What is vascular dementia. Is vascular dementia curable and how long do people live with this diagnosis? Definition of disease. Causes of the disease

– a mental disorder characterized by a persistent decrease in intelligence and disturbances in social adaptation. Occurs due to brain damage due to vascular pathology: hypertension, atherosclerosis, strokes, etc. Accompanied by impaired cognitive activity, memory disorders, deterioration of thinking, decreased ability to plan and control one’s actions. The diagnosis is made on the basis of anamnesis, clinical picture and data additional research. Treatment is etiopathogenetic and symptomatic pharmacotherapy, prevention of the progression of vascular disorders.

ICD-10

F01

General information

Vascular dementia is a serious medical and social problem. Average duration life is increasing, more and more elderly patients suffering from vascular diseases brain, the prevalence of vascular dementia is increasing. Patients with such dementia need not only treatment, but also special care - and this is also a problem that relatives usually have to solve. Vascular dementia reduces the life expectancy of patients and worsens its quality. Treatment of this pathology is carried out by specialists in the field of neurology and psychiatry.

Causes of vascular dementia

The immediate cause of the development of vascular dementia is the death of brain cells due to insufficient blood circulation or complete cessation of blood flow to some part of the brain tissue. Impaired blood supply may result from an acute catastrophe or chronic dysfunction. Acute catastrophe - ischemic or hemorrhagic stroke. Ischemic stroke, which causes vascular dementia, can develop against the background of atherosclerosis, certain heart diseases and cerebral vascular abnormalities. The cause of ischemic stroke is a blockage of the cerebral arteries by a thrombus or embolus.

To identify and assess the severity of diseases that provoke the development of vascular dementia, patients are referred for consultation to

Treatment of vascular dementia

The treatment plan is drawn up individually, taking into account the nature and characteristics of the course of the underlying pathology. The goal of therapy is the maximum possible restoration and constant maintenance of adequate blood flow in the brain, as well as compensation for disorders resulting from vascular dementia. An appropriate diet is prescribed and measures are taken to stabilize blood pressure. Nootropics, antioxidants, vasoactive drugs, neuropeptides, MAO inhibitors, neurotrophic agents, membrane-stabilizing drugs, etc. are used to correct cognitive impairment.

For vascular dementia complicated by a depressive disorder, serotonin reuptake inhibitors are used, for anxiety and insomnia, sedatives are prescribed, and for psychotic disorders, antipsychotics are used. Patients with vascular dementia may experience paradoxical reactions to medicines, therefore, during the treatment process, constant monitoring of somatic and mental state the patient and promptly replace the drug if there is no effect or the patient’s condition worsens. Medicines that negatively affect cognitive function are prescribed only when necessary, in small doses and short courses.

Drug therapy for vascular dementia is supplemented non-drug methods treatment and qualified care. If possible, the patient is referred to group therapy and/or occupational therapy to support social and motor skills. A patient with vascular dementia is provided with comfortable and safe living conditions: they are allocated a separate room with comfortable furniture, good lighting and a sufficient amount of stimuli (TV, radio), if necessary, the keys are taken away, and the possibility of turning on the gas stove on their own is excluded. The prognosis for vascular dementia is determined by the severity of changes in the brain and the characteristics of the course of the underlying disease.

Vascular dementia is a syndrome characterized by deterioration mental abilities, 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, which 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 examination 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 the main cause of dementia is Alzheimer's disease, a disease that is associated with the death of nerve cells. It has been established that signs of this dangerous illness may be caused by problems with blood circulation in the brain. It is in this case that we are talking about dementia of vascular origin.

Such a disease in 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. . It is believed 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 circulating blood volume, 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 failure 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 does the quality of life of people become worse. 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. Symptoms of damage to deep zones are observed white matter 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 they are not prescribed correct treatment. It has been noted that sick people are diagnosed with Alzheimer's disease, in the treatment of which other drugs are used. 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 get tested 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? Except clinical signs The patient’s mental state is diagnosed 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 independently take medications 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.

Vascular dementia (dementia) is a disease acquired during life, which most often develops in older people after 60 years of age.

According to medical statistics, this disease more often affects men. There are cases of diagnosing pathology in young people. Progressive vascular dementia is the most common of all neurological diseases after.

This is one of the types of dementia, which is distinguished by its vascular origin, that is, damage occurs to individual areas in the area of ​​​​the blood vessels of the brain and.

At the same time, insufficiency of the most important cognitive (cognitive) functions of the brain, which provide the ability to cognition and study of the surrounding world, perceive it as a single whole, and apply this knowledge in the process of life, intensively develops.

Thinking abilities and the ability to make correct decisions are gradually lost, the assimilation of new information deteriorates, the decline in intelligence progresses, and control over emotions and actions weakens. Accordingly, it becomes impossible to analyze one’s health status and understand the presence of a disease.

Dementia of this type leads not only to the loss of work skills, but also to the gradual loss of the ability to care for oneself.

Mechanism of occurrence and development of the disease are mechanisms of the pathogenesis of vascular dementia. There have been cases of the development of senile dementia in the presence of both causes. Signs of the disease appear faster and are more pronounced.

Both cerebral circulation disorders and insufficiency lead to the fact that in certain areas of the brain cells stop receiving the nutrients and oxygen necessary for life and die.

With a heart attack of a small number of neurons, there are no manifestations of the disease, since living brain cells compensate for their functions. When a large area of ​​the brain is damaged, symptoms of vascular dementia appear. But in cases of even slight damage to the area responsible for cognitive functions, dementia begins to develop and progress.

Main causative factors of the disorder

Medicine calls enough a large number of Reasons why vascular dementia may develop:

• acute heart failure;
• chronic cerebral ischemia (blockage of small vessels);
• vasculitis ( autoimmune diseases, in which the walls of blood vessels are affected).

There are a number of factors contributing to the development of the disease:

• elderly age(60 years and older);
• heart disease (with atrial fibrillation, ischemic disease, heart defects);
• arterial hypertension or hypotension;
• diabetes;
• heredity;
• bad habits;
• sedentary lifestyle.

Increasing prevalence arterial hypertension made it a leader among all risk factors for the emergence and further development of this type of dementia.

Stages of dementia development

The course and development of vascular dementia is conventionally divided into three stages, which differ in symptoms and their severity:

1. Easy stage senile dementia is characterized by blurred manifestations of the disease. The patient, as a rule, does not notice them. Sometimes relatives and friends pay attention to changes in his life and behavior. At the same time, a slight decrease in intelligence becomes noticeable, and a dramatic change in mood and emotions can occur. But the patient controls them and controls his actions. He copes independently everyday issues and does not need outside help.
2. Moderate Vascular dementia has more pronounced and noticeable manifestations. The patient’s life is complicated by the inability to navigate in space; a personality disorder occurs with behavioral deviations. Signs of aggression appear. Skills and abilities in handling household appliances, devices, communications equipment and the simplest objects are lost. The patient needs outside help.
3. Coping with severe Dementia is only possible with the constant help of loved ones. At this stage, a deep breakdown of the psyche is expressed. Difficulties arise with eating, control over the processes of urination and bowel movements is lost. The patient cannot perform simple hygiene procedures; he does not accept his family and friends. The patient is completely dependent on others.

However, it cannot be said that all cases of vascular dementia develop to a severe condition, although most forecasts are not encouraging - the duration and quality of life are not encouraging.

Symptoms at each stage

The first symptoms of vascular dementia begin with a noticeable expression of conservatism in the patient’s views, judgments and actions. At the same time, some character traits are aggravated. Excessive distrust or obstinacy, frugality and other changes appear.

Mental activity and memory gradually deteriorate. This is soon accompanied by unclear speech.

In addition, vascular dementia, which appears as a result of damage to certain areas of the brain, is manifested by a variety of symptoms:

1. Cell death in midbrain characterized by confusion and obscurity. At further development When suffering from illness, the patient withdraws into himself, loses interest in what is happening around him, in communicating with loved ones and relatives. He doesn't care about his appearance, and he stops following him.
2. Cell damage hippocampus(parts of the brain in the temple area), responsible for long-term storage of information, leads to amnesia. The patient cannot remember events that happened today or recently, although he can reproduce those that happened a long time ago.
3. in the frontal lobes brain manifests itself in indifference, apathy, laziness, loss of interest in communication. There may be illogical behavior, which is expressed in the monotonous repetition of a phrase or word that has long been known to the patient.
4. At in the subcortical regions There is significant absent-mindedness of the patient's attention, which makes it impossible to concentrate on one task or subject. He cannot highlight the main thing and determine the secondary in the information received, or analyze it. All his endeavors are unsuccessful.

In addition to cognitive impairment, almost all patients have problems with urination, which often becomes spontaneous.
Emotional disturbances and instability during the course of the disease often lead to depressive states, loss of optimism and self-confidence.

Methods for diagnosing pathology

Timely diagnosis of vascular dementia in initial stages gives a chance for recovery, in more complex cases, a correctly diagnosed and selected treatment will help stop the development of the disease. For this purpose, modern neurologists use the following research:

• studying the history of life and illness;
• carrying out psychological tests to identify cognitive impairment;
• blood pressure control;
• clinical blood test;
• determination of blood sugar;
• determination of lipid content in the blood and the level of cholesterol concentration in it.

Modern instrumental methods diagnostics that determine the degree of damage to the blood vessels of the brain and its tissues:

• radioisotope research of the brain;
• (determination of blood flow);
• angiography (x-ray examination of blood vessels);
• echocardiography.

Studying the research results, their analysis and comparison allows us to establish an accurate diagnosis.

Principles of treatment of vascular dementia

Since there are many causative factors for the development of vascular dementia, its treatment is prescribed in accordance with their predominance and taking into account the mechanism of development of the disease. Therefore, treatment for each patient is selected individually and adjusted in the process.

Drug treatment is aimed primarily at reducing the risk of occurrence or recurrence of stroke and other cardiovascular diseases.

This is provided by antiplatelet (antiplatelet) drugs that prevent the possibility of blood clots forming in blood vessels (Aspirin, Trental, Clopidogrel, Ticlopidine). An anticoagulant is also used indirect action Warfarin.

Such drugs are prescribed and used with extreme caution, as they have a number of contraindications.

To improve cognitive functions and slow down the development of their disorders, Pentoxifylline and anticholisterase drugs are used - Donepezil (Aricept), Galantamine (Reminyl). At treatment of mild and moderate dementia, Memantine is used, which prevents the development of brain dysfunction.

Currently, drugs that lower blood cholesterol levels - statins (Simvastatin, Atorvastatin and others) are becoming popular in the treatment of dementia.

Do not lose their relevance (, Pramiracetam, Cerebrolysin), which have a complex effect on brain cells brain and improving its functions.

For patients with hypertension, blood pressure is monitored and medications are prescribed to reduce it. Thus, eliminating one of the serious factors in the development of the disease.

When mental problems appear, antidepressants are prescribed and relieved. Treatment at home is considered the most favorable, especially for mild and moderate stages of the disease.

Prognosis for recovery and life expectancy

Complete recovery was recorded in approximately 15% of patients in the initial stages of the disease. The rest most often die within 4-5 years of detection and treatment of senile dementia or earlier. The life expectancy of each patient with vascular dementia is different and it is difficult to predict.

In the case of a gradual and slow course of the disease and maintaining skills Everyday life, you can live 10 - 20 years. In severe cases - no more than 10 years. But quality care and daily care from loved ones and relatives can prolong the patient’s life.

Concomitant diseases such as pneumonia and general purulent infection can also lead to death.

The general condition of the patient, the rate of progression of the pathology, living conditions and quality of care are decisive in their life expectancy.

Forewarned and forearmed!

A healthy and active lifestyle and complete abstinence can protect older people from vascular dementia. bad habits, moderate loads, optimism, development of intelligence, .

Treatment of diseases that are risk factors for vascular dementia and preventing their exacerbation is also an important preventive measure.

Needs to be controlled arterial pressure, blood sugar and cholesterol levels in order to prevent damage to the blood vessels of the brain and the development of senile dementia.

It is worth paying attention to nutrition. It should be varied and balanced, with a sufficient amount of vegetables and fruits, products containing essential vitamins and microelements.

You should not abuse antidepressants and sleeping pills. Lots of communication, travel and new experiences will prevent the onset of dementia.

When an elderly person’s memory becomes impaired, their character deteriorates, and their hygiene habits change, these may simply be natural signs of the body’s aging. But only a medical specialist can help determine this condition more accurately. As soon as these changes become noticeable, it is important to seek advice, as they can signal a disease that completely changes the life of not only the patient, but also the people who surround him. If a diagnosis of vascular dementia is established, the symptoms and treatment of which should be known to loved ones in order to make coexistence acceptable and be prepared for the consequences of the progression of the disease.

What is vascular dementia and its causes

Vascular dementia is characterized by a gradual mental disorder and a decrease in intelligence, which leads to maladjustment of the patient in society. The sick person is unable to work in his profession, and subsequently loses the ability to self-care.

Among all cases of dementia in the world, vascular dementia accounts for 15-20%, and is considered the second most common after Alzheimer's disease. But in the post-Soviet space, where cardiovascular diseases flourish, this type of dementia holds the palm.

The main reasons that lead to the development of vascular dementia:

• strokes due to blockage of cerebral vessels by atherosclerotic plaques or emboli;
• intracerebral bleeding, flowing under the meninges or permeating the brain tissue - often with arterial hypertension or angiopathy;
• multiple repeated embolization of cerebral vessels in heart diseases - arrhythmias, atrial myxoma, endocarditis;
• vasculitis of various origins - autoimmune, infectious, nonspecific.

Vascular dementia: symptoms and treatment

Unlike the degenerative type of dementia, when all symptoms develop gradually in an increasing manner, signs of vascular dementia appear, as a rule, after an episode of cerebral vascular accident and progress “stepwise”, with periods of stabilization of the process. Some time after the stroke, the following changes become noticeable:

• violations emotional sphere– irritability, touchiness, fatigue, tendency to depression, sudden mood swings;
• weakening of attention, decreased ability to concentrate, absent-mindedness, progressive decline in intelligence;
• forgetfulness, impaired memory for recent events, immersion in the past with the loss of recently acquired skills and habits;
• speech impairment - slowing down, “looping” on the same phrases;
• gait disturbance – it becomes slow, unsteady and “shuffling”;
• general cerebral disorders - nausea, dizziness, headaches, fainting;
• urinary dysfunction - may appear on early stages disease, in contrast to Alzheimer's disease, when this symptom is characteristic of the late period.

Important signs that dementia is of vascular origin are neurological disorders corresponding to the foci of brain damage, which can be identified using electroencephalography, computed tomography or magnetic resonance imaging.

Treatment of vascular dementia is aimed at

• elimination of the consequences of a vascular accident,
• prevention of repeated violations,
• limitation of the affected area,
• maintaining sufficient blood supply to brain tissue.

For this purpose, a complex of drugs that prevent blood clots is used - antiplatelet agents, drugs that improve the condition of brain cells and neuroprotective agents. Self-medication in this case is unacceptable.

Vascular dementia in the elderly

Older people are characterized by a more rapid development of symptoms of the disease, since in most cases there is an initial vascular pathology, and concomitant diseases only aggravate the condition. In severe cases, psychosis, delusional states, and hallucinations may develop.

But despite the tragedy of the situation in which the patient and his environment find themselves, vascular dementia very rarely reaches the total stage. Patients often retain everyday skills, general life attitudes, and a critical attitude towards themselves.

Progressive vascular dementia

The progression of vascular dementia depends on the rate of development of the disease against which it developed. Timely and adequate treatment of heart disease, correction of lipid metabolism disorders leading to atherosclerosis, normalization of blood sugar levels, fight against obesity are measures that can slow down the deterioration of cerebral circulation, and therefore stop the development of vascular dementia.

Diagnosis of vascular dementia - life expectancy

Unlike the degenerative type of dementia, the life expectancy of patients with a vascular origin of the disease is shorter, since the underlying disease does not provide a chance for longevity. The cause of death in such patients is usually a heart attack or stroke, often repeated, as well as pneumonia.

Vascular dementia is an acquired disease that is characterized by mental disorders, namely, the patient’s intelligence deteriorates and social adaptation disappears. This happens due to brain damage as a result of certain diseases.

It is noted that most often Alzheimer's type dementia is diagnosed in people over 60 years of age, but in Lately the disease is “getting younger”; the reasons for this dynamics have not yet been established.

The diagnosis of “vascular dementia” is established on the basis of the data collected during the initial examination of the data and after all necessary diagnostic measures. In most cases, complete atrophy of the brain occurs, which makes the pathological process irreversible.

According to the International Classification of Diseases, Tenth Revision, this disease belongs to the section “ mental disorders and behavioral disorders” has its own meaning - ICD-10 code F00-F01.9.

Cases of self-healing or successful therapy folk remedies relatively of this disease not installed. In addition, you need to understand that with this form (of dementia) in older people, the latter require constant care and supervision.

Etiology

Alzheimer's type dementia is caused by the following etiological factors:

• with frequent attacks;
• spicy;
• cerebral ischemia in chronic form(blockage of small vessels occurs).

A hereditary predisposition cannot be ruled out either. If there are cases of diagnosis in the family history, then there is a high probability that the same ailments will occur in a generation at the appropriate age.

In addition to the main etiological reasons, it is necessary to highlight a number of factors that are not the main ones, but predispose to the development of subcortical vascular dementia:

• bad habits;
• an insufficient amount physical activity;
• elderly age;
• previous severe trauma or surgical intervention on the brain;
• a history of psychiatric illnesses;

Availability of several etiological factors significantly increases the risk of developing such a disease in old age.

Classification

Based on the etiological factor, two forms of vascular dementia are distinguished:

• dementia that occurs against the background of a cerebral stroke;
• dementia due to chronic ischemia;
• mixed dementia.

Based on the nature of the localization of the pathological process, the following are distinguished:

• subcortical vascular dementia;
• temporal part;
• frontal lobes;
• midbrain;
• cerebral cortex.

In addition, there are several stages of development of such a pathological process:

• predisposition stage;
• asymptomatic stage of cerebral ischemia. Violations, in this case, can only be detected by CT or MRI;
• stage of initial manifestation of the clinical picture;
• stage of moderately severe disorders in the functioning of the brain, namely memory deterioration, slight deterioration in cognitive abilities;
• advanced stage, which is characterized by a pronounced symptom complex;
• stage of severe dementia;
• the final stage that always ends fatal due to the development of associated complications.

In addition, the following should be noted - the development of the clinical picture can be either smooth or lightning fast. The severity of symptoms may alternate between periods of exacerbation and a long phase of remission.

Symptoms

The initial stages of the development of this disease in older people are asymptomatic in most cases. The time at which the first clinical signs appear will depend on the etiological factor. Thus, with a stroke, the first symptoms in older people appear after 1-3 months. In the event that dementia of the Alzheimer's type manifests itself against the background of several microstrokes and other etiological factors, then pronounced symptoms can be observed six months later.

In general, the clinical picture is characterized as follows:

• gradual memory deterioration. It should be noted that, unlike Alzheimer's disease, in this case this process occurs in a milder form;
• slowing down of mental activity;
• changes in a person’s psychotype;
• narrowing the range of interests. To some things that previously interested the patient, he shows complete indifference;
• periods of apathetic mood;
• speech and writing disorders;
• it becomes difficult for the patient to perceive new information and even individual words;
• excessive talkativeness with a lack of understanding of the essence of what was said;
• the patient does not understand the speech addressed to him if it consists of several sentences;
• long-term memory deteriorates - some life events are completely erased;
• social disadaptation - a person cannot make a purchase on his own, pay for transport fare, gets lost in the area;
• changes in gait are observed;
• The simplest everyday operations are also beyond the power of a person;
• attacks and;
• epileptic seizures.

In the final stages of the development of the disease, a person is no longer able to perform simple actions of self-care and to cope with natural physiological needs. At this stage of development of the disease, the patient needs round-the-clock care; he cannot be left alone, as this is dangerous for his life and for those around him.

Despite the fact that the clinical picture of senile dementia of this form is clearly expressed, in no case should you independently compare symptoms and treatment and carry out therapeutic measures on this basis.

Diagnostics

In this case, you will need to consult a neurologist and psychiatrist. After examining the patient by specialists, the patient’s status is verified according to special criteria for dementia according to the ICD-10 system or according to Khachinsky.

It goes without saying that diagnosis is made not only on the basis of a physical examination and psychiatric tests. The fundamental diagnostic methods, in this case, are:

• CT and MRI of the brain;
• Ultrasound of great vessels;

In addition, you should carry out differential diagnosis regarding Alzheimer's disease.

As a rule, the above diagnostic measures are sufficient to establish an accurate diagnosis and determine further treatment tactics.

Treatment

For vascular dementia, treatment is aimed at stopping attacks, slowing the progression of the disease and improving the quality of a person’s life. Unfortunately, it is impossible to completely eliminate the disease.

However, you need to understand that, subject to timely application for medical care through drug therapy and following all the doctor’s recommendations, you can achieve a significant improvement in the patient’s well-being.

In this case, the doctor may prescribe the following medications:

• to improve cell metabolism;
• antiplatelet action;
• neuroprotective spectrum of action;
• neuroleptics;
• sedatives;
• antidepressants.

The duration of taking the drugs and their dosage are strictly prescribed by the attending physician. As an addition to the main course of treatment, herbal preparations and herbal decoctions may be prescribed.

Except drug treatment, it is mandatory to comply with the following general medical instructions:

• skilled nursing;
• compliance with a special diet, which is prescribed individually;
• occupational therapy;
• social adaptation.

The issue of hospitalization is decided on an individual basis, however, it is noted that a change of environment can negatively affect the course of the pathological process. Therefore, it is best if the therapy takes place in a home environment familiar to the patient.

Life expectancy for this disease largely depends on the etiology, stage and form of development, and the timeliness of therapeutic measures. In addition, the patient's age and general history should be taken into account.

Prevention

Prevention of vascular dementia consists of the following measures:

• prevention cardiovascular diseases;
• maintain a sufficient level of physical and intellectual activity both in youth and in old age;
• balanced diet;
• elimination of bad habits, moderate consumption of alcoholic beverages;
• timely and correct treatment of all diseases;
• for hypertension - control blood pressure, take the necessary medications, systematically visit a doctor for preventive purposes.

At the moment, there are no drugs whose action would be aimed at completely eliminating such a disease and reversing those pathological processes which are caused by it.

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