Cerebrovascular disease in the early stages is manifested by a decrease in working capacity, increased fatigue, a decrease in the background mood, sleep disturbances, when the patient wakes up in the middle of the night and then cannot fall asleep. Then the symptoms of cognitive impairment join, i.e. memory decreases, thinking slows down, verbal counting becomes difficult, excessive fussiness appears. In the future, persistent headaches, tinnitus, dizziness join. Periodically, cerebral crises develop, which proceed with a gross dysfunction of the brain and are manifested by the development of weakness in the limbs on the one hand, impaired speech, sensitivity, vision. If such symptoms disappear within 48 hours, then they speak of a transient violation of cerebral circulation. If the symptoms persist longer, then it is a stroke. In this case, gross dysfunctions of the nervous system can persist until the end of life, disabling the patient. A stroke can be ischemic, in the case of closure of the vessel lumen by an atherosclerotic plaque or thrombus, or hemorrhagic, when the integrity of the vascular wall is disturbed and a cerebral hemorrhage occurs.

Leukoencephalopathy of the brain is a pathology in which a lesion of the white matter is observed, causing dementia. There are several nosological forms caused by various reasons. Common to them is the presence of leukoencephalopathy.

The disease can be provoked by:

• viruses;
• vascular pathology;
• insufficient supply of oxygen to the brain.

Other names for the disease: encephalopathy, Binswanger's disease. The pathology was first described at the end of the 19th century by the German psychiatrist Otto Binswanger, who named it after himself. From this article you will find out what it is, what are the causes of the disease, how it manifests itself, is diagnosed and treated.

Classification

There are several types of leukoencephalopathy.

Small focal

This is leukoencephalopathy of vascular origin, which is chronic pathology developing against the background high pressure... Other names: progressive vascular leukoencephalopathy, subcortical atherosclerotic encephalopathy.

The same clinical manifestations with small focal leukoencephalopathy has discirculatory encephalopathy - a slowly progressive diffuse lesion of the cerebral vessels. Previously, this disease was included in the ICD-10, now it is absent.

Most often, small-focal leukoencephalopathy is diagnosed in men over 55 years of age who have a genetic predisposition to the development of this disease.

The risk group includes patients suffering from such pathologies as:

• atherosclerosis (cholesterol plaques clog the lumen of the vessels, as a result, there is a violation of the blood supply to the brain);
• diabetes mellitus (with this pathology, the blood thickens, its course slows down);
• congenital and acquired pathologies of the spine, in which there is a deterioration in the blood supply to the brain;
• obesity;
• alcoholism;
• nicotine addiction.

Also, errors in the diet and a hypodynamic lifestyle lead to the development of pathology.

Progressive multifocal leukoencephalopathy

This is the most dangerous form of the development of the disease, which often becomes the cause of death. Pathology is of a viral nature.

It is caused by human polyomavirus 2. This virus is observed in 80% of the human population, but the disease develops in patients with primary and secondary immunodeficiency. Their viruses, getting into the body, further weaken the immune system.

Progressive multifocal leukoencephalopathy is diagnosed in 5% of HIV-positive patients and in half of AIDS patients. Previously, progressive multifocal leukoencephalopathy was even more common, but due to HAART, the prevalence of this form has decreased. The clinical picture of pathology is polymorphic.

The disease manifests itself with symptoms such as:

• peripheral paresis and paralysis;
• unilateral hemianopsia;
• stunning syndrome;
• personality defect;
• defeat of FMN;
• extrapyramidal syndromes.

CNS disorders can vary significantly from mild dysfunction to severe dementia. Speech disorders, complete loss of vision can be observed. Often, patients develop severe disorders of the musculoskeletal system, which cause loss of performance and disability.

The risk group includes the following categories of citizens:

• patients with HIV and AIDS;
• receiving treatment with monoclonal antibodies (they are prescribed for autoimmune diseases, oncological diseases);
• underwent a transplant internal organs and taking immunosuppressants to prevent rejection;
• suffering from malignant granuloma.

Periventricular (focal) form

It develops as a result of chronic oxygen starvation and impaired blood supply to the brain. Ischemic areas are located not only in white, but also in gray matter.

Usually, pathological foci are localized in the cerebellum, brain stem and frontal part of the cerebral cortex. All these structures of the brain are responsible for movement, therefore, with the development of this form of pathology, movement disorders are observed.

This form of leukoencephalopathy develops in children who have pathologies accompanied by hypoxia during delivery and within a few days after birth. Also, this pathology is called "periventricular leukomalacia", as a rule, it provokes cerebral palsy.

Disappearing white matter leukoencephalopathy

It is diagnosed in children. The first symptoms of pathology are observed in patients aged 2 to 6 years. It appears due to a gene mutation.

Patients have:

• impaired coordination of movement associated with damage to the cerebellum;
• paresis of the arms and legs;
• memory impairment, decreased mental performance and other cognitive impairments;
• optic nerve atrophy;
• epileptic seizures.

Children under one year old have problems with feeding, vomiting, high fever, mental retardation, excessive excitability, increased muscle tone of the arms and legs, convulsions, sleep apnea, coma.

Clinical picture

Usually, the signs of leukoencephalopathy build up gradually. At the onset of the disease, the patient may be absent-minded, awkward, indifferent to what is happening. He becomes tearful, has difficulty pronouncing difficult words, his mental performance decreases.

Over time, sleep problems join, muscle tone rises, the patient becomes irritable, he has involuntary eye movement, and tinnitus appears.

If you do not start to treat leukoencephalopathy at this stage, but it progresses: psychoneurosis, severe dementia and seizures occur.

The main symptoms of the disease are the following deviations:

• movement disorders, which are manifested by impaired coordination of movement, weakness in the arms and legs;
• there may be unilateral paralysis of the arms or legs;
• speech and visual disorders (scotoma, hemianopsia);
• numbness of various parts of the body;
• swallowing disorder;
• urinary incontinence;
• epileptic seizure;
• weakening of intelligence and slight dementia;
• nausea;
• headaches.

All signs of damage to the nervous system progress very quickly. The patient may have false bulbar palsy, as well as parkinsonian syndrome, which is manifested by a violation of gait, writing, and body tremors.

Almost every patient has a weakening of memory and intelligence, instability when changing body position or walking.

Usually people do not understand that they are sick, and therefore their relatives often bring them to the doctor.

Diagnostics

To diagnose leukoencephalopathy, the doctor will prescribe a comprehensive examination. You will need:

• examination by a neurologist;
• general analysis blood;
• blood test for the content of narcotic, psychotropic drugs and alcohol;
• magnetic resonance imaging and computed tomography, which can identify pathological foci in the brain;
• electroencephalography of the brain, which will show a decrease in its activity;
• ultrasound dopplerography, which allows you to detect a violation of blood circulation through the vessels;
• PCR, which allows you to identify the DNA pathogen in the brain;
• brain biopsy;
• lumbar puncture, which shows an increased concentration of protein in cerebrospinal fluid.

If the doctor suspects that a viral infection is the basis of leukoencephalopathy, he prescribes electron microscopy to the patient, which will reveal the pathogen particles in the brain tissues.

With the help of immunocytochemical analysis, it is possible to detect antigens of the microorganism. In the cerebrospinal fluid with this course of the disease, lymphocytic pleocytosis is observed.

Tests for psychological condition, memory, movement coordination.

Differential diagnosis carried out with diseases such as:

• toxoplasmosis;
• cryptococcosis;
• HIV dementia;
• leukodystrophy;
• lymphoma of the central nervous system;
• subacute sclerosing panencephalitis;
• multiple sclerosis.

Therapy

Leukoencephalopathy is an incurable disease. But you definitely need to go to the hospital for the selection of drug treatment. The goal of therapy is to slow the progression of the disease and activate brain function.

Treatment of leukoencephalopathy is complex, symptomatic and etiotropic. In each case, it is selected individually.

The doctor may prescribe the following medications:

• drugs that improve cerebral circulation (Vinpocetine, Actovegin, Trental);
• neurometabolic stimulants (Phezam, Pantocalcin, Lucetam, Cerebrolysin);
• (Stugeron, Curantil, Zylt);
• multivitamins, which include B vitamins, retinol and tocopherol;
• adaptogens such as aloe extract, vitreous;
• glucocorticosteroids that help stop inflammatory process(Prednisolone, Dexamethasone);
• antidepressants (fluoxetine);
• anticoagulants to reduce the risk of thrombosis (Heparin, Warfarin);
• with the viral nature of the disease, Zovirax, Cycloferon, Viferon are prescribed.

Additionally shown:

• physiotherapy;
• reflexology;
• acupuncture;
• breathing exercises;
• homeopathy;
• phytotherapy;
• collar zone massage;
• manual therapy.

The difficulty of therapy lies in the fact that many antiviral and anti-inflammatory drugs do not penetrate the BBB, therefore, do not affect pathological foci.

Prognosis for leukoencephalopathy

Currently, the pathology is incurable and always ends in death. How long they live with leukoencephalopathy depends on whether antiviral therapy was started on time.

When the treatment is not carried out at all, the patient's life expectancy does not exceed six months from the moment a violation of the brain structures is detected.

With antiviral therapy, life expectancy increases to 1-1.5 years.

There were cases of acute pathology, which ended in the death of the patient a month after its onset.

Prophylaxis

There is no specific prophylaxis for leukoencephalopathy.

To reduce the risk of developing pathology, the following rules must be observed:

• strengthen your immunity by hardening and taking vitamin and mineral complexes;
• normalize your weight;
• to live an active lifestyle;
• be in the fresh air regularly;
• stop using drugs and alcohol;
• quit smoking;
• avoid casual sex;
• use a condom in case of accidental intimacy;
• eat a balanced diet, vegetables and fruits should prevail in the diet;
• learn how to properly cope with stress;
• set aside enough time for rest;
• avoid excessive physical activity;
• when identifying diabetes mellitus, atherosclerosis, arterial hypertension, take medications prescribed by a doctor in order to compensate for the disease.

All these measures will minimize the risk of developing leukoencephalopathy. If the disease still occurs, you need to seek medical help as soon as possible and begin treatment that will help increase life expectancy.

Leukoencephalopathy is chronic illness, which has the ability to progress, and due to the destruction of white matter cells of the brain. This pathology leads to dementia in old people, or dementia.

In 1894, the physician Binswanger described in detail the destructive effects of leukoencephalopathy.

This pathology is called Binswanger's encephalopathy disease. In modern medicine, PML (progressive multifocal pathology) is increasingly diagnosed - this leukoencephalopathy has the etiology of the virus.

Leukoencephalopathy of the brain - what is it?

Destructive cell death in nervous system of the brain, which is provoked by hypoxia from insufficient blood flow to the organ leads to - microangiopathy. The disease leukoaraiosis, as well as the pathology of lacunar-type infarctions, change the structure of white matter cells.

These changes are the consequences of poor circulation of blood flow in the organ.

The manifestations of leukoencephalopathy are associated with the severity of the disease, and the symptoms depend on the type of pathology. The subcortical type is very often associated with frontal destruction, and is detected in epileptic seizures.

Pathology has chronic form progress with their relapses. Elderly people suffer from leukoencephalopathy, but cases of this diagnosis are not uncommon in younger patients.

The main causes of brain diffusion are:

• Insufficiency of blood flow in the brain (ischemia provocateur);
• Lack of nutrition for brain cells due to hypoxia;
• Causes that are caused by a variety of diseases.

Etiology of Binswanger pathology - leukoencephalopathy

The etiology of the disease leukoencephalopathy is divided into:

• Congenital etiology;
• Acquired type of etiology of the disease.

Congenital etiology of leukoencephalopathy is an anomaly during the period of intrauterine formation of brain cells of the unborn baby.

The reasons for the intrauterine inappropriate formation of the fetus can be:

• Lack of oxygen, which provoked hypoxia of brain cells;
• Infectious diseases in a pregnant woman;
• Viruses that, through the placental connection, got from the mother to the developing child;
• If the mother has an immunodeficiency pathology.

The acquired etiology of leukoencephalopathy can be with such provocative diseases:

• Consequences of injury to brain cells;
• Effects on the brain of toxins;
• After pathology - radiation sickness;
• For diseases of liver cells that do not remove all the necessary from the bloodstream toxic substances that maximally pollute the biological fluid carrying these elements through the blood supply system to the brain;
• With malignant neoplasms in the organs;
• With lung disease, when the body does not receive the required dose of oxygen;
• At high index blood pressure- hypertonic disease;
• With a low blood pressure index - hypotension;
• AIDS;
• Blood cell leukemia;
• Cancer neoplasms in the blood;
• Pathology of lymphogranulomatosis;
• Pulmonary tuberculosis;
• Diseases of an oncological nature - sarcoidosis;
• Metastasis of cancer cells to the hepatic organ and the brain.

Icb code 10

By international classification diseases of the tenth revision of ICD-10 - this pathology belongs to the class:

I67.3 is a progressive pathology of vascular leukoencephalopathy;

I67.4 - hypertensive encephalopathy;

A81.2 - progressive multifocal disease - leukoencephalopathy.

Types of pathology

This classification includes groups of leukoencephalopathy pathology. Since the causes of this disease are many, therefore, the varieties of this pathology also have their own characteristic differences in etiology, in their manifestation and course.

It can be roughly divided into 3 types of leukoencephalopathy:

• Leukoencephalopathy of a vascular nature;
• Pathology of hypoxic - ischemic type;
• Hemorrhagic leukoencephalopathy.

But a diffuse multifocal form of the disease is often found.

Vascular leukoencephalopathy

The cause of vascular leukoencephalopathy is hypoxia of cerebral vessels, as well as their ischemia. This etiology implies inadequate performance of their functions by the vessels of the brain. Violations of the functionality of cerebral vessels most often provoke disturbances, or pathologies in the blood flow system of the body.

In connection with this etiology, there are several subspecies of vascular leukoencephalopathy:

Leukoencephalopathy of the venous type. Poor circulation leads to this type of pathology. venous blood(what kind of blood is that). This type of disease refers to a mild and long period of development. From the moment of the first symptomatology, several calendar years can pass until the next stage in the development of the disease.

At initial stage in a mild degree of leukoencephalopathy, a medical treatment course of therapy is carried out, which can permanently save the patient from pathology.

At an advanced stage, a complicated form of the disease develops quite quickly and leads to irreversible and incurable consequences.

Leukoencephalopathy of an atherosclerotic nature. The reason for this type of pathology is arterial atherosclerosis. Cholesterol forms atherosclerotic plaques on the walls of the arteries, which leads to poor blood flow or blockage of the arteries.

In elderly patients, atherosclerosis can develop due to improper functioning of the digestive system, or from non-observance of the culture of food - the use of large amounts of cholesterol-containing food.

When the cerebral vessels are blocked, oxygen starvation of the brain cells begins. It is possible to cure this type of pathology only when diagnosing it on early stage occurrence.

If atherosclerotic leukoencephalopathy is not diagnosed in a timely manner, it can develop rapidly and very quickly turn into a complicated form, and lead to irreversible processes in the brain and in the body. This pathology is subcortical atherosclerotic leukoencephalopathy.

Hypertensive leukoencephalopathy. The provocateurs of this type of pathology can be: vascular eclampsia, renal nephritis in the acute phase of the disease, jumps in the blood pressure index, as well as the most dangerous provocateur, this is a hypertensive crisis.

Hypertensive crisis causes acute form encephalopathy, which immediately leads to irreversible consequences of the state of the brain.

It is impossible to predict this type of pathology. Leukopathy of vascular origin has similar symptoms with the pathology of discirculatory encephalopathy. An accurate diagnosis of leukoencephalopathy, which is identified as a small focal probably of vascular origin, can be made by a specialized doctor - a neurologist, after a comprehensive diagnostic study of the etiology.

Leukoencephalopathy of hypoxic-ischemic type

Any leukoencephalopathy of a vascular nature can also be attributed to the type of hypoxic-ischemic, since each of the vascular types of pathology leads to cerebral hypoxia, which provokes leukoencephalopathy.

But this type of pathology is allocated to a separate category in the classification, due to the fact that leukoencephalopathy is a complicated form of difficult labor in newborn babies.

The hypoxic-ischemic type of encephalopathy occurs in a child during its intrauterine formation, as well as with complications during the birth process.

The development of this pathology is not predictable, and the consequences are also different. The minimal loss of brain functionality in children can lead to inattention of the baby, with the inability to concentrate and memorize the necessary information - this is an easy degree of consequences of the hypoxic-ischemic type of pathology.

The perinatal form of leukoencephalopathy can also be attributed to the hypoxic-ischemic type of leukopathy foci in the brain.

This encephalopathy develops according to the principle of an adult disease, but there is only one difference - its occurrence occurred in the womb, or at first immediately after the moment of birth.

Hemorrhagic type of leukoencephalopathy

This type of brain pathology arises from vitamin deficiency of brain cells. Lack of vitamin thiamine leads to the development of multifocal leukoencephalopathy of a hemorrhagic nature.

This type of pathology proceeds in the same way as the development of other types of encephalopathy occurs, but the etiology of this type is:

• Pathology in digestive system that provoked anorexia;
• Prolonged gag reflex and a large number of vomit from the body;
• Hemodialysis;
• Acquired Immunodeficiency Syndrome (AIDS).

Progressive multifocal leukoencephalopathy

This pathology is fatal dangerous species disease and is caused by the papillomavirus. Quite often it is fatal. This is a pathology that develops in more than 50.0% of AIDS patients.

A progressive multifocal form of leukoencephalopathy manifests itself:

• Body paralysis;
• Unilateral hemianopsia;
• Peripheral paresis;
• Personality consciousness defect;
• Expiramidal species syndromes.

Disability with this type of pathology comes quite quickly, since its development occurs rapidly against the background of reduced immunity. There is a decrease in the functionality of the locomotor apparatus, speech and hearing aids.

During the progression of the disease, paralysis of body parts and partial paralysis of the brain occurs.

Periventricular form

This type of pathology comes from brain hypoxia with chronic insufficiency blood in the cerebral vessels. Areas of ischemic lesion are found not only in the white medulla, but also in the cells of the gray matter.

Localization of this destruction occurs in:

• Cerebellum;
• Bilateral pathology in the frontal regions of the cerebral cortex;
• In the trunk of the brain organ.

All parts of the brain that are susceptible to damage affect the development of motor functions. Disorder of these areas leads to paralysis of some parts of the body.

In newborn children, this type of leukoencephalopathy develops pathology - children cerebral paralysis.This happens a few hours after the birth of the baby.

Leukoencephalopathy, in which the white medulla disappears

This type is diagnosed in childhood from 2 calendar years to 6 years. Such a disappearance occurs in the cerebral cortex due to gene mutations. This pathology has a single nonspecific focus, or small-focus foci that affect all parts of the brain.

Symptoms of this type:

• There is no coordination in movement;
• Limb paresis;
• Decrease in memory, or its loss;
• Visual impairment - the nerve of the optic organ atrophies;
• Epileptic seizures.

These children have a problem with food intake, they are highly excitable, and also have increased muscle tone.

How long do you live with leukoencephalopathy?

This pathology is the most dangerous disease of brain cells. With a stable course of pathology, the life span is measured according to medical forecasts a little more, two calendar years.

In the acute course of the disease, which immediately turned into a complicated form - no more than 30 calendar days.

The average life indicator with a diagnosis of leukoencephalopathy is no more than 6 calendar months, from the moment of establishing the exact type of diagnosis of pathology. In a given disease, time can decide the outcome of life - in a positive direction, or lead to death.

The faster the diagnosis is carried out and the cause of the disease is found, the faster you can start therapy and save a person's life.

Features of the disease

Leukoencephalopathy is an incurable brain disease that affects the white matter of the brain. This pathology is a focal lesion, as well as a multifocal lesion of the white matter in the brain.

The etiology of the disease is viruses that are destructive for the body and primarily affect brain cells.

The onset of pathology comes from reduced functionality immune system, mainly in people of deeply advanced age, as well as when the body is affected by the pathology of immunodeficiency. With AIDS, leukoencephalopathy develops in any age group.

There is a problem in drug therapy for this type of brain disease.

The thing is that in the brain there is a barrier through which only preparations containing fats can enter the brain cells.

These fat-soluble drugs can affect brain cells, but drugs that can effectively and quickly cure leukoencephalopathy are based on water. Water-soluble medicines are not able to overcome the brain barrier.

Therefore, to date, pharmacological companies have not been able to develop drugs for the medically effective treatment of pathology - leukoencephalopathy.

Signs of the development of leukoencephalopathy

Signs of many types of leukoencephalopathy appear gradually. At the beginning of development, bouts of forgetfulness and absent-mindedness appear. A person experiences difficulties in memorizing information, in pronouncing long and difficult words.

There is a constant feeling of self-pity, and the patient cries a lot. The intellectual performance of the brain is significantly reduced.

In the further development of pathology, insomnia appears, which can alternate with an endless desire to sleep. Muscle tone rises, which together leads to groundless irritability of the patient.

At this stage of the development of the disease, severe tinnitus appears, as well as involuntary twitching of the optic nerve, which leads to unreasonable movement of the pupils.

If you don't start complex therapy at least at this stage, then the disease will lead to:

• Psychoneurosis pathologies;
• To muscle cramps;
• Dementia;
• Partial memory loss;
• To the pathology of dementia.

Leukoencephalopathy symptoms

The symptoms of this pathology develop suddenly and progress at a rapid pace, which can lead the patient to the following signs of the disease:

• Bulbar paralysis;
• Parkinson's syndrome;
• Gait disturbed;
• Hand tremors occur;
• There are signs of body trembling.

Patients with such symptoms are not aware of their pathology and brain damage, therefore, it is necessary for relatives to promptly force such people to undergo a diagnosis in order to know how to treat the disease.

Diagnostics

To establish a diagnosis of leukoencephalopathy of cells of brain tissue, it is necessary to undergo a series of diagnostic tests:

• Visual examination by a neurologist doctor and taking anamnesis;
• Laboratory clinical blood test (general);
• Analysis of blood composition for the presence of psychotropic elements, alcohol, and drugs containing substances in it;
• MRI and CT (tomography - computer, or magnetic resonance imaging) to identify a focus in the parts of the brain;
• Instrumental diagnostics by electroencephalography method will reveal a decrease in the brain activity of organ cells;
• Doppler ultrasonography is a technique that detects pathology and disorders in the blood flow system, as well as cerebral vessels;
• PCR analysis to detect the virus in the body. According to this analysis, the DNA of the provocateur virus is determined;
• Brain cell biopsy;
• Puncture of the cerebrospinal fluid.

If it is revealed that viruses are the provocateur of leukoencephalopathy, then diagnostics is also carried out using the method of electron microscopy of brain cells.

Differential diagnostic research is carried out with the following pathologies:

• Disease toxoplasmosis;
• Pathology of cryptococcosis;
• Dementia with HIV;
• Disease leukodystrophy;
• CNS lymphoma disease;
• Pathology sclerosing panencephalitis of the subacute type;
• Multiple type of sclerosis.

Drug therapy for leukoencephalopathy

Leukoencephalopathy is a pathology that is incurable. The goal of drug treatment is to halt the progression of the disease and prolong the patient's life for several years.

It is necessary to treat this pathology in a complex manner with the use of medicines, as well as:

• Physiotherapy;
• Physiotherapy;
• Massage;
• Manual therapy;
• Treatment with phyto drugs;
• Acupuncture.

Drug therapy is selected according to an individual scheme by the attending doctor:

General measures are:

• Healthy lifestyle;
• Timely treatment of all pathologies of the vascular system;
• Culture of food and rejection of addictions;
• Adequate stress on the body;
• Engage in the prevention and treatment of pathologies that have become provocateurs of leukoencephalopathy.

This pathology is incurable and the prognosis for life depends on timely diagnosis and disease progression.

With a minimum, or not correct treatment, the disease progresses faster - the prognosis is unfavorable, no more than 6 calendar months.

When carrying out drug therapy of viruses - life expectancy increases by 12 - 18 calendar months.

Vascular subcortical encephalopathy is characterized by gait disturbances, dysfunction of the pelvic organs, mild or moderate neurological symptoms (usually passing), progressive dementia, volitional and emotional disturbances. The disease develops gradually. Both a continuous progressive course and slow progression with long periods of stabilization are possible. Worsening symptoms are usually directly related to prolonged increases in blood pressure. The end result is complete helplessness, inability to self-care, and lack of control over the functions of the pelvic organs.
Dementia has a character typical of vascular diseases brain. There is a deterioration in memory, a decrease in the level of judgments, a slowdown and instability of mental processes. "Emotional incontinence" is often revealed - a pronounced inability to restrain emotions with a predominance of asthenic reactions. Long periods of stabilization and even temporary regression of existing violations are possible.
Depending on the prevailing symptomatology, dysmnestic, amnestic and pseudoparalytic dementia are distinguished. With dysmnestic dementia, there is a mild decrease in memory and intelligence, a slowdown in physical and mental reactions. Criticism to one's own state and behavior is slightly violated. In the clinical picture of amnestic dementia, pronounced memory impairments for current events prevail while preserving past memories. For pseudo-paralytic dementia, a stable, monotonous complacent mood, minor memory disturbances and a pronounced decrease in criticism are characteristic.
Clinical picture with all forms of dementia, it is very variable, the predominance of both cortical and subcortical disorders can be detected, while cortical disorders are accompanied by a more noticeable decrease in intellectual and mnestic activity. In some cases, epileptic seizures are observed. Dementia is accompanied by disturbances in the emotional and volitional sphere. Neurosis-like phenomena, increased exhaustion and decreased mood are possible. In the later stages of the disease, there is limited interest, emotional impoverishment, and loss of spontaneity.
Gait disorders, like dementia, progress gradually. At first, the steps become shallower, the patient begins to shuffle his feet, and it is hard to lift his legs off the ground. Subsequently, the automatism of walking is disturbed, the gait becomes slow and careful, all movements are controlled deliberately, as if the patient is walking on slippery ice. Allocate following signs gait disturbances in Binswanger's disease: decreased stride length, slowed walking, the need for increased stability, difficulty starting to walk, and reduced stability when turning.