinks that he is talking to an absolutely healthy person, and only a randomly asked question reveals that the old man who speaks so interestingly, reporting a lot of examples from the past, is not able to say how old he is, whether he has a family, where he lives and with whom says now.
Senile dementia in the elderly in most cases is not accompanied by psychotic conditions that are inherent in the vascular form of this disease. This, of course, greatly facilitates the life of both the patient himself and his relatives, since such a patient does not cause serious trouble to his surroundings.
But often in this category of patients there are signs of psychosis, which are accompanied by insomnia or inversion (time shift) of sleep. In these patients, hallucinations may appear, suspiciousness is aggravated, mood swings occur from tenderness to aggression.
And all these severe symptoms can be provoked by changes in blood sugar levels, pressure drops and other health problems. Therefore, it is very important to protect elderly people with dementia from all kinds of diseases, both chronic and acute.
Why does senile dementia occur?
For what reason senile dementia appears in the elderly, why in these cases the human brain begins to age faster than normal, is still not completely clear.
Some researchers believe that in old age there are violations of immune regulation, which causes autoimmune processes. And the resulting autoantibodies damage brain cells. Cerebrospinal fluid, which normally contains immunocompetent cells that play a protective role, greatly changes their ratio and properties in old age, which leads to pathological changes in the central nervous system.
Dementia in the elderly is also caused by a genetic factor. It was found that the risk of the disease increases by 4.3 times in those families where there have already been cases of this pathology. Somatic diseases can reveal the symptoms of this mild senile dementia, change its picture and accelerate the course, while the timely elimination of these ailments can in some cases lead to a slower development of dementia.
Life expectancy of patients with a diagnosis of dementia, at what age should it be expected
Researchers from the University of Cambridge identified patients with an established diagnosis of senile dementia. How many years such patients live, according to scientists, largely depends on external factors, but on average it is 4.5-5 years.
By the way, statistics confirm that dementia occurs in about 2% of cases between the ages of 60 and 69, and up to 20% of older people are affected by it after 80 years. By the age of 90, the risk of getting sick increases to 45%.
Although it should be noted that the figures given are very approximate, since a fairly large percentage of older people do not fall under the supervision of psychiatrists, because they do not have psychotic conditions, and it all comes down to problems with memory, intelligence and slight mood swings. Such patients are in families, it is quite convenient to take care of them, and they do not create big problems for loved ones.
Speaking about how long people with dementia live, it should be emphasized once again that there are just very few deaths from this diagnosis. These include only those who died from accidents related to the characteristics of this disease. Basically, death occurs from a stroke or heart attack, most often accompanying the vascular form of the disease.
What is the prognosis for dementia
Being more and more common in the elderly, the described pathology is mostly irreversible, and modern medicine, unfortunately, can only slow down the process or remove the unpleasant symptoms that occur when a dementia is diagnosed.
It is difficult to say exactly how many years they live with this disease, since, for example, with the rapid progression of the vascular form, a lethal outcome is possible after a few months. The cause in this case is most often in the form of sepsis (in bedridden patients) or pneumonia.
Dementia represents the most severe clinical variant of cognitive dysfunction in the elderly. Dementia is a diffuse disorder of mental functions as a result of organic brain damage, manifested by primary disorders of thinking and memory and secondary emotional and behavioral disorders. Y. Melikhov wrote: “ The most evil cartoons are drawn by time ».
Dementia occurs in 10% of people over 65, and in people over 80 it reaches 15-20%. There are currently 24.3 million people with dementia worldwide. At the same time, by 2040 the number of patients with dementia will reach 81.1 million.
At the stage of dementia, the patient completely or partially loses his independence and independence, often needs outside care. For example, Gerald Ford wrote about former US President Ronald Reagan: It was sad. I stayed with him for half an hour. I tried to remind him of various episodes of our friendship, but, unfortunately, nothing came of it ...". Below are pictures painted in different years by the German artist K. Horn, who suffered from dementia.
« The roles have been played out, but we have already forgotten how to live "(V. Scheucher).
In line with this, Reisberg et al. (1998) suggested the concept (theory) of retrogenesis (reverse development). It has been proven that the presence of dementia not only reduces the adaptation of a person in society, but also increases mortality by 2.5 times compared to persons without dementia (4th place in the structure of mortality). In addition, dementia ranks third among the "costly" diseases. For example, in the United States, the cost of treating one patient with dementia per year is $40,000.
Dementia is a syndrome that develops with a variety of brain diseases. The literature describes more than 100 nosological forms that can lead to dementia.
widely used in the diagnosis of dementia. ICD-10 diagnostic criteria:
Criteria for the severity of dementia
Light
Medium
heavy
The most common cause of dementia is Alzheimer's disease(at least 40% of cases of dementia). AT basis of Alzheimer's disease lies accumulation of abnormal β-amyloid protein with neurotoxic properties.
According to ICD-10, dementia of the Alzheimer's type is divided into:
With this pathology in the foreground are progressive memory impairments for current, and then to more distant events, in combination with disorders of spatial orientation, speech and other cognitive functions.
Criteria for the diagnosis of "probable Alzheimer's disease"
(G. McKahn et al., 1984):
Mandatory features:
Additional diagnostic features:
Signs that do not contradict the diagnosis of Alzheimer's disease (after excluding other diseases of the central nervous system):
Signs that exclude the diagnosis of Alzheimer's disease:
In 10-15% of cases, vascular dementia develops. Under the term "vascular dementia"(1993) it is customary to understand several clinical-pathomorphological and clinical-pathogenetic syndromes, common to which is the relationship of cerebrovascular disorders with cognitive impairment.
According to ICD-10 vascular dementia subdivided into:
Pathophysiological classification of vascular dementia(Chui, 1993):
Criteria clinical diagnosis of "probable vascular dementia"
(G. Roman et al., 1993):
key question is to establish a reliable cause of the association between cerebrovascular disease and dementia. This requires the presence of one or two of the following features:
or stepwise progression of a cognitive defect.
The main clinical manifestations of vascular dementia
according to T. Erkinjuntti (1997) modified.
The course of the disease
Neurological/psychiatric symptoms
Accompanying illnesses
History of cardiovascular diseases (not in all cases): arterial hypertension, coronary heart disease
instrumental data
CT or MRI: focal infarcts (70-90%), diffuse or "spotted" (irregular) changes in the white matter (in 70-100% of cases), especially if pronounced changes capture more than 25% of the total area of the white matter.
Single photon emission computed tomography: "spotted" (irregular) decrease in regional cerebral blood flow.
EEG: in the case of EEG changes, focal disturbances are characteristic.
Laboratory data
There are no specific tests.
According to the literature, 50-60% of cases of vascular dementia are associated with stroke(especially repetitive). Thus, a stroke increases the risk of developing dementia by 5-9 times. The overall prevalence of dementia in patients with stroke is 20-25%. " The softening of the brain is manifested in the firmness of the position "(V. Scheucher).
The presence of dementia significantly increases the mortality of post-stroke patients (37% higher compared to persons without dementia) and reduces the quality of rehabilitation treatment (i.e., dementia can be considered as a "negative predictor" of the effectiveness of rehabilitation measures). At the same time, the presence of dementia increases the cost of rehabilitation treatment by 10 times or more.
The most important risk factors development of vascular dementia are arterial hypertension, heart disease (including heart surgery) and diabetes mellitus. The prevalence of arterial hypertension among people over 60 reaches 80%. The most common form (up to 70%) of arterial hypertension in the elderly is the so-called isolated systolic arterial hypertension(SBP>140 mm Hg and DBP<90 мм рт. ст.). Артериальная гипертония приводит к изменениям сосудистой стенки (липогиалиноз), преимущественно в сосудах микроциркуляторного русла. Вследствие этого развивается артериолосклероз, что обусловливает изменение физиологической реактивности сосудов. По данным НИИ неврологии (2005), лишь только в 35% случаев у больных с цереброваскулярной патологией на фоне артериальной гипертонии отмечается физиологическая нормальная цереброваскулярная реактивность (по данным пробы с нитроглицерином). В остальных же случаях ответная реакция может быть физиологической сниженной (19%), разнонаправленной (23%), извращенной (13%) и отсутствовать (10%). В таких условиях снижение артериального давления (в том числе вследствие неадекватной гипотензивной терапии) приводит к снижению перфузии и развитию ишемии белого вещества головного мозга.
In the elderly, the prevalence of coronary heart disease exceeds 20%, while there is a diffuse and more pronounced lesion of all three main coronary arteries (painless forms of the disease are more often detected) and the severity of coronary heart disease with frequent deaths. The consequence of this pathology is a decrease in cardiac output, a decrease in arterial blood flow to the vessels of the brain, and a decrease in its blood supply. The resulting hypoxia of the brain contributes to the deterioration of cognitive functions.
The incidence of brain pathology after CABG varies from 2 to 8% (mean 5%). According to Roach G.W. et al. (1996) neurological complications of heart surgery are divided into:
According to statistics, cognitive impairment after CABG ranges from 12 to 79%.
The main mechanisms of brain damage in patients undergoing CABG under cardiopulmonary bypass:
Massive cerebral embolism as a complication of cardiac surgery is relatively rare. According to Barbut D. et al. (1996), cerebral microembolism during heart surgery using cardiopulmonary bypass is recorded in 100% of patients. According to Pugsley et al. (1994), in the case of detection of 1000 or more microembolic signals (TCD method), changes in the neuropsychological status 8 weeks after surgery are observed in 43% of patients, while with the registration of 200 or less microembolic signals, this figure is 8.6%.
As for diabetes, according to the figurative expression of A. Efimov, "... diabetes begins as a metabolic disease, and ends as a vascular pathology." At the same time, even despite the usefulness of hypoglycemic therapy, the incidence of diabetic encephalopathy (as a manifestation of central neuropathy), the clinical picture of which is dominated by cognitive impairment, reaches 78%. It should be noted that the previous hypoglycemic conditions have a pronounced effect on the development of memory disorders in diabetes mellitus.
However, in recent years, much attention has been paid to mixed dementia(10-15% among all dementias). For example, stroke can be considered as the direct cause of dementia in only 50% of patients with post-stroke dementia. In other cases, the nature of the cognitive defect is of the primary degenerative (often Alzheimer's) nature of dementia or a combination of vascular and Alzheimer's changes (mixed dementia). Such a frequent combination is explained by the presence of common risk factors. Table 2 presents the main risk factors for cardiovascular disease that can trigger the development of Alzheimer's disease.
table 2
Dementia is not a specific disease, but a general term used to describe a gradual decline in mental abilities. It affects intellectual and social abilities, making everyday life difficult. Dementia can change memory, language skills, judgment, lead to disorientation, and change a person's personality.
Dementia can be caused by various diseases that affect the brain, the most common of which is.
Other forms of this disorder include vascular dementia, Lewy body dementia (abbreviated as LTB), frontotemporal dementia, and mixed dementia.
These types of dementia differ in underlying causes and may affect certain specific symptoms as well as their progression.
What is dementia?
Dementia (acquired dementia) is a pathology that is a severe form of a disorder of higher brain and nervous activity, provoked by brain lesions that are organic in nature.
Causes
The disease is a common cause of dementia. It accounts for 60% to 80% of dementia cases and affects about 5% of people over 65 years of age. It usually occurs in old age, affecting 20% to 25% of people over 80 years of age.
Despite constant progress in science and many promising theories, the exact causes of Alzheimer's disease currently remain unclear. Aging and genetic factors (family history) are considered the most important risk factors for developing Alzheimer's disease.
Vascular dementia occurs due to decreased blood flow, leading to cell death in the brain. This can occur as a result of clogging of blood vessels in the brain with blood clots or fatty deposits, for example, during. Vascular dementia accounts for 15% to 25% of dementia cases. This disorder causes mental loss that may be sudden, gradual, or permanent.
Dementia with Lewy bodies ranges from 5% to 15% of cases of dementia. Lewy bodies are abnormal protein formations that accumulate in the brain, causing mood swings, motor problems, thinking and behavioral disorders. This type of dementia usually progresses quickly and often, among its symptoms, there are visual hallucinations.
Frontotemporal dementia results from a crack in nerve cells in two specific parts of the brain called the frontal lobe and temporal lobe. It provokes speech disorders, changes the character and behavior of the victim.
Dementia can also have a mixed origin, especially in the elderly. The most common form of dementia is mixed dementia. associated with a combination of Alzheimer's disease and vascular dementia.
Diseases such as Huntington's disease, and Creutzfeldt-Jakob disease may cause specific symptoms of dementia. Dementia can also be caused by a number of factors that can damage the brain, such as alcoholism and drug use.
The most common factors leading to the development of a pathological disorder include:
- oncology (tumor in the brain);
- alcoholism and drug use;
- blockage of blood vessels in the brain;
- head injuries and injuries;
- and viral encephalitis;
- neurosyphilis;
- chronic form;
- and so on..
Some cases of dementia may be reversible or may improve once the cause is removed. Unfortunately, when dementia is caused by conditions such as Alzheimer's disease, brain damage, or blockage of blood vessels, the disorder is irreversible.
Symptoms
Sometimes we forget where we left our car keys or tell the same story to a friend or relative. This behavior is usually due to information overload resulting from an active and stressful life and is not necessarily a sign of dementia.
As we age, people's memory sometimes functions differently. For example, it may process information more slowly. These changes are normal and do not affect daily life. On the contrary, dementia leads to disability and is not associated with the normal aging process.
Although dementia manifests differently for each person, the most common symptoms are:
- gradual loss of memory of recent events and inability to learn new things;
- increased tendency to repeat, lose items, get confused and get lost in familiar places;
- the ability to reason and think logically is undermined;
- increased tendency to irritability, anxiety, depression, confusion and agitation;
- more and more difficult to communicate and use words (for example, forgetting words or using them incorrectly);
- changes in personality, behavior, or mood swings;
- decreased ability to concentrate or pay attention;
- inability to plan and complete multi-step tasks (such as paying bills);
Before a person is diagnosed with dementia, their symptoms must be severe enough to affect their independence and ability to perform everyday tasks.
The symptoms of dementia can vary depending on their original cause. For example, people with dementia with Lewy bodies often have prolonged visual hallucinations. Some forms of dementia can also affect younger people, not just older people, and progress more quickly.
Severity of dementia
- Light. In this case, the patient retains the ability for independence and awareness of everything that happens, but social adaptation is disturbed. Patients develop lethargy and rapid fatigue from any, even the most insignificant loads, there is a loss of interest in everything that happens, frequent mood swings.
- Moderate. Pathological changes manifest themselves more clearly, memory is impaired, the ability to navigate even in your apartment, house, in any familiar area is lost. The patient does not recognize the faces of people he knows and relatives, he should not be left alone due to the fact that he can harm himself.
- Heavy. At this stage, there is a complete degradation of the patient and his personality, he completely ceases to understand where he is and what he is told, he is not able to eat and swallow food himself, involuntarily urinates in his pants.
According to the place of its localization, dementia is:
- Cortical. Damage to the cerebral cortex. Most often provokes this form of Alzheimer's disease and alcoholism.
- subcortical. The structure of the brain in its subcortical part is affected.
- Cortical-subcortical. The cortex and structures in the brain are affected.
- Multifocal. It is marked by the formation of many lesions in the brain.
The main forms of dementia
Dementia Alzheimer's type
This type of dementia is a common type of dementia, accounting for 35 to 60% of the total number of pathological abnormalities in all types of organic disorders.
Common factors that provoke this form of dementia:
- age - most often it is diagnosed in patients over the age of 80 years;
- the presence of close relatives diagnosed with Alzheimer's disease;
- hypertension and atherosclerosis;
- diabetes and obesity;
- previously suffered head injuries and the absence of intense intellectual activity in the patient for a long time;
- belonging to the female sex.
Signs of this type of dementia:
- weakening of short-term memory, while a person critically perceives his condition for a sufficiently long period of time, feeling justified anxiety, a certain absent-mindedness;
- characteristic disorder of the central nervous system and manifestations of egocentrism and senile grouchiness, a certain suspicion, gradually developing into manic conflict;
- gradually, against the background of the signs described above, the patient may develop a delusional type of damage that is peculiar to this type of dementia - a person will blame neighbors, relatives, his surroundings and strangers.
The treatment of this type of dementia is complex, taking into account the treatment of diseases that aggravate the manifestation of the disease (obesity and, hypertension or atherosclerosis).
In the early stages, herbal remedies are prescribed - this is an extract of ginkgo biloba, nootropic compounds - cerebrolysin or piracetam, drugs that increase blood flow in the brain - nitrogoline, CNS stimulants and actovegin.
If the manifestation of the pathology is more serious - doctors prescribe medications classified as inhibitors - this will significantly improve the socialization and adaptation in society of patients with a similar diagnosis.
Vascular dementia
In this case, dementia as a separate, independent pathology is considered after the following vascular diseases:
- after a hemorrhagic type, when there is a rupture of blood vessels.
- after the ischemic type of stroke suffered by the patient - in this case we are talking about pathological blockage of the vessel and subsequent deterioration, or cessation of blood flow in a certain area.
In this case, there is a large-scale damage and death of brain cells - the symptoms that are focal in their manifestations will come to the fore, which will be directly predetermined by the localization of the affected area in the patient.
Regarding the risk factors that provoke this type of dementia, which is caused by its genesis by vascular pathologies distinguish the following:
- developing hypertension;
- increase in blood lipid levels;
- systemic course of atherosclerosis;
- smoking;
- problems with the heart muscle - the development of coronary disease, arrhythmias, or valve damage;
- sedentary lifestyle;
- diabetes;
- thrombus formation and systemic vasculitis.
In addition to the signs already described above, many patients often complain of rapid fatigue and difficulty concentrating during one or another long-term activity, problems with switching attention from object to object.
Another symptom characteristic of this type of dementia is a slow reaction during intellectual activity - it is the impaired blood circulation that contributes to such a slow reaction even when performing the simplest tasks.
Treatment of vascular dementia at the very beginning involves, first of all, the normalization and improvement of impaired blood flow in the brain. After - a course of stabilization of the process that provokes the development of the senile form of dementia is carried out, that is:
- treatment of hypertension;
- atherosclerosis;
- normalization of sugar (glucose) in the blood in diabetes mellitus.
Mixed dementia
Most often combines the causes and symptoms of dementia provoked by Alzheimer's disease and vascular dementia.
The treatment regimen is similar to the vascular type of dementia.
Dementia with Lewy bodies
The root causes of this degenerative process, as well as the mechanisms of its development, have not yet been studied by specialists. The only thing that doctors note is that hereditary predisposition is of no small importance in this pathology - in accordance with medical statistics, this type of dementia occupies about 15-20% of the total number of senile manifestations of CNS disorders in the total number of diagnoses.
So in many of its symptoms, this type of dementia is often similar to the forms described above. The characteristic symptoms of this type of dementia are manifestations of fluctuations - these are sharp deviations in intellectual, mental activity.
If we are talking about the manifestation of small forms of fluctuations, then patients most often complain of temporary disturbances in their manifestations in the inability to focus on one subject, object or task, the process of their implementation.
If we are talking about large forms of fluctuations - the patient is unable to recognize certain objects, relatives and friends, does not orient himself in the area.
A distinctive symptom of this type of dementia is auditory and visual, in some cases, gustatory and tactile hallucinations.
Among other things, the patient develops a number of autonomic disorders:
- orthostatic hypotension;
- fainting and;
- problems with the digestive tract, frequent constipation.
- failure in the urinary system.
The course of treatment for dementia with Lewy bodies is similar in its preparations and treatment regimens for Alzheimer's pathology.
Alcoholic type of dementia
The alcoholic type of dementia develops in a patient with prolonged, protracted, more than 15-20 years, alcohol abuse, due to poisoning with toxins and poisons of the brain.
In addition to the fact that toxins act directly on the gray matter of the brain itself and the work of the central nervous system, alcohol and its toxins also affect other organs and systems, causing damage to the structure of liver cells and disruption of the vascular system.
Every alcohol addict at the last stage of its course is diagnosed with personality degradation, enhanced by atrophic, negative and irreversible changes in the structure of the brain in the form of destruction of the furrows of the cerebral cortex and ventricles of the brain.
In its manifestation, the alcoholic type of dementia shows itself as a decrease in the patient's intellectual abilities, such as memory and the ability to concentrate on one task, thought, and the ability to think abstractly.
Diagnostics
The diagnosis of dementia is made by examining the symptoms that preceded it and a physical examination.
Your doctor may ask you a series of questions to assess your intelligence, that is, all brain functions related to memory, memories, decision making, language, daily recognition of familiar objects, and the ability to follow appropriate instructions.
Magnetic resonance imaging and CT of the brain will reveal changes that have occurred in the structure of the brain. Computed tomography (CT) or magnetic resonance imaging (MRI) are useful for identifying conditions (such as stroke) that can cause dementia.
The final confirmation of the diagnosis can only be obtained after a biopsy to study the structure of a piece of brain tissue or an autopsy performed after death.
Treatment and prevention
Treatment for dementia can vary depending on the cause. Alzheimer's therapy is needed to minimize memory loss and behavioral symptoms that gradually worsen.
Treatment for Alzheimer's usually involves the use of a range of medications (which can also be used to treat other forms of dementia), including:
- cognitive enhancers;
- tranquilizers;
- antidepressants;
- anxiolytic drugs;
- anticonvulsants.
There is no definitive cure for Alzheimer's, and there are no drugs that can stop or reverse the brain damage it has caused. However, there are medications available to reduce the severity of some symptoms and slow the progression of the disease.
Drugs such as Donepezil, Rivastigmine and Galantamine, can help stop memory regression.
Stroke prevention is very important in the case of vascular dementia. People with high blood pressure or high cholesterol, who have had transient ischemic attacks (TIAs), or who have had a stroke should receive ongoing treatment for these conditions to prevent future vascular dementia.
In order to treat and help people with dementia, it is important to focus on all the activities that a person can still safely perform. They should be encouraged to continue their daily activities and maintain social relationships as much as possible.
It is also important to help them lead a healthy lifestyle through exercise, proper nutrition, and adequate fluid intake. Special diets and supplements are usually not needed.
Here are some tips that you may find helpful if you are caring for a sick elderly person with dementia:
- provide patients with action lists steps to be taken, including time, place, and appropriate telephone numbers, to facilitate these tasks;
- structure and stabilize the environment, minimize unnecessary sounds and noises that cause anxiety;
- set the order of activities during the daytime and during sleep to try to reduce disorientation and anxiety;
- speak slowly and calmly, formulate only one idea and only one task at a time;
- reduce the risks of human loss and wandering by putting in his pocket a card with his name, address and phone number;
- make sure the house is safe leaving the furniture in the same place, removing unnecessary dangerous items, the first aid kit and setting the water heater to a low temperature to avoid burns;
- prohibit a person with dementia from driving a vehicle if he drives a car. Take a driver or have someone take the person to the right place.
Caring for someone with dementia is a very difficult task. It is important to show understanding, patience and compassion. Participation in support groups and communities is sometimes helpful for those caring for a patient with Alzheimer's disease.
We must be prepared for a gradual deterioration in the condition of a loved one and plan for constant care. In some cases, the best solution for an Alzheimer's patient and their family members is to send the person to a nursing home.
Interesting
The percentage of the population suffering from a diagnosis of dementia is growing every year. To date, 47.5 million cases have been officially registered. By 2050, the number of patients is projected to actually triple.
Not only people who have been diagnosed with this disease suffer from the manifestations of the disease, but also those close to them who care for them around the clock.
Understanding what kind of disease is dementia. And how to resist it.
Dementia: Description of the disease
Dementia is a chronic progressive brain disease and is an acquired mental disorder leading to disability.In the course of the disease, changes in all higher cognitive functions are noted:
- memory;
- thinking;
- attention;
- ability to navigate in space;
- assimilation of new information.
Degradation in dementia is observed to a greater extent than in normal aging.
And also often the disease is accompanied by emotional changes:
- irritability;
- depression states;
- increased anxiety;
- social maladaptation;
- decrease in the level of self-esteem;
- lack of motivation;
- indifference to what is happening around.
For reference!
In most cases, dementia triggers irreversible processes. But if the cause of the disease is established in time and eliminated, then the treatment will give positive results and delay the onset of the severe stage.
Dementia in the elderly
The largest percentage of patients with this diagnosis are elderly people. This category includes women and men in the age group from 65 to 74 years.
The term “presenile dementia” or “presenile dementia”, that is, presenile dementia, is used to refer to the representatives of this sample. In most cases, the causes of deviations in the elderly are disorders of the vascular system and atrophic processes occurring in the brain cells.
Senile dementia or senile dementia refers to the generation over 75 years of age. Quite often, this age is characterized by dementia of a mixed type, where several factors that caused the disease are combined. A disease of mixed genesis is quite difficult to treat. This is due to the comorbidity of pathologies.
According to the statistics of age-related dementia, women are more susceptible. This observation is associated with a longer life expectancy. And also an important role is played by the hormonal characteristics of older women.
The clinical picture of dementia in the elderly depends on:
- from the state of the body to the onset of the manifestation of primary symptoms;
- from the factors that caused the disease;
- on the intensity of development of deviations.
Alcohol abuse leads to the failure of all body systems. Although European scientists have concluded that moderate consumption of natural wine in the amount of 300 grams per week reduces the risk of developing dementia.
Treatment
Dementia is completely incurable.Therapy includes:
- slowing down the process of cell death;
- withdrawal of symptoms;
- psychological assistance in adaptation;
- prolongation of life with a diagnosis.
- improve the state of memory, thinking, attention, ability to navigate in space;
- minimize the manifestation of disorders in the behavior of the patient;
- improve the quality of life.
- drug therapy;
- treatment at the physical level (the use of gymnastics, occupational therapy, massage sessions, taking therapeutic baths, classes with a speech therapist);
- socio- and psychotherapy (work with a psychologist, both the patient and the people who care for him, counseling on providing proper care, as well as working with cognitive functions).
- neurotrophics (improve brain nutrition);
- neuroprotectors (slow down atrophic processes);
- antidepressants.
Close people are advised to ensure that the patient adheres to a clear daily routine, allocating time daily for training mental activity, moderate physical activity and quality rest. It is desirable to do physical activity (walking, exercising, swimming) with the patient. When keeping company, you can give prompts in time, as well as provide a good mood and give a feeling of acceptance and support.
Particular attention should be paid to the nutrition of the patient. The diet must be replenished with products that lead to lower cholesterol levels in the body:
- various types of nuts;
- legumes;
- barley;
- avocado;
- blueberry;
- vegetable oils.
- seafood;
- lean meats;
- sauerkraut;
- dairy products.
It is better to serve boiled or steamed dishes. Avoid salt as much as possible. It is important to give the patient to drink about one and a half liters of clean water per day.
Living with a diagnosis
If you turn to specialists when the first symptoms of dementia appear, then the treatment will be effective. A person will be able to lead a habitual way of life for a long time, dealing with household issues. In no case should you self-medicate without consulting a doctor.Dementia requires ongoing treatment. Therefore, close people of the patient need to be patient and help in everything. It is important to protect him from stressful situations and provide proper care.
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