Atherosclerotic dementia
Atherosclerotic dementia is usually caused by chronic ischemia of the brain, and cerebrovascular atherosclerosis. It's so-called vascular dementia is the second most frequent cause of senile dementia. A common harbinger of this ailment is the so-called stage. neurasthenic, during which the patient's efficiency decreases: it is easy to bore, sometimes it snoozes. Usually in this period he has the feeling that something bad is happening to him, often is clearly hypochondriac.
Diagnosis of atherosclerotic dementia
Typically, the doctor during the standard interview is informed about the fact that the patient has had "small cerebral infarctions" at the time of which he had periodic, usually short-term states of impaired consciousness. The doctor often also finds in such patients the existence of a number of minor speech-related symptoms or in a neurological examination. It may be weakness of one of the limbs, slight spastic symptoms, visual field defects, parkinsonism, dysarthria, gait disorders, etc.
Illness messengers usually have three symptoms:
• headaches, often persistent, lasting for weeks
• dizziness, usually transient
• memory problems.
The patient often has smaller or larger speech disorders, i.e. aphasia.
Almost always, along with speech disorders, there is a disturbance of thinking as "thinking and speech are like two sides, reverse and obverse on the same coin". Some patients also have aprexia, akakulia or other similar impairment syndromes that indicate brain damage.
Course of illness
In the early stages of this type of dementia, patients complain of increased dizziness and headaches. These pains can be persistent and persist for many weeks. Relatively often, the patient has fainting. We also sometimes see full epileptic seizures. Almost half of all patients with atherosclerotic dementias have arterial hypertension, the course of which is usually long-term and the treatment is improperly conducted. Atherosclerosis also present in other arteries causes diseases of many organs.
Atherosclerosis usually affects the entire area of the patient's brain, and the lesions have the character of small scattered remains after the stroke. This situation causes the picture of this disease to be heterogeneous and a multitude of symptoms is possible.
Disturbances of consciousness
The disturbances of consciousness are visible in the majority but in certain periods they may be unstable. They may increase or disappear depending on the time of day or night, depending on the general condition of the patient and the medicines he takes.
Affective disorders
The disturbances of affect in the form of lability and sometimes irritability are extremely characteristic of patients with atherosclerotic dementia. Such persons sometimes experience exaggerated facial features that have previously been embarrassing for the environment. The stinginess, overbearing or tyranny of a family can be enhanced. Sometimes, a feature that succumbs to this caricature overgrowth is excessive suspicion. The patient has the impression that everyone wants to cheat him, use him. Carrying out the smallest renovation at home is almost impossible, because it is associated with an increase in this suspicion. Such a patient, often together with his spouse, are stuck in an old, unrepaired house or apartment, so that they can not let any stranger there. Exaggerated avarice is the reason for tyrannizing the family. Every smallest purchase requires justification and explanation that it was not extravagant.The house almost does not heat up, the hot water is strictly regulated, no guests are allowed.
Inclination to egotism, lack of moral brakes
While the atherosclerotic lesions in particular affect the patient's frontal lobes, he displays uncontrollable egotism, lack of moral brakes, and often unrestrained sexual arousal. It can then come to various torts, which often end in court cases, and even incapacitation or forced hospitalization.
In psychogeriatry, "the brain of a patient with described dementia, on the section looks like" moth-eaten ", there are pale foci of reduced consistency, areas of the brain tissue that died earlier from the patient due to ischemia". Sometimes these changes are not visible to the naked eye and only histopathological examination reveals the extent of the havoc in the brain that atherosclerosis has done.
Patients with cognitive impairment should be diagnosed clinically with the necessary minimum standard tests. We may be forced to first diagnose the "cognitive disorder syndrome", and as we get the data, we can specify the diagnosis.
Epidemiology, or how often does this condition happen?
Demental disorders of higher activities - thinking and speech - are often observed in the elderly population. Dementia on the vascular bed is about 10-20% of the causes of cognitive dysfunction. Vascular dementia also arises on the basis of multi-infarct changes, strokes in the strategic area of the brain, and small subcortical infarctions. Strategic sites for dementia are located in the area of the anterior cerebral artery, posterior cerebral artery, left-angle cerebral angioma, parietal lobes and temporomandibular cortex on both sides, visual thalamus, spilled changes in the white matter - leukoarajozy.
Risk factors for vascular dementia:
Researchers believe that the prevalence of the disease is greater than previously thought and occurs after: stroke, intracranial bleeding or ischemia of the white subcortical substance.
It is believed that healthy older people in whom MRI has detected asymptomatic cerebral infarcts are at increased risk for cognitive dysfunction and dementia. Specialist medical intervention to reduce vascular risk may prevent dementia or delay its occurrence
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774Warszawa, Dolna 4 lok. 15
