More complex types of presenile and senile forms of the disease are also often left without the attention of a neuropathologist, since a person does not notice forgetfulness, distracted attention and increased fatigue.

As a result, he gets to the doctor, being in the middle stage of degradation.

Is an active activity, social interaction with others and attention to their health from an early age.

Dysfunction can be primary (as in diseases, brain injuries and strokes, directly or selectively affecting the brain) and secondary (as in systemic diseases or disorders, when the brain is involved in the pathological process along with other organs and systems)

Dementia [dementia] (F00-F03) is a syndrome caused by brain damage (usually chronic or progressive) in which many higher cortical functions are impaired, including memory, thinking, orientation, comprehension, numeracy, learning, speech and judgment ... Consciousness is not obscured. Decreased cognitive function is usually accompanied, and sometimes preceded by, deterioration in control over emotions, social behavior, or motivation. This syndrome is observed in Alzheimer's disease, in cerebrovascular diseases and in other conditions that primarily or secondarily affect the brain.

If necessary, an additional code is used to identify the initial disease.

Alzheimer's disease is a primary degenerative brain disease of unknown etiology with characteristic neuropathological and neurochemical manifestations. The disease usually begins quietly and slowly, but progresses steadily over several years.

Vascular dementia is the result of cerebral infarction due to cerebral vascular disease, including cerebrovascular disease in hypertension. Heart attacks are usually small, but their cumulative effect is manifested. The disease usually begins at a later age.

Includes: atherosclerotic dementia

Cases of dementia associated with (or suspected to be associated with) causes other than Alzheimer's disease or cerebrovascular disease. The disease can begin at any age, but less often in old age.

Primary degenerative dementia NOS

Use an additional code to indicate senile dementia with delirium or acute confusion.

Excludes: old age NOS (R54)

A syndrome characterized by a pronounced impairment of memory for recent and long-term events, with the preservation of the ability to close memories, a decrease in the ability to study new material and a violation of orientation in time. Confabulations may be a characteristic feature, but perception and other cognitive functions, including intelligence, are usually retained. The prognosis depends on the course of the underlying disease.

Korsakov's psychosis, or syndrome, non-alcoholic

Excluded:

• amnesia:
  • NOS (R41.3)
  • anterograde (R41.1)
  • dissociative (F44.0)
  • retrograde (R41.2)
• Korsakov syndrome:
  • alcoholic or unspecified (F10.6)
  • caused by the use of other psychoactive substances (F11-F19 with a common fourth character. 6)

Ecologically nonspecific organic cerebral syndrome, characterized by a simultaneous disturbance of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotions, cyclicity of sleep and wakefulness. The duration of the condition varies and the severity ranges from moderate to very severe.

Included: acute (s) (s) or subacute (s) (s):

• brain syndrome
• state of confusion (non-alcoholic etiology)
• infectious psychosis
• organic reaction
• psychoorganic syndrome

Excludes1: delirium tremens, alcoholic or unspecified (F10.4)

This heading includes mixed conditions causally associated with brain disorders due to primary disease of the brain, a systemic disease secondary to affecting the brain, exposure to exogenous toxic substances or hormones, endocrine disorders or other somatic diseases.

Excluded:

• Related:
  • delirium (F05.-)
  • dementia classified in F00-F03
• due to the use of alcohol and other psychoactive substances (F10-F19)

Personality and behavioral changes can be residual or associated with brain disease, damage and dysfunction.

• organic NOS
• symptomatic NOS

Excludes1: psychosis NOS (F29)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) has been adopted as a single normative document to take into account the incidence, reasons for medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170

A new revision (ICD-11) is planned by WHO in 2017 2018.

As amended and supplemented by WHO

Processing and translation of changes © mkb-10.com

ICD-10 Dementia Criteria

Criteria for dementia, including differential diagnostic classifications, are determined International classification diseases of the 10th revision (ICD-10). These include:

• memory impairment (inability to remember new material, in more severe cases - difficulty in reproducing previously learned information);
• impairment of other cognitive functions (impaired judgment, thinking - planning and organizing one's actions - and information processing), their clinically significant decrease in comparison with the initial higher level;
• the clinical significance of the detected disorders;
• impairment of cognitive functions is determined against the background of intact consciousness;
• emotional and motivational disorders - at least one of following signs: emotional lability, irritability, apathy, antisocial behavior;
• the duration of the symptoms is at least 6 months.

Coding of diseases associated with cognitive disorders according to ICD-10.

For primary encryption, a mark (+) is used. Key numbers marked with an asterisk (*) cannot be used as standalone key numbers, but only in conjunction with another, involuntary key number; the primary key number in these cases is marked with a superscript plus.

F00 * Dementia in Alzheimer's disease (G30 .– +):

Primary degenerative cerebral disease of unknown etiology,

Typical neuropathological and neurochemical signs,

Predominantly latent onset and slow but constant progression of the disease over several years.

F00.0 * Dementia in early-onset Alzheimer's disease (G30.0 +)

Onset of the disease before the age of 65 (type 2),

Relatively sharp deterioration during the illness,

Distinct and numerous violations of the higher functions of the cortex

F00.1 * Dementia in late-onset Alzheimer's disease (G30.1 +)

Onset after the 65th year of life (type 1),

The main symptom is the slow development of memory impairments.

F00.2 * Dementia in Alzheimer's disease, atypical or mixed (G30.8 +)

F00.9 * Dementia in Alzheimer's disease, unspecified (G30.9 +)

Brain damage as a consequence of vascular disease

The cumulative effect of multiple mini-factors

Early onset

F01.0 Vascular dementia, acute onset

After a series of cerebral hemorrhages as a consequence of cerebrovascular thrombosis, embolism, or bleeding

In rare cases - the result of extensive necrosis

F01.1 Multi-infarction dementia

Gradual onset, after several ischemic attacks

F01.2 Subcortical vascular dementia

History of hypertension, ischemic foci in the white matter of the hemispheres

The bark is intact

F01.3 Mixed cortical and subcortical vascular dementia

F01.8 Other vascular dementia

F01.9 Vascular dementia, unspecified

F02 * Dementia in other diseases classified elsewhere

F02.0 * Dementia in Pick's disease (G31.0 +)

F02.1 * Dementia in Creutzfeldt-Jakob disease (A81.0 +)

F02.2 * Dementia in Huntington's disease (G10 +)

F02.3 * Dementia in Parkinson's disease (G20 +)

F02.4 * Dementia in human immunodeficiency virus [HIV] disease (B22.0 +)

F02.8 * Dementia in other specified diseases classified elsewhere

F03 Dementia, unspecified

The task of the specialist who diagnoses dementia is to make a reasonable selection of possible reasons cognitive impairments of those that were the main ones in this particular case.

To assess the severity of cognitive impairments, both quantitative neuropsychological methods and clinical scales are used, which assess both cognitive and other (behavioral, emotional, functional) symptoms of dementia and memory impairment. One of the most complete clinical scales, very often used in practice, is the Global Deterioration Rating.

ICD code: F03

Dementia, unspecified

Dementia, unspecified

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Senile dementia

ICD-10 code

Associated diseases

Senile dementia by source ‘Diseases and syndromes’

Names

Description

Among mental illnesses that occur in old age, senile dementia is the most frequent (it accounts for 12 to 34.4% of all cases of mental illness). Severe senile dementia affects about 5.6% of senile persons, and together with persons whose senile dementia is mild or moderate, about 10-15%. With an increase in average life expectancy, the risk of disease increases. In women, senile dementia occurs 2-3 times more often than in men. In the vast majority of patients, the disease develops between 65-76 years. The average age at which the disease begins in men is 73.4 years, in women - 75.3 years.

Symptoms

The simple form begins subtle, with mental disorders inherent in aging. Acute onset of the disease indicates an increase in pre-existing mental disorders provoked by any somatic illness... In patients, mental activity decreases: the pace of mental activity slows down, its qualitative and quantitative deterioration occurs (the ability to focus and switch attention is impaired, its volume is narrowed; imagination, the ability to abstract, analyze and generalize, as well as resourcefulness and ingenuity when solving the questions posed life). The sick person is increasingly showing conservatism in judgments, actions, and worldview. The present is regarded by him as petty, not worthy of attention, or is simply rejected. In the past, the patient sees mainly positive, worthy to serve as an example in various life situations. There is a tendency to edification, intractability, reaching stubbornness, irritability in case of disagreement or contradiction. At the same time, selective heightened suggestibility is often noted. Interests inherent in the past are narrowed, especially concerning general issues. The patient pays more attention to his physical condition, especially to physiological functions. Affective resonance decreases: indifference appears and grows to what does not directly affect the patient. Weakened (up to complete disappearance) of attachment, incl. To relatives. The understanding of the relations existing between people is lost. For many, a sense of tact and bashfulness is reduced or simply disappears. The range of mood shades is narrowed. In some patients, complacency, carelessness, a tendency to joking or monotonous jokes begin to prevail, in others, capriciousness, discontent, petty pickiness. In all cases, there is a depletion of the previous characterological traits. Consciousness of the listed personality changes disappears early or does not arise at all.

If, before the illness, patients had pronounced psychopathic traits, especially sthenic ones (persistence, greed, categoricalness, imperiousness), at the onset of the illness they usually sharpen, often caricatured (senile psychopathization). Avarice develops, often accompanied by the accumulation of rubbish, accusations against loved ones concerning irrational (according to patients) everyday expenses are growing, the existing morals are usually condemned, especially marital relations, often unceremonious interference in intimate life loved ones.

Initial psychological changes and accompanying personal changes are accompanied by a decrease in memory, primarily for current events. People around them usually notice them later than changes in the character of patients. This is due to the fact that the patients revive the memories of past life events, taken by loved ones for the preservation of memory (“she remembers everything so well”), as well as in connection with the preservation of some of their external forms of behavior. Memory decay occurs according to the laws of progressive amnesia. First, memory for abstract and differentiated concepts suffers, for example, names, dates, titles, terms, then fixative amnesia is added, which is expressed in the inability to remember current events. There is amnestic disorientation in time (patients cannot name the date, day of the week, month), amnestic chronological disorientation (they cannot name the dates of the most important events in public and private life). In the future, amnestic disorientation in the environment appears (patients cannot say where they are or they call another place) and finally amnestic spatial disorientation (leaving the house, the patients do not find their way back, confuse the location of the premises in the apartment). Recognition of persons in the immediate environment is impaired, they begin to be called by other people's names (for example, a daughter is mistaken for a mother and is named accordingly). With the development of total dementia, recognition of one's own external appearance is disturbed: "What kind of old woman is this?" - says the patient, looking at herself in the mirror. Forgetting the present is accompanied by the revival of memories of the past, often relating to youth and childhood. In some cases, “life in the past” appears. At the same time, patients consider themselves young, even children, and talk about their past life as about present-day events. Often such "memories" are pure fiction (ekmnestic confabulations).

With senile dementia, there is a clear dissociation between pronounced and even very deep dementia and the preservation of the automated former external forms of behavior: the manner of behaving that existed in the past is preserved, including gestures, correct speech, often with lively intonations, patients appropriately use certain common expressions. Preservation of external forms of behavior, often talkativeness of patients, their "excellent memory" (for individual events of the past), usually mislead strangers; they think they are talking to absolutely healthy people... And only a randomly asked question suddenly discovers that a person conducting a lively conversation, reporting various, sometimes interesting, facts from the past and as if reacting correctly to the words of the interlocutor, does not know how old he is, who his family consists of, what year it is now, does not know where he lives and with whom he is talking.

In the initial periods of illness, there is a constant association between distinct dementia and good physical condition. Patients S. S. Usually mobile, quickly make precise movements, if necessary, perform certain familiar actions. Only in advanced cases does physical insanity develop.

Severe dementia is accompanied by the development of amnestic aphasia, the initial phenomena of sensory aphasia and apraxia. These disorders are in some cases pronounced sharply, and clinical picture begins to resemble Alzheimer's disease. Single and few reduced epileptic seizures, often reminiscent of fainting, are possible. Sleep disorders are characteristic: patients fall asleep and wake up at an indefinite time, duration (usually deep sleep) ranges from 2-4 to 20 At the same time, periods of prolonged wakefulness appear. If they happen at night, then the patients wander around the apartment, perform their usual everyday activities, for example, light the gas, put an empty saucepan on the burner, and open the taps. If the patients are in the hospital, then they straighten the bed of their neighbors, briskly look under the beds. Often this activity manifests itself in the form of “getting ready for the trip”; at the same time, patients collect bed and personal linen in a bundle, look for something, sit on the bed or tread around it. The questions asked are often answered that they need to go, they often say "home to mom."

In the final stage of senile dementia, cachexia develops. Patients lie in an embryo position, are in a drowsy state, do not react to others, sometimes they mumble something indistinctly. Oral automatisms are usually observed.

Presbyophrenia (Wernicke's chronic presbyophrenia, or confabulatory form) is the mildest form of senile dementia; it occurs when a simple form of atherosclerosis of the vessels of the brain is complicated. Presbyophrenic patients are lively, mobile and good-natured people. They speak a lot, their vocabulary is rich. In the statements, fiction prevails, referring to the events of the past and partly to the present. False recognitions associated with memory disorders are characteristic: the patients around them are mistaken for persons whom they knew earlier. Presbyophrenia resembles Korsakov's syndrome; the difference is that it has progressive amnesia. Presbyophrenia develops mainly in persons of the cycloid type. In the past, these are usually active, lively, cheerful and lively people.

In cases where the simple form of senile dementia is complicated by somatic, including infectious, diseases, acute presbyophrenia occurs. It is characterized by states of confusion in the form of professional or exaggerating delirium, occasionally amentia. After their disappearance, a pronounced increase in dementia is observed.

The psychotic form (senile insanity) can occur in the form of delusional, hallucinatory delusional, paraphrenic and affective psychoses. In the debut of senile insanity, psychopathic personality changes are constantly expressed. Memory disorders develop slowly. Psychosis usually occurs after 2-7 years. Delusional psychoses are characterized by a paranoid syndrome with delusions of damage, robbery, less often with delusions of persecution, poisoning. Delirium extends mainly to those in the immediate environment. In some patients, the paranoia syndrome is further complicated by verbal hallucinosis. Threats, accusations, damage prevail in the content of hallucinations. Verbal hallucinosis is possible without prior paranoia. Usually hallucinosis in a short time is complicated by fantastic content, a picture of hallucinatory, then confabulatory paraphrenia arises.

Affective psychoses are manifested by manic and depressive states. A manic state - senile (senile) mania - is characterized by an increased complacency, stupid efficiency, an overestimation of one's personality, and erotic ideas. In a depressive state, or senile depression, a monotonous anxious-depressed mood with separate delusional ideas of ruin, impoverishment, hypochondriacal or nihilistic character is usually noted.

Dementia in the psychotic form develops slowly, often until the death of patients without reaching the degree that is observed in the simple form.

Diagnostics

Differential diagnosis

Causes

Pathological aging is also caused by a genetic factor. The risk of the disease is 4.3 times higher in those families in which there were already cases of senile dementia. For individuals, the constitutional factor matters. So, with presbyophrenia, patients have a cycloid hyperthymic character and often a picnic physique, patients with senile insanity with a predominance of delusional and hallucinatory disorders have paranoid and epileptoid character traits, and among the relatives of patients there are often people with a psychopathic disposition and suffering from mental illness ( and schizophrenic psychosis), arising for the first time in old age. Somatic diseases are able to reveal the symptoms of previously mild senile dementia, modify its clinical picture, and accelerate the rate of development of dementia. Timely elimination of somatic diseases in some cases can lead to the subsequent milder development of senile dementia.

Vascular dementia code according to ICD 10

To mental disorders, accompanied by habitual signs: loss of memory, reason, impaired thinking, speech, etc. relate different kinds dementia. Among them is vascular dementia, code for microbial 10, this pathology differs in the cause and developmental characteristics.

All types of mental disorders in which mental functions are impaired: memory, reason, etc. represent dementia. With the interconnection of cerebrovascular disorders with intellectual dysfunctions accompanying human behavior, a vascular type of dementia occurs. The signs are manifested in a variety of ways, the diagnosis is established by analyzing the localization of brain damage, the nature of the course of the pathology. To accurately determine the causes of the disease, a thorough examination of the condition is required, to study the history, the degree of neuropsychological, neurological disorders.

How to identify a problem by symptoms

Dementia of the vascular type can be detected by certain signs.

1. In contrast to the primary, degenerative type of dementia, in the condition we are describing, from 10 to 30% of cases there are seizures of epilepsy.
2. Focal lesions cause impairment of motor functions, which is the primary sign of vascular dementia. Approximately 27 to 100% of those suffering from the disease cannot walk normally, their movements are inhibited, steps are shuffling, loss of stability occurs, as a result of which patients often fall, hit on corners, jambs, etc.
3. Problems with urination. Almost all patients with the vascular type of dementia suffer frequent urination, are forced to visit the toilet every minute. There is also a factor of urinary incontinence, which manifests itself more often at night.
4. Violations in the expression of human emotions. In case of illness, a person does not show his reaction well, there are no signs of pleasure, joy, grief, etc. on his face.
5. Frequency of violations. Experts observing the behavior of patients note that dysfunctions can be expressed both vividly and almost imperceptibly. Also, the severity of the conditions can vary depending on the time of day, day.
6. Senile dementia code 10 has a smooth type of progression. If the problem is a consequence of a stroke, then cognitive processes can recover, but it will not be possible to reach the stroke level. In such cases, the diagnosis of dementia in an elderly person is usually not carried out, since the disease develops slowly and imperceptibly. Over time, additional symptoms are added to some symptoms.

Vascular dementia mcb 10: causes

The factors influencing the development of senile dementia are the following points:

• head injury;
• development of neoplasms in the brain;
• carried over infectious diseases: encephalitis, meningitis, etc.;
• heart attacks, cerebral strokes;
• transferred operations;
• endocrine system diseases;
• alcohol and drug abuse;
• excessive enthusiasm for drugs.

All of these factors, as well as others affecting the development of cerebral dysfunction, can lead to irreversible processes. Also, experts consider one of the main reasons - a genetic predisposition.

Important: if older family members - parents, grandmothers, grandfathers have characteristic symptoms of dementia, it is necessary to take preventive measures minimizing risks.

Signs of vascular dementia

According to the classification, the ICD identifies the following criteria:

1. Memory problems. The patient is not able to perceive information or reproduce what has already been learned.
2. Inability to think logically, set tasks, solve them, plan and organize actions.
3. Emotional and motivational disorder. With dementia, there is unreasonable aggression, apathy, irritability, and strange behavior.

Adverse factors

The provoking moments in the development of dementia include the following:

Floor. After lengthy research, experts say that the majority of dementia sufferers are women. There is a hypothesis that the problem is caused by a lack of a female hormone - estrogen, which stops being produced from the moment of menopause. However, the vascular type of dementia affects the male body more, as it is the strong half of humanity that often suffers from diseases associated with blood vessels and heart.

Age. Dementia is one of the main signs of old age. It is in old age that the likelihood of developing an ailment is high. Violations occur mainly between the ages of 70 and 80 years, about 20% of the total number of people are affected by the disease.

Genetics. Heredity matters if parents develop senile dementia before old age. In cases where the disease has arisen after 60 years, the risk of inheriting the disease decreases significantly.

Dementia ICD code 10: how to treat

If a person has the symptoms described above, medical intervention is necessary. At the initial stage, the disease can be controlled and prevented from the development of exacerbation with the help of techniques that activate the mental and physical activity of the patient. When diagnosed, an experienced specialist examines the work thyroid gland, brain, conducts special testing.

As a treatment, they are used medications, psychosocial impact. The list of medicines includes antidepressants, sedatives, antipsychotics, nootropics that promote blood circulation, reduce the acute phases of seizures.

With psychosocial impact, an emphasis is placed on caring for and custody of a sick person by his relatives and friends.

Important: Doctors do not recommend placing a patient with microbial dementia in a special institution. Here the saying “Houses and walls heal” comes into play. In an unfamiliar, official environment, exacerbations are possible, dementia progresses, the state is accompanied by aggression or complete apathy.

Prevention of senile dementia

Given the fact that the disease cannot be cured, you need to think about its prevention in advance. It all starts from a young age, it depends on how a person has lived life. In fact, you can avoid insanity, the main thing is to follow banal, but very useful recommendations.

• Healthy eating. Exclude fatty, spicy fried, smoked foods from the diet. More "lean" on fresh vegetables, fruits, steamed dishes baked in the oven.

• Drink plenty of fluids. Water is the main supplier of oxygen to cells. With a lack of fluid, the work of the whole body is disrupted, there are interruptions in the heart, blood vessels, kidneys, liver, etc.
• Activity. Physical inactivity is the enemy of man, it creates a state in which all processes slow down, metabolism is inhibited, and the brain does not receive enough oxygen, which causes cell death.

None of us is immune from diseases associated with old age. The behavior of a person with dementia causes irritation and grief. In any case, you need to be patient and take the problem as a fact. No matter how difficult it is, you need to honor your duty to your parents and try to alleviate their condition.

This block includes a number of mental disorders, grouped together due to the presence of obvious etiological factors, namely, the cause of these disorders was brain disease, brain injury or stroke, leading to cerebral dysfunction. Dysfunction can be primary (as in diseases, brain injuries and strokes, directly or selectively affecting the brain) and secondary (as in systemic diseases or disorders, when the brain is involved in the pathological process along with other organs and systems)

Dementia [dementia] (F00-F03) is a syndrome caused by brain damage (usually chronic or progressive) in which many higher cortical functions are impaired, including memory, thinking, orientation, comprehension, numeracy, learning, speech and judgment ... Consciousness is not obscured. Decreased cognitive function is usually accompanied, and sometimes preceded by, deterioration in control over emotions, social behavior, or motivation. This syndrome is observed in Alzheimer's disease, in cerebrovascular diseases and in other conditions that primarily or secondarily affect the brain.

If necessary, an additional code is used to identify the initial disease.

Alzheimer's disease is a primary degenerative brain disease of unknown etiology with characteristic neuropathological and neurochemical manifestations. The disease usually begins quietly and slowly, but progresses steadily over several years.

Vascular dementia is the result of cerebral infarction due to cerebral vascular disease, including cerebrovascular disease in hypertension. Heart attacks are usually small, but their cumulative effect is manifested. The disease usually begins at a later age.

Includes: atherosclerotic dementia

Cases of dementia associated with (or suspected to be associated with) causes other than Alzheimer's disease or cerebrovascular disease. The disease can begin at any age, but less often in old age.

Dementia, unspecified

Presenile:

• dementia NOS
• psychosis NOS

Primary degenerative dementia NOS

Senile:

• dementia:
  • NOS
  • depressive or paranoid type
• psychosis NOS

Use an additional code to indicate senile dementia with delirium or acute confusion.

last changes: January 2017

Organic amnestic syndrome, not caused by alcohol or other psychoactive substances

A syndrome characterized by a pronounced impairment of memory for recent and long-term events, with the preservation of the ability to recall the nearest future, a decrease in the ability to study new material and a violation of orientation in time. Confabulations may be a characteristic feature, but perception and other cognitive functions, including intelligence, are usually retained. The prognosis depends on the course of the underlying disease.

Korsakov's psychosis, or syndrome, non-alcoholic

Excluded:

• amnesia:
  • anterograde (R41.1)
  • dissociative (F44.0)
  • retrograde (R41.2)
• Korsakov syndrome:
  • alcoholic or unspecified (F10.6)
  • caused by the use of other psychoactive substances (F11-F19 with a common fourth character. 6)

Ecologically nonspecific organic cerebral syndrome, characterized by a simultaneous disturbance of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotions, cyclicity of sleep and wakefulness. The duration of the condition varies and the severity ranges from moderate to very severe.

Included: acute (s) (s) or subacute (s) (s):

• brain syndrome
• state of confusion (non-alcoholic etiology)
• infectious psychosis
• organic reaction
• psychoorganic syndrome

Excludes: delirium tremens, alcoholic or unspecified (

Dementia is the most severe clinical variant cognitive dysfunction in old age. Dementia is understood as a diffuse impairment of mental functions as a result of organic defeat the brain, manifested by primary disorders of thinking and memory and secondary emotional and behavioral disorders. Yu Melikhov wrote: “ The most evil cartoons are drawn by time ».

Dementia occurs in 10% of people over 65 years old, and in people over 80 years old, it reaches 15-20%. There are currently 24.3 million dementia patients worldwide. At the same time, by 2040, the number of patients with dementia will reach 81.1 million.

At the stage of dementia, the patient completely or partially loses his independence and independence, often needs outside care. So, Gerald Ford wrote about the former US President Ronald Reagan: “ It was sad. I stayed with him for half an hour. I tried to remind him of various episodes of our friendship, but, unfortunately, nothing came of it ...". Below are pictures painted in different years by the German artist K. Horn, who suffered from dementia.

« The roles are played out, but we have already forgotten how to simply live "(V. Scheucher).

Accordingly, Reisberg et al. (1998) suggested the concept (theory) of retrogenesis (reverse development)... It has been proven that the presence of dementia not only reduces the adaptation of a person in society, but also increases mortality by 2.5 times compared with persons without dementia (4th place in the structure of mortality). In addition, dementia ranks third among the "costly" diseases. For example, in the United States, the cost of treating one patient with dementia per year is 40 thousand dollars.

Dementia is a syndrome that develops with a variety of diseases of the brain. The literature describes more than 100 nosological forms that can lead to dementia.

It is widely used to diagnose dementia diagnostic criteria for ICD-10:

Dementia severity criteria

Easy

Average

Heavy

Most common reason dementia is Alzheimer's disease(at least 40% of dementia cases). V basis of Alzheimer's disease lies accumulation of abnormal protein β-amyloid with neurotoxic properties.

According to ICD-10, dementia of the Alzheimer's type is divided into:

With this pathology in the foreground are progressive memory impairments for the current and then to more distant events, in combination with impaired spatial orientation, speech, and other cognitive functions.

Criteria for the diagnosis of probable Alzheimer's disease
(G. McKahn et al., 1984):

Mandatory signs:

Additional diagnostic signs:

Signs that do not contradict the diagnosis of Alzheimer's disease (after excluding other diseases of the central nervous system):

Signs that rule out the diagnosis of Alzheimer's disease:

In 10-15% of cases, vascular dementia develops. Under the term "vascular dementia"(1993) it is customary to understand several clinical-pathomorphological and clinical-pathogenetic syndromes, common to which is the relationship of cerebrovascular disorders with cognitive impairments.

According to ICD-10, vascular dementia subdivided into:

Pathophysiological classification vascular dementia (Chui, 1993):

Criteria clinical diagnosis"Probable vascular dementia"
(G. Roman et al., 1993):

The key issue is the establishment of a reliable cause of the relationship between cerebrovascular disease and dementia. This requires one or two of the following:

or a gradual progression of a cognitive impairment.

The main clinical manifestations vascular dementia
by T. Erkinjuntti (1997) with changes.

The course of the disease

Neurological / psychiatric symptoms

Accompanying illnesses

A history of cardiovascular disease (not in all cases): arterial hypertension, ischemic disease hearts

Instrumental data

CT or MRI: focal infarctions (70-90%), diffuse or "patchy" (irregular) changes white matter(in 70-100% of cases), especially if pronounced changes cover more than 25% of the area of ​​all white matter.

Single-photon emission computed tomography: "spotty" (irregular) decrease in regional cerebral blood flow.

EEG: in case of EEG changes, focal disorders are characteristic.

Laboratory data

There are no specific tests.

According to the literature, 50-60% of cases of vascular dementia are associated with suffered a stroke(especially repetitive). So, a stroke increases the risk of developing dementia by 5-9 times. Moreover, the overall prevalence of dementia in patients with stroke is 20-25%. " Softening of the brain manifests itself in a firm position "(V. Scheucher).

The presence of dementia significantly increases the mortality rate of post-stroke patients (37% higher than in those without dementia) and decreases the quality of rehabilitation treatment (ie, dementia can be considered a “negative predictor” of the effectiveness of rehabilitation measures). At the same time, the presence of dementia increases the cost of rehabilitation treatment by 10 or more times.

The most important risk factors development of vascular dementia are arterial hypertension, heart disease (including heart surgery) and diabetes mellitus... The prevalence of arterial hypertension among people over 60 years of age reaches 80%. The most common form (up to 70%) of arterial hypertension in the elderly is the so-called isolated systolic arterial hypertension(SBP> 140 mm Hg and DBP<90 мм рт. ст.). Артериальная гипертония приводит к изменениям сосудистой стенки (липогиалиноз), преимущественно в сосудах микроциркуляторного русла. Вследствие этого развивается артериолосклероз, что обусловливает изменение физиологической реактивности сосудов. По данным НИИ неврологии (2005), лишь только в 35% случаев у больных с цереброваскулярной патологией на фоне артериальной гипертонии отмечается физиологическая нормальная цереброваскулярная реактивность (по данным пробы с нитроглицерином). В остальных же случаях ответная реакция может быть физиологической сниженной (19%), разнонаправленной (23%), извращенной (13%) и отсутствовать (10%). В таких условиях снижение артериального давления (в том числе вследствие неадекватной гипотензивной терапии) приводит к снижению перфузии и развитию ишемии белого вещества головного мозга.

In old age, the prevalence of coronary heart disease exceeds 20%, while there is a diffuse and more pronounced lesion of all three main coronary arteries (painless forms of the disease are more often detected) and the severity of the course of coronary heart disease with frequent deaths. The consequence of this pathology is a decrease in cardiac output, a decrease in arterial blood flow to the vessels of the brain, and a decrease in its blood supply. The resulting hypoxia of the brain contributes to the deterioration of cognitive functions.

The incidence of brain pathology after CABG surgery varies from 2 to 8% (an average of 5%). According to the classification of Roach G.W. et al. (1996) neurological complications of heart surgery are divided into:

According to statistics, cognitive impairment after CABG is 12 to 79%.

The main mechanisms of brain damage in patients who underwent CABG under cardiopulmonary bypass:

Massive cerebral embolism as a complication of heart surgery is relatively rare. According to Barbut D. et al. (1996), cerebral microembolism during cardiac surgery using artificial circulation is recorded in 100% of patients. According to Pugsley et al. (1994), in the case of detection of 1000 or more microembolic signals (by the TCD method), changes in neuropsychological status 8 weeks after the operation are noted in 43% of patients, while when registering 200 or less microembolic signals, this indicator is 8.6%.

As for diabetes mellitus, according to the figurative expression of A. Efimov "... diabetes begins as an metabolic disease, and ends as a vascular pathology." At the same time, even despite the usefulness of hypoglycemic therapy, the incidence of diabetic encephalopathy (as a manifestation of central neuropathy), in the clinical picture of which is dominated by impaired cognitive functions, reaches 78%. It should be noted that hypoglycemic conditions that have been transferred have a pronounced effect on the development of mnestic disorders in diabetes mellitus.

However, in recent years, much attention has been paid to mixed dementia(10-15% among all dementias). For example, stroke can be considered as a direct cause of dementia in only 50% of patients with post-stroke dementia. In other cases, the nature of the cognitive defect is of a primary degenerative (more often Alzheimer's) nature of dementia, or a combination of vascular and Alzheimer's changes (mixed dementia). Such a frequent combination is due to the presence of common risk factors. Table 2 lists the main risk factors for cardiovascular disease that can trigger the development of Alzheimer's disease.

table 2

─ this is an acute or chronic loss of cognitive activity due to a decrease in the diffuse nature of the cerebral blood supply, or local infarction foci associated with cerebrovascular pathology.

The international code for vascular dementia in ICD-10 is F01.

The tenth revision of the ICD-10 classification of dementia classes is characterized by:

• Persenial type of Alzheimer's dementia characterized by:

1. Started in the presenile age group.
2. Slow course in the initial stages, rapid progress in the clinical stages.
3. Cortical disorders of the early stages.
4. Severe local damage to the higher functions of the cerebral cortex.
5. The duration of self-criticism.
6. Homogeneous clinical picture in the form of aphasic, apraxic, agnosic manifestations.

• Senile type of Alzheimer's dementia characterized by:

1. Started in the older age group.
2. Less progressive course.
3. Disorder of cortical functions in the later stages.
4. Cortical functions generally deteriorate slowly.
5. Self-criticism is lost in the early stages.
6. Heterogeneous characteristics of clinical manifestations.

Characteristic

A severe clinical type of impaired cognitive function is typical for persons of senile (senile) age. This is a general idea of ​​dementia. It should also be understood as a diffuse type of impairment of psycho-functions due to organic destruction of the brain. Dementia is characterized by primarily impaired mental activity, memory and secondarily manifested violations of the emotional sphere with behavior.

About the diagnostic criteria for ICD-10

Dementia can be suspected if:

• A person's memory is impaired, he cannot remember new concepts, reproduce previously learned material.
• Impaired cognitive ability. Cannot reason, think, plan, organize, process the information received.
• High value of clinical manifestations.
• Cognitive dysfunction is manifested when the patient's consciousness is preserved.
• Emotional background and motivation are disturbed.
• Symptoms have been observed for at least six months.

About the root causes

Vascular dementia is the second most important underlying cause of dementia in the elderly. Mostly men are affected, as a rule, after the age of 70. It often manifests itself in patients with vascular pathology in the form of:

• hypertension;
• diabetes mellitus;
• high blood lipid levels;
• vasoconstriction during smoking;
• stroke manifestations.

Many patients have vascular dementia and.

The manifestation of vascular dementia occurs due to the fact that the cerebral type of infarction foci (less often against the background of hemorrhages) provoke the fact that the brain loses a large number of neuronal or axonal brain structures, its work is disrupted. Vascular dementia manifestations are considered a consequence of microvascular pathology (with lacunar pathology) or larger vessels (multi-infarction type of dementia).

About symptoms

Symptoms are similar to other types of dementia manifestations. But since the main root cause of vascular dementia lies in cerebral infarction conditions, pathology tends to take place in a discrete form. In each case, a decrease in intellectual activity is expressed, rarely followed by a subsequent recovery period. With the progress of pathology, the development of a deficiency syndrome is often expressed, presented in the form of:

• overestimated deep tendon reflex activity;
• contradiction symptom;
• disturbed gait;
• muscle weakness in the arms and legs;
• hemiplegic manifestations;
• a syndrome characterized by the fact that the patient forcibly cries and laughs;
• extrapyramidal disorders.

In cerebral ischemia with affected microvessels, the deteriorated condition manifests itself gradually. Cognitive performance suffers selectively. Patients with speech impairments are able to become aware of their problem, which exposes them to depressive states.

About diagnostics

Diagnostic measures for vascular dementia are similar to other types of dementia manifestations. In the presence of neurological symptoms or proven cerebrovascular pathology, a thorough examination of the patient for stroke pathology is necessary.

Computed tomography and magnetic resonance imaging will reveal a multiplicity of bilateral infarction manifestations in the hemispheric zones, limbic structures, a multiplicity of lacunar cystic formations or the periventricular nature of the destruction of the white medulla, spread deep into the hemispheric regions.

Differential diagnostic methods for vascular dementia, also when there is Alzheimer's disease, will be useful using the ischemic scale developed by Khachinsky.

About treatment

The five-year mortality limit will be about 60%, and it is more than for a large number of other dementia types, most likely due to atherosclerotic changes.

Treatments are basically the same as for other different types of dementia. But the vascular type can be prevented, progress can be slowed down:

• decrease in blood pressure, its control;
• lowering blood cholesterol levels;
• control of blood glucose levels;
• excluding smoking.

The effectiveness of drugs that improve cognitive performance, with the inclusion of cholinesterase inhibitory agents, has not been identified. But these funds are able to provide assistance even if the patient has Alzheimer's disease. Medicines that correct depressive, psychotic manifestations with sleep disorders will also be useful.