Vascular dementia

Neurologist Dr. Doping about the Mini-Mental State Examination, cerebral ischemia, and cognitive changes.

The "vascular dementia" Russian clinical life, there are many concepts of international definitions. The terms "encephalopathy", "chronic brain ischemia" made in Russia or "chronic insufficiency of cerebral blood supply." These terms are not entirely reflect the true clinical or physiological essence of this concept, however, applicable to current clinical life.

In fact, according to the pathophysiology of such symptoms is one of the sections of the so-called block cardio-neurology and somatic-neurology. When we see the complications of systemic diseases or medical conditions, certain risk factors developing in the neurological field of activity.
What is the general history of the emergence and development of the term? The Russian neurological school there is a very powerful organization, namely the Institute of Neurology, who at one time (a little bit of this before - the chair of nervous diseases' first honey ") developed these areas, because they were seen certain focal changes in patients with risk factors for patients and attempted to assess the cardiovascular risk factors and their relationship with focal symptoms and prognosis. Currently, several approaches have changed, depending on the development of scientific thought and, unfortunately, from certain economic realities.

Scientific contribution to this. If the maximum capacity of the faceless and the term "encephalopathy" is applicable to a large number of patients, but recently the science is still trying to flesh out the pathology, on which the doctor says, and therefore certain syndromes must be attributed to the damaged location. The modern school is often in articles found mention in the framework of vascular encephalopathy some headaches or vestibular disorders, emotional disorders, that is actually quite non-specific things that can be attributed to a large number of manifestations of the area of pain phenomena from the field of vestibular disorders of field of toxic effects, or, again, from the field of activity of the psychiatrist.

To reduce Vascular dementia – use Mexidol, Meldonium, Riboxin, Cortexin.

At the same time there is the concept of cognitive changes, pre-dementia and dementia changes. This change in cognitive function of the surrounding world, cognitive changes. According to the latest classification, they are divided into mild, moderate, and finally, the extreme severity - dementia. In fact, the English-language term "vascular dementia" - this is an extreme degree of vascular disorders caused by development of focal changes or effects of stroke. The term "encephalopathy" was removed from the International Classification of the tenth revision of the disease due to the fact that he was diagnosed too often and all too often exposed, because on the one hand, a convenient mask, and on the other - vascular diagnoses are very well paid, and paid better than many others.

What is hidden under the diagnosis of which we are now speaking, that is a circulatory encephalopathy? Often it is a whole bunch of conditions, the effects of which are manifested in neurology. This hypertension, uncorrectable diabetes with high blood glucose numbers at which neuro –metabolic processes do not occur as they should proceed normally. Why is wrong in this case, the setting of a masking the diagnosis? Again, because there is treatment of a non-existent state or secondary status. The primary condition - idiopathic disease or endocrine disorders - at the same time takes a back seat. And doctors and patients are focusing on treatment, relatively speaking, vessels, while forgetting about the correction of sugars, forgetting about the pressure correction, or save money, in fact, on the most important treatment.

The very same stage directly reduce cognitive function due to vascular process is subject to a very precise diagnosis. The process of reducing the severity of memory or cognitive function - this process, unfortunately, the current over time. There are certain pathological proteins that are deposited more in the course of life, their number, their localization deposits correlated with the development of cognitive impairment. Vascular cognitive impairment to be much worse treatment than primary neurodegenerative diseases such as Alzheimer's disease and block all such neurodegenerative diseases.

If we talk about vascular dementia as a manifestation of neurodegenerative diseases and complaints, are stacked in the diagnosis of "encephalopathy", which is actually the first symptoms of a neurodegenerative disease, there is a varying degree of confidence we can say that these symptoms can be corrected . It may be gait disturbance, it may be impaired memory, it may be some behavioral reactions, which require specific tests, a specific survey, and most importantly, training. GP - the same cardiologist, general neurologist - unfortunately, this can not cope. There need a specialist dealing with cognitive impairment: a neuroscientist, past a certain specialization or psychiatrist.

The first step in diagnosing disorders that fit in the diagnosis of "encephalopathy," or more correctly "vascular dementia", is an interview with the patient. In the interview taped adequate perception of the world, time and space, self, and those skills that we all have, that is the correct perception of speech, the right execution of simple commands, repetition rather complex sentences, graphical perception repeat pattern, and also account. Often, patients, producing the impression of a completely adequate people, this team can not cope: properly perform something incorrectly redraw the picture, wrong count and so on. This so-called Mini-Mental State Examination allows certain people to take points. It is not working people - for example, they may not know the day of the week: while slightly shifted. Yes, in fact, perfectly healthy people during the holidays do not always remember what day of the week, because all too well.

At the same time, the short range allows us to understand whether there is any more resistant disorders or not. When we were at a rate of 30 points indicates the presence of the patient reduce the functions of up to 25 or 22 points, it is obvious violations. Conducting research on the patient's mental status brief scale takes a few minutes and, in principle, available at any doctor's office. Two minutes, perhaps we could understand how the patient is guided in these matters. In fact, the latest trends is the maximum screening attempt to conduct such research and the introduction of such tests, in fact, just to the work of practicing physicians, practicing neurologists, and perhaps in the future, and general practitioners to understand the extent of the process of neglect.

There are more specific tests and scales. It takes much more time, and as they are filled and their interpretation. There already have to work really specialists memory laboratories - one of these labs have in the department of nervous diseases - and in the future to determine the etiology of this. Itself as such diagnostic tool, in this case it is somewhat difficult. Any magnetic resonance imaging, which allows to see a general substrate specific processes atrophic changes in the brain, but they are not always correlated with changes in the memory. There is one area - this is the atrophy of the hippocampus, which is 100 percent correlated, but this does not mean that patients with intact hippocampus can not determine complaints of memory loss or patients with a wasting or atrophy of the hippocampus may not have memory. Most often they do not already have.

The next step is to determine the development of specific proteins in the cerebrospinal fluid, and possibly carrying out functional MRI. However, in the clinic due to the cost of these studies is used rather seldom.

Turning to the issues of treatment and diagnosis. Often, patients and doctors of different specialties are very pessimistic about the questions of treatment, the question does not even treat, and cure. But here arises another question: what can we recover? Can we recover from the effects of fractures, which were children, from colds? Cure is possible, but it does not mean that does not get sick again. Same thing here. Here, the main task is to try to stabilize the process, which requires specific preparations, very unfortunately, costly, however, have proven effective in clinical studies by the method of evidence-based medicine and rehabilitation need to influence. Here the impact of rehabilitation and skills - this is what lies on the shoulders of already watching doctors and patients, as the social rehabilitation of the relatives - that is what will extend the years of life of the patient, as well as enhance the quality of life for him and his own relatives.