The appearance of forgetfulness and inattention is usually explained by the development of Alzheimer’s disease. At the same time, impaired cognitive functions may be the first and only symptom of other, no less dangerous diseases.
aif.ru talks about this Deputy Director of the Scientific Center of Neurology, Head of the Angioneurological Department, Corresponding Member of the Russian Academy of Sciences Marine Tanashyan.
Lidia Yudina, aif.ru: – Many people believe that dementia is a consequence of neurodegenerative processes that affect the brain …
Marine Tanashyan: – Alzheimer’s, Parkinson’s, Wilson’s diseases, etc. are not so common and cause dementia mainly in very old people. In addition to neurodegenerative dementia, there is also vascular dementia, which is much more common, since it develops against the background of the most widespread diseases – diabetes mellitus (which, according to experts, affects at least 9 million people in our country alone) and arterial hypertension (it is recorded in 40 % of people under 55 and 60% after 60).
– How are these diseases related to the work of the brain?
“If in neurodegenerative diseases dementia is associated with the accumulation of beta-amyloid protein in brain cells, then an increase in blood pressure and blood sugar levels provokes a violation of the tone and permeability of small vessels with the development of cerebral microangiopathy. This is manifested by impaired blood supply (more often ischemia) to various parts of the brain and, as a result, a rupture of neural connections between them, contributing to the development and progression of cognitive dysfunction (impaired memory, speech, thinking and learning processes).
– Diabetes mellitus of the second type and arterial hypertension “get younger” from year to year and are often recorded already in 40-year-olds. How long after the onset of these diseases do brain changes occur?
— More often, cognitive impairments are detected at an advanced stage of the disease, when the brain damage has already been irreversibly completed. At the same time, we often see patients who have symptoms of vascular dementia at the initial stage or with an asymptomatic course of the underlying disease, and it is the manifestations of vascular pathology of the brain that prompt neurologists that the patient should be referred to an endocrinologist or cardiologist with whom we work. in tandem.
What are these distinguishing symptoms?
– When it comes to dementia, many people think of a bedridden patient who cannot remember his name. In fact, patients with dementia for the time being can look perfectly healthy, work successfully and earn good money. Only a doctor is able to notice the signs of an impending disaster and determine the cause that caused them.
If the main symptoms of neurodegenerative diseases are speech disorders and spatial problems (a person can get lost in a familiar place), then vascular dementia is more characteristic of attention disorders, short-term memory, emotional disturbances, changes in character (tearfulness and irritability), decreased motivation.
Even if at the first stage these violations are not expressed, you need to understand that over time they will progress and at some point lead to full-fledged dementia, in which a person will be completely dependent on others.
Are these disorders treatable?
– It is impossible to eliminate the existing changes in the brain at the current stage of the development of medicine. However, in the early stages of arterial hypertension and diabetes mellitus, properly selected therapy can prevent the appearance of new foci of cerebral ischemia and reverse cognitive changes, in some cases to the initial level.
At later stages, given the leading vascular nature of cognitive dysfunction, detailing and treatment of the main stages of cerebrovascular accident are required – these are drugs that improve the blood supply to the brain and its metabolism. There are groups of drugs (anticholesterase and glutamatergic) that are used to restore and regulate neural connections, improve memory functions and concentration, nootropics and neuroprotectors (to restore the metabolism of brain cells), antioxidant therapy – all of them can slow down the rate of progression of cognitive impairment.
But it is difficult to talk about the “explosive” effect of their use – therefore, the sooner doctors state cognitive impairment, the more opportunities doctors have to correct them.
Poems while running
Do traditional brain training methods work for vascular dementia?
— Neurologists never tire of repeating that cognitive functions are improved by any mental load — mental counting, crossword puzzles, memorizing poetry, learning foreign languages. This happens due to the involvement of other brain structures in the work and the formation of new neural connections between them.
A good effect is also given by physical activity, the lack of which often leads to the development of cardiovascular diseases and diabetes mellitus, as well as to vascular dementia.
It is also important at any age to maintain the same social circle and maintain an interest in life. Observations show that in the group of socially active patients who are engaged in intellectual and physical work, the prevalence of cognitive disorders, even in the presence of vascular pathologies, is much lower.