Dementia (dementia): causes, how it develops, types, manifestations, diagnosis, treatment. Cognitive Impairment in Medical Practice: Dementia What is dementia

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.

With age, a person begins to experience failures in all systems and organs. There are deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, against the background of mental abnormalities, behavior changes, unreasonable depressions appear, emotionality decreases, and the person begins to gradually degrade.

Dementia usually develops in older people. It affects several psychological processes: speech, memory, thinking, attention. Already at the initial stage of vascular dementia, the resulting disorders are quite significant, which affects the quality of life of the patient. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave the professional field, and they simply cannot do without constant supervision of the household.

General characteristics of the disease

Acquired disorders of cognitive functions that negatively affect the daily activity and behavior of the patient are called dementia.

The disease can have several degrees of severity depending on the social adaptation of the patient:

Mild degree of dementia - the patient has a degradation of professional skills, his social activity decreases, interest in favorite activities and entertainment is significantly weakened. At the same time, the patient does not lose orientation in the surrounding space and can serve himself independently.
Moderate (medium) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to independently open the lock on the front door. Such a degree of severity in common parlance is often referred to as "senile insanity." The patient needs constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
Severe degree - the patient has a complete disadaptation to the environment and degradation of the personality. He can no longer do without the help of loved ones: he needs to be fed, washed, dressed, etc.

There are two forms of dementia: total and lacunar.(dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). A typical variant of lacunar dementia can be considered in the initial stage.

The form of total dementia is characterized by absolute personal degradation. The patient is subjected to intellectual and cognitive impairments, the emotional-volitional sphere of life changes radically (there is no sense of shame, duty, vital interests and spiritual values disappear).

From a medical point of view, there is such a classification of types of dementia:

Atrophic-type dementias (Alzheimer's disease, Pick's disease) - occur, as a rule, against the background of primary degenerative reactions occurring in the cells of the central nervous system.
Vascular dementias (atherosclerosis, hypertension) - develop due to circulatory pathologies in the vascular system of the brain.
Mixed type dementias - the mechanism of their development is similar to both atrophic and vascular dementias.

Dementia often develops due to pathologies that lead to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as a severe complication of the disease. In addition, conditions such as skull trauma, brain tumors, alcoholism, etc. can become causes of dementia.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, unreasonable aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal decay, are relevant.

Vascular dementia

This type of disease is associated with impaired cognitive function due to the pathology of blood flow in the brain. Vascular dementia is characterized by a long development of pathological processes. The patient practically does not notice that he develops brain dementia. Due to disturbances in blood flow, certain brain centers begin to experience why the death of brain cells occurs. A large number of these cells leads to brain dysfunction, which is manifested by dementia.

The reasons

Stroke is one of the root causes of vascular dementia. Both, and, which distinguish a stroke, deprive the brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are at particular risk of developing dementia.

It can also cause dementia. Due to low blood pressure, the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can also be caused by ischemia, arrhythmia, diabetes, infectious and autoimmune vasculitis, etc.

As mentioned above, often the cause of such dementia can be. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing cognitive impairment. This dementia differs from other dementias in the gradual progress of the clinical picture, when episodic improvements and deterioration of the patient's condition periodically replace each other. Atherosclerotic dementia is also characterized by dizziness, speech and visual deviations, and delayed psychomotor.

signs

Usually, a doctor diagnoses vascular dementia in the case when cognitive dysfunctions began to appear after a trauma or stroke. A harbinger of the development of dementia is also considered a weakening of attention. Patients complain that they cannot concentrate on a certain object, concentrate. Characteristic symptoms of dementia are changes in gait (minching, wobbly, "skiing", unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - also an alarming signal. Even at the beginning of the disease, the patient has some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia in the initial stages, the patient is given a special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

By the way, with vascular type of dementia memory deviations are not particularly pronounced, which cannot be said about the emotional sphere of activity. According to statistics, about a third of patients with vascular dementia are in a depressive state. All patients are subject to frequent mood swings. They can laugh until they cry, and suddenly they begin to sob bitterly. Often patients suffer from hallucinations, epileptic seizures, show apathy towards the outside world, prefer sleep to wakefulness. In addition to the above, the symptoms of vascular dementia include impoverishment of gestures and facial movements, i.e., impaired motor activity. Patients have urination disorders. A characteristic feature of a patient suffering from dementia is also slovenliness.

Treatment

There is no standard, template method for the treatment of dementia. Each case is considered by a specialist separately. This is due to the huge number of pathogenetic mechanisms that precede the disease. It should be noted that full dementia is incurable, therefore, the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia, too, is carried out with the help of those that have a positive effect on brain tissue, improving their metabolism. Also, the treatment of dementia involves the treatment of directly diseases that led to its development.

To improve cognitive processes, (cerebrolysin) and nootropic drugs are used. If the patient is exposed to severe forms of depression, then along with the main treatment for dementia, antidepressants are prescribed. For the prevention of cerebral infarction, antiplatelet agents and anticoagulants are prescribed.

Do not forget about: giving up smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that demented people often have such an unpleasant trait as slovenliness Therefore, relatives need to provide proper care for the sick. If the household cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, is worth discussing with those who have already encountered similar problems in the forum dedicated to vascular dementia.

Video: vascular dementia in the program “Live Healthy!”

Senile (senile) dementia

Many, observing elderly households, often notice changes in their condition associated with character, intolerance and forgetfulness. An irresistible stubbornness appears from somewhere, it becomes impossible to convince such people of something. This is due to brain atrophy due to the large-scale death of its cells due to age, i.e., senile dementia begins to develop.

signs

First, an elderly person begins slight deviations in memory- the patient forgets recent events, but remembers what happened in his youth. With the development of the disease, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have practically no psychotic states, which greatly facilitates the life of both the patient himself and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis, accompanied by either sleep inversion. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful tenderness to righteous anger, i.e. the global form of the disease develops. Changes in blood pressure (hypotension, hypertension), changes in blood levels (diabetes), etc. can provoke the onset of psychosis. Therefore, it is important to protect demented elderly people from all kinds of chronic and viral diseases.

Treatment

Healthcare workers advise against treating dementia at home regardless of the severity and type of disease. Today there are many boarding houses, sanatoriums, the main direction of which is the maintenance of just such patients, where, in addition to proper care, the treatment of the disease will also be carried out. The question, of course, is debatable, since in an atmosphere of home comfort it is much easier for a patient to endure dementia.

Treatment of dementia of the senile type begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their impact is manifested in an increase in the ability of the patient's nervous system to adapt to the resulting physical and mental stress.

As mandatory drugs for the treatment of dementia of any type, nootropic drugs are used that significantly improve cognitive abilities and have a restorative effect on memory. In addition, in modern drug therapy, tranquilizers are often used to relieve anxiety and fear.

Since the onset of the disease is associated with serious memory impairment, you can use some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have a calming and hypnotic effect.

Video: cognitive training for dementia patients

Dementia of the Alzheimer's type

Today it is perhaps the most common type of dementia. It refers to organic dementia (a group of dementive syndromes that develop against the background of organic changes in the brain, such as cerebrovascular disease, traumatic brain injury, senile or syphilitic psychosis). In addition, this disease is quite closely intertwined with types of dementia with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), sharing many symptoms with them. Often even doctors confuse these pathologies.

The most significant factors provoking the development of dementia:

Old age (75-80 years);
Female;
Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
Arterial hypertension;
Diabetes;
Atherosclerosis;
Obesity;
Disease related.

The signs of dementia of the Alzheimer's type are generally identical to the symptoms of vascular and senile dementia. These are memory impairments, first recent events are forgotten, and then facts from life in the distant past. With the course of the disease, emotional-volitional disorders appear: conflict, grouchiness, egocentrism, suspicion (senile personality restructuring). Lack of cleanliness is also present among the many symptoms of dementia syndrome.

Then the delusion of “damage” is revealed in the patient, when he begins to blame others for the fact that something was stolen from him or they want to kill him, etc. The patient develops a craving for gluttony, vagrancy. At the severe stage, the patient is completely apathetic, he practically does not walk, does not talk, does not feel thirst and hunger.

Since this dementia refers to total dementia, then the treatment is selected comprehensively, covering the therapy of concomitant pathologies. This type of dementia is classified as progressive, it leads to disability, and then death of the patient. From the onset of the disease to death, as a rule, no more than a decade passes.

Video: how to prevent the development of Alzheimer's disease?

epileptic dementia

Quite a rare disease arising, as a rule, on the background or schizophrenia. For him, a typical picture is the paucity of interests, the patient cannot single out the main essence, or generalize something. Often epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient is constantly expressed in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious God-fearing appear.

Alcoholic dementia

This kind of dementia syndrome is formed due to a long alcohol-toxic effect on the brain (for 1.5-2 decades). In addition, factors such as liver damage and disorders of the vascular system play an important role in the development mechanism. According to studies, at the last stage of alcoholism, a patient has pathological changes in the brain area, which are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia can regress if the patient completely refuses alcoholic beverages.

Frontotemporal dementia

This presenile dementia, often referred to as Pick's disease, implies the presence of degenerative abnormalities affecting the temporal and frontal lobes of the brain. In half of the cases, frontotemporal dementia develops due to a genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decorum and sexual promiscuity, bulimia and urinary incontinence.

Effective in the treatment of such dementia have shown themselves such drugs as Memantine (Akatinol). Such patients live no more than ten years, dying from immobility, or parallel development of genitourinary, as well as pulmonary infections.

Dementia in children

We considered the varieties of dementias that affect exclusively the adult population. But there are pathologies that develop mainly in children (Lafort, Niemann-Pick, etc.).

Childhood dementias are conditionally divided into:

Dementia in children can be a sign of a certain mental pathology, such as schizophrenia or mental retardation. Symptoms appear early: the child's ability to remember something abruptly disappears, mental abilities decrease.

Therapy of childhood dementia is based on the cure of the disease that provoked the onset of dementia., as well as on the general course of pathology. In any case, the treatment of dementia is carried out with the help and exchange of cellular substances.

With any type of dementia, relatives, relatives and household members should treat the patient with understanding. After all, it is not his fault that he does sometimes inadequate things, this is what the disease does. We ourselves should think about preventive measures so that the disease does not hit us in the future. To do this, you should move more, communicate, read, engage in self-education. Walking before going to bed and active rest, giving up bad habits - this is the key to old age without dementia.

Currently, Alzheimer's disease and (somewhat less frequently) vascular dementia appear among the diseases that cause dementia most often in the media. However, both diseases are inferior in prevalence to mixed type dementia, or mixed dementia.

Mixed is called dementia, which develops against the background of a combination of vascular lesions of the brain and primary degenerative disorders (more often - Alzheimer's disease).

According to numerous studies, at least half of patients with Alzheimer's disease suffer from disorders of the circulatory system of the brain. Along with this, approximately 75% of patients diagnosed with vascular dementia have symptoms of neurodegenerative processes.

This information allows scientists to make an assumption about the existence of a relationship between these diseases. In support of this hypothesis, clinical studies show that stroke and coronary disease increase the risk of developing Alzheimer's disease. This is quite understandable. The deposition of toxic protein plaques in the brain begins long before the first signs of the disease appear. However, thanks to the reserve of cells, the brain compensates for the first losses, and outwardly the process of atrophy does not manifest itself in any way. Only after the reserve is exhausted, the patient is diagnosed with cognitive and behavioral disorders. Cell death associated with vascular problems reduces the reserve and thereby accelerates the appearance of external signs of the disease. The inverse relationship is also quite understandable. Alzheimer's disease increases the risk of vascular diseases of the brain, since the deposition of beta-amyloid (senile plaques) occurs both in the very substance of the brain and on the walls of blood vessels, leading to their damage.(angiopathy).

It is also important to note that primary degenerative processes and vascular diseases have many common prerequisites. These include: 

carriage of the apoE4 gene,
high blood pressure, 
atherosclerosis of cerebral vessels, 
arrhythmias,
high cholesterol, 
bad habits (malnutrition, smoking),
physical inactivity.

Therefore, the frequent combination of Alzheimer's disease and vascular dementia is quite natural.

How to recognize mixed dementia

Suspicion of mixed dementia is appropriate in cases where the appearance of cognitive disorders of the Alzheimer's type (memory impairment similar to those occurring in Alzheimer's disease) is preceded by cardiovascular diseases (hypertension, atherosclerosis).Mixed dementia can be distinguished from Alzheimer's by the presence ofother than typicalfor Alzheimer's diseasememory problems, specific cognitive impairments characteristic of diseases associated with dysfunction of the frontal lobes: thisattention problems, impaired ability to plan one's actions,slowness in doing intellectual work. At the same time, spatial orientation disorders and other symptoms of Alzheimer's disease appear much less frequently.

Dementia is a disease characterized by a persistent and irreversible impairment of a person's intellectual activity, accompanied by various deviations in behavior and physical condition. This type of mental disorder can occur due to any infectious disease of the brain, strokes, brain injuries. Often this disease is observed in the elderly due to various microstrokes and age-related changes.

If dementia is caused by two or more diseases, it is called mixed. By its nature, this is the same extensive, irreversible deterioration in intellectual activity, like just dementia. Mixed dementia is characterized by the following symptoms:

Memory problems such as: forgetfulness, difficulty remembering. A person suffering from mixed dementia can remember the events of distant years, but cannot say exactly what he ate for breakfast;

Various behavioral disorders. A person may behave inappropriately: hyperactive or, conversely, too sluggish. As a rule, at such moments he is not aware of his actions;

Decreased mental activity. With mixed dementia, it is quite difficult to perform simple addition or subtraction, solving elementary problems. A person cannot understand the speech addressed to him, as well as express his needs, feelings at the verbal level;

There are various cognitive impairments, characterized by violations of cause-and-effect relationships. The person is disoriented, he is not interested in anything.

In addition to intellectual and cognitive disorders, mixed dementia is accompanied by hypertension and atherosclerosis. When the disease occurs, the narrowing of blood vessels, the appearance of plaques, which leads to an increase in pressure. All this together contributes to the deterioration of the general condition of a person, making him unsuitable for social life.

To make a diagnosis of mixed dementia, a qualified doctor is needed who will compare the symptoms of each individual type of mental disorder and collect a competent history. In addition, additional studies will be needed to clarify, for example, MRI, complete blood count, and identification of blood pressure dynamics.

There is no cure for mixed dementia, except in rare cases. However, it is possible to alleviate the patient's condition with the help of auxiliary drugs and procedures, as well as help him adjust to life in society.

Since mixed dementia occurs due to brain damage, vascular changes, about half of the patients also suffer from, which also provokes dementia.

Causes of mixed dementia

Like any other disease, mixed dementia develops due to certain reasons, the main of which is vascular pathology. It can occur at any age, but the advantage is diagnosed in people after 50 years of age. Vessels wear out not only by age.

Wrong lifestyle: smoking, alcohol, fatty foods can accelerate the process of deterioration in the quality of blood vessels. When Alzheimer's disease is attached to vascular pathologies, mixed dementia is also provoked in most cases.

To all of the above, brain injury can also be added. However, trauma itself can cause illness. Trauma provokes vascular pathology - mixed dementia follows.

The main risk factors leading to the occurrence of vascular problems, due to which mixed dementia can be diagnosed, include:

smoking. It has long been known that this bad habit provokes pollution not only of the lungs, but also of the vessels themselves. And long-term and frequent smoking is detrimental not only to blood vessels, but also to brain cells;
diabetes. This disease itself causes exorbitant damage to blood vessels, clogging them with plaques that are difficult to treat;
the presence of the apoE4 gene. This gene can be detected only after passing a special analysis. Unfortunately, this gene provokes the disease, although there is no absolute certainty that it is activated during life, but there is a risk;
atrial fibrillation, persistent uncontrolled hypertension, hypodynamia, metabolic syndrome.

The brain has its own supply of so-called reserve cells. In the presence of some disease that is asymptomatic in the brain, diseased cells are replaced by healthy ones, compensating for them. In people who have had latent infections, the risk that the reserve of healthy cells will quickly dry up, thereby provoking mixed dementia, increases.

All of the above are just prerequisites that, under certain conditions, can be combined, causing dementia of mixed genesis.

Treatment and prognosis of mixed dementia

To improve the patient's well-being, complex treatment is required, which will be aimed at correcting all aspects of neurophysiological disorders. The first is drug therapy. Patients are prescribed drugs to dilate blood vessels, normalize their activity. Constant dynamic monitoring of blood pressure is carried out, and in case of its persistent violation, drugs are prescribed to normalize the pressure.

In the presence of Alzheimer's disease, drugs are prescribed that reduce the consequences of the pathology. It is important to combine drug therapy with the creation of a psychologically favorable atmosphere. For this patient, they settle in a quiet, calm place, without annoying elements: bright light, loud sounds. It is useful to watch quiet, calm programs. Usually such patients need good care, for this it is better to hire a nurse who will be with the patient all the time. Psychotherapy, music therapy and fairy tale therapy, along with alternating other psychotherapeutic means, give a good effect.

According to the latest statistics, more than 2 million people in Russia live with a diagnosis of dementia. According to WHO forecasts, as early as 2030, the number of patients worldwide may increase to 80 million.

This disease affects mainly the elderly and is characterized by serious pathologies of the brain, in which the mental, speech and other abilities of a person are partially or completely lost. It is no coincidence that the people call the disease “senile dementia”.

There are several varieties of this disease: Alzheimer's disease, alcoholic dementia, vascular dementia, mixed dementia, etc. Mixed dementia occupies a special place in the classification due to the fact that it develops as a result of two or more pathological processes in the cerebral cortex, therefore, it is characterized by symptoms of several diseases .

Causes of the disease

Mixed dementia occurs in medical practice much more often than other varieties - in about 50% of all cases.

The main reason is the simultaneous damage to the brain by cerebrovascular disease, which is characterized by pathology of cerebral vessels with impaired blood circulation in them, and neurodegenerative damage, as a result of which brain cells die, which leads to complete degradation of the personality.

This disease is called “mixed” because several diseases are factors in its development: for example, Alzheimer's disease and vascular dementia or the combination of dementia with Lewy bodies with an alcoholic form. There are other examples of combinations of various diseases leading to mixed dementia. This diagnosis is made if it is impossible to explain the clinical picture of one of the varieties of this disease.

There are many factors that can lead to the development of the disease. Among them:

The disease in its development goes through several stages. It begins long before the first clinical manifestations. At first, vascular diseases affect the cells of the brain, but it can compensate for these disorders due to the reserve of healthy cells.

With the addition of Alzheimer's disease, accelerated death of neurons occurs. Amyloid plaques are formed in them, which are insoluble round formations from pathological proteins. When cells die due to damage to the vessels of the brain, the supply of neurons is depleted. Alzheimer's disease sets in, accelerating the development of vascular pathologies due to the accumulation of amyloids both in the neurons themselves and in the vascular walls. As a result, many brain functions are lost, and senile dementia develops.

Clinical manifestations of mixed dementia

Symptoms of the disease of any form of dementia are similar to each other and depend on the stage and degree of the disease, however, with mixed dementia, all disorders are recorded against the background of Alzheimer's disease and vascular pathologies - strokes, cerebral ischemia, etc.:

Allocate mild, moderate and severe degree of dementia of mixed type:

Diagnosis of mixed dementia

There are several types of the disease, the clinical manifestations of which differ slightly from each other. The genesis of dementia cannot be determined only by the presence of symptoms; additional examination tools are needed - cognitive testing, a clinical blood test and a brain scan.

Doctors are convinced that the diagnosis of "mixed dementia" is possible only if the clinical picture cannot be explained by the course of only one disease.

This diagnosis is usually made in three cases:

Mixed dementia with damage to the cerebral vessels is evidenced by progressive disorders of mental activity and memory impairment. To make a diagnosis, the presence of patients with Alzheimer's disease among the closest relatives of the patient is also taken into account. In rare cases, a person with dementia can tell the doctor about his symptoms, so the doctor pays great attention to talking with the patient's relatives to make a correct diagnosis. The anamnesis is clarified: the presence of craniocerebral injuries, hypertension, diabetes mellitus, thyroid diseases, etc.

Common research methods for mixed dementia are magnetic resonance imaging and computed tomography of the brain. During the procedure, a neurologist can detect atrophic phenomena, injuries, the presence of tumors and other pathologies of the organ, as well as analyze the state of the blood vessels.

Treatment and prognosis for mixed dementia

This type of senile dementia is difficult to treat, due to the fact that it is accompanied by other disorders. Treatment for mixed dementia is complex. On the one hand, it should eliminate the causes that gave rise to vascular pathologies. For this, drugs are prescribed that reduce blood pressure, statins and antiplatelet agents, and drugs are also prescribed to improve cerebral circulation. On the other hand, it is necessary to slow down the course of Alzheimer's disease. Even in the last stage of mixed dementia, drug therapy is used to prevent dementia from progressing.

Patients with mixed dementia often experience depression, which reduces the patient's activity and depresses his condition. In addition, depression adversely affects cognitive processes. To stabilize the mental state, antidepressants are prescribed with minimal side effects. Their treatment should be course.

In addition to drug therapy, the patient is provided with security and constant monitoring: they install video cameras, blockers on gas stoves and electricity, or hire a nurse. To maintain social skills, patients with senile dementia are referred to sessions of group psychotherapy, occupational therapy.

The prognosis for mixed dementia depends on many factors. If a person falls ill after 65 years, the disease can proceed for several years, if after 85 years, and according to statistics, in the USA every second person who has lived to this age is affected by senile dementia, the disease can be rapid and last only a few months. There is no single answer.

It is known that at the moment there is no effective drug that can prevent dementia.

Preventive measures should be aimed at the treatment of cerebrovascular diseases. Patients after strokes are advised to re-learn how to walk, write, speak, and visit public places. Older people are encouraged to maintain mental and social activity.