Discirculatory encephalopathy (DEP) is a complex disease of the vascular system, the course and progression of which is difficult to stop. The disease is a chronic lesion of brain tissue caused by a malfunction in blood circulation. Among all diseases with neurological symptoms, DEP is the most common.
Not so long ago, this pathology was classified as “age-related” ailments - those that occur, as a rule, in old age. However, in recent years the situation with the incidence has changed, and today DEP is diagnosed in able-bodied adults from 40 years old. The danger of the disease is that its irreversible course leads to a change in thinking, psychoemotional state. In some cases, physical and mental health suffers, and disability is lost. Often, such patients need outside help, as caring for themselves and performing basic household tasks becomes incomprehensible to them.
What are the causes of this disease?
Depending on the degree of discirculatory encephalopathy, the nature of the pathological process is determined. The severity of symptoms is affected by the strength of chronic damage to nerve tissue, which most often occurs as a result of prolonged hypoxia. The cause of oxygen starvation of brain cells is vascular pathology, therefore this disease is classified as cerebrovascular disease.
Since the development of DEP is based on a violation of the blood supply to the brain, the elimination of the factors provoking it is of particular importance for effective treatment. The most likely causes of discirculatory brain encephalopathy are:
- Atherosclerosis. The occurrence of cholesterol plaques characteristic of this disease prevents the full movement of blood through the cerebral vessels.
- Arterial hypertension. Against the background of high blood pressure, a spasm of small vessels occurs, which is a favorable condition for the development of dystrophy and sclerosis of the vascular walls. Ultimately, this leads to limited oxygen availability.
Other factors causing DEP are diabetes mellitus, intervertebral hernias, abnormalities in the development of vessels of the head and neck, and serious injuries. In elderly patients, a combination of several factors often occurs: for example, atherosclerosis and diabetes mellitus, hypertension and hernia. It is also possible the presence of several diseases at once, which allows us to conclude about encephalopathy of mixed pathogenesis.
To activate this irreversible pathological process, the action of a certain factor is necessary. The “impetus” to the development of the disease may be:
- overweight;
- alcohol and smoking abuse;
- unbalanced nutrition;
- lack of full motor activity.
How does the disease manifest
Faced with the diagnosis, not only patients should understand what it is - “cerebral disc encephalopathy”, but also their close relatives. It is important to have an idea according to which scenario the pathology will develop, what the patient’s family is preparing for and how to behave with him. With encephalopathy, the burden of responsibility and care falls on the shoulders of people from the immediate environment of the patient. For them, even communication and living with a patient suffering from DEP can be a difficult task. So, for example, in case of degree 2 disculatory encephalopathy, contact with the patient becomes difficult. Often, he does not understand others, does not realize what is happening or perceives everything in his own way. At the same time, motor activity and connected speech may not be affected for a long time.
Symptoms of the disease are a whole complex of neurological, intellectual, psychoemotional, motor disorders, the severity of which determines the degree of discirculatory encephalopathy and predict the further course of the disease. Doctors distinguish three stages of DEP:
- First one. The disease is characterized by the appearance of minor cognitive disorders that do not interfere in the least with labor activity, maintaining a familiar lifestyle.
- The second one. With discirculatory encephalopathy, 2 degrees of the manifestation of the disease are aggravated, impaired intelligence, motor functions, mental disorders become more noticeable.
- The third. The most difficult stage. In the third stage, the disease is vascular dementia with a significant decrease in intelligence, mental abilities, and neurological status disorder. In the third stage of discirculatory encephalopathy, the patient loses his legal capacity.
Symptoms of the first stage
Basically, degree 1 dyscirculatory encephalopathy occurs with minor changes in the emotional state. Clinical signs appear gradually. People around and over again pay attention to changes in character, but often do not attach special importance to them, attributing them to fatigue, age, and illness. In the predominant number of cases, patients with the initial stage of DEP are absorbed by depression, but rarely complain of a bad mood, more often show apathy, despite the fact that patients have no real reason for their feelings.
Any mood changes are ignored, while somatic disorders cause increased anxiety in patients. Sudden changes of mood are possible from a depressing feeling to unexpected joy, from crying to angry attacks in the direction of others. Patients with a 1 degree of discirculatory encephalopathy are distracted and forgetful, suffer from insomnia, headaches, and feel constant fatigue.
Cognitive impairment includes difficulty with concentration, memory impairment, fatigue with minimal mental activity. A person loses his former organization, ability to plan time, fulfillment of duties. At the initial stage of the disease, the first motor disturbances are possible. Dizziness, nausea, and staggering gait are not ruled out.
What happens in the second stage
How long can I live with grade 2 dyscirculatory encephalopathy? In general, the disease does not pose a threat to the life of the patient at this stage, but its progression leads to increased symptoms and a deterioration in the quality of life of the patient. Intelligence, memory, attention and thinking continue to decline, while the patient himself always exaggerates his capabilities, since he does not feel the effects of encephalopathy on himself.
Relatives should be aware of all the symptoms of the patient. Often in elderly patients, orientation in space and time is disturbed. If a person leaves the house himself, it is advisable to put a note with an address in his pocket, since there is a high risk that the patient will be lost, forget the way home, etc.
The emotional sphere continues to suffer. If at the first stage the patient experienced sharp mood swings, then with degree 2 discirculatory encephalopathy, their place is steadily occupied by apathy and indifference to others. Movement disorders become even more noticeable. Patients usually walk slowly while shuffling their feet.
It is important to understand that there is no line between the third stage of DEP and degree 2 discirculatory encephalopathy. Treatment at the last stage of the disease practically does not bring a positive effect, being essentially palliative. A third-degree DEP is characterized by a complete disability and the possibility of independent existence.
Last stage
Only a few specialists try to treat dyscirculatory encephalopathy. As a rule, at this stage of the disease, the patient can no longer be helped with medicines. All that can be done for him is to provide quality care and care. The patient may be completely absent coherent speech, periodically occur neurological symptoms, including motor disorders (paresis, paralysis, convulsions). Patients with dyscirculatory encephalopathy of the last stage lose their ability to control the processes of defecation and urination.
In a state of dementia, a person cannot survive without assistance. The patient is like a baby who has not yet acquired independent self-care skills and spends most of his time sitting or lying in bed. The main responsibilities for maintaining the vital functions of a patient with DEP are borne by the family. It is especially important to provide good dietary nutrition, regularly perform hygiene procedures and prevent the occurrence of pressure sores.
If the patient at the last stage is still able to get up and walk, one should not forget about poor coordination of movements and high risk of falling. For seniors with discirculatory encephalopathy, serious fractures can be fatal.
Diagnosis and basic principles of therapy
The appearance of a syndrome of discirculatory encephalopathy with severe symptoms indicates the irreversibility of the pathological process and the lack of a chance of recovery. The treatment of this disease is more of a preventive nature, so the success of therapy largely depends on the timeliness of diagnosis. Since the first symptoms of DEP go unnoticed by relatives and the patient himself, finding the pathology at an early stage is not an easy task.
Neurologists are involved in the treatment of discirculatory encephalopathy. The risk group for this disease includes all older people suffering from diabetes mellitus, atherosclerosis, and hypertension. In addition to examination by a specialist who must assess the general condition of the patient and identify cognitive impairment, the results of several research procedures will be needed. The diagnostic program includes:
- electroencephalography;
- Doppler ultrasound examination of the vessels of the neck and head;
- CT, MRI;
- electrocardiography;
- blood tests for cholesterol, glucose level.
In most cases, consultation with an ophthalmologist, endocrinologist, cardiologist and angiosurgeon is required.
Treatment of discirculatory encephalopathy is a set of measures aimed not only at combating the manifestations of the disease, but also eliminating the causes of the changes. At the same time, the therapy, in addition to the medical one, includes social and psychological aspects, since DEP leads to disability and disability.
Prevention of strokes, correction of the course of the underlying cause of the disease and maintenance of the functions of the brain by constantly improving blood supply in it are the primary tactics for treating dyscirculatory encephalopathy. Medicines can give a good result in the initial stages of the disease, but only with the active participation and desire of the patient. With a diagnosis of “discirculatory encephalopathy”, first of all, it is necessary to eliminate risk factors or, at least, reduce their impact on the patient. Therefore, the first thing to do is adjust the diet and lifestyle.
Unfortunately, the patient has little chance of a successful recovery with a second degree of discirculatory encephalopathy. Treatment of this disease allows you to suspend its progression and keep the patient's condition at a level acceptable for independent life.
Medication-free treatment
Non-drug therapy of DEP is based on several components:
- diet food;
- losing weight to the maximum allowable limit values;
- quitting alcohol and smoking;
- sufficient physical activity.
Since overweight is an absolute risk factor for the development of vascular pathologies, it is important to review your diet. The diet in this disease is designed to normalize fat metabolism and stabilize blood pressure. For this reason, the patient is recommended:
- Minimize the consumption of animal fats by replacing them with vegetable fats, and get protein mainly from fish of low-fat varieties.
- Reduce the amount of salt eaten to 5 g per day.
- Consume foods enriched with calcium, magnesium, potassium, focusing on fresh vegetables and fruits.
- Refuse dishes fried in oil. Alternative - boiled, stewed, baked in the oven goodies.
At the early stage of DEP, when the first alarming signs of disturbances in the brain appear, it is enough to make the necessary adjustments to lifestyle and nutrition. If the disease does not recede and rapidly progresses, drug therapy cannot be dispensed with.
Use of drugs
Medication can be pathogenetic, aimed at the underlying disease, and symptomatic, designed to stop the symptoms of discirculatory encephalopathy. Surgery may sometimes be required.
Pathogenetic therapy involves the fight against high blood pressure, vascular damage with atherosclerotic plaques, metabolic disorders. In order to treat dyscirculatory encephalopathy of the brain, medications of different groups are prescribed.
High Pressure Medication
To control the course of hypertension, apply:
- Angiotensin-converting enzyme inhibitors . These drugs are prescribed for patients with high blood pressure, especially at a young age. The most effective means are “Capropril”, “Lisinopril”, “Kaptopres”, “Lozartan”, “Tenorik”. Medicines of this group contribute to the inhibition of hypertrophic processes in the heart and arterioles, restore blood circulation and microcirculation.
- Beta blockers. These include drugs “Atenolol”, “Pindolol”, “Anaprilin”, which lower blood pressure and have a beneficial effect on the heart muscle, which is especially necessary for patients with arrhythmia and chronic heart failure. Beta blockers are generally taken concurrently with ACE inhibitors.
- Calcium antagonists. Medicines of this group have a hypotensive effect and stabilize the heart rhythm, eliminating spasms of blood vessels, lowering the tension of the walls of arterioles and stimulating blood flow in the brain. The most popular antagonist drugs are Nifedipine, Diltiazem, Verapamil.
- Diuretics Such medicines as Furosemide, Veroshpiron, Hypothiazide and others indirectly have a hypotensive effect due to the removal of excess fluid from the body, thereby reducing the volume of circulating blood. Diuretics are prescribed for patients with discirculatory encephalopathy in combination with ACE inhibitors, calcium antagonists and beta-blockers.
Drug Cholesterol Control
Since atherosclerosis, which leads to vascular pathology of the brain, is a consequence of hypercholesterolemia, a patient with DEP must follow a strict diet and exercise. If the correction of the diet and exercise do not bring positive dynamics, the patient will be prescribed the following drugs:
- "Acipimox", "Enduracin" - drugs containing nicotinic acid.
- "Gemfibrozil", "Clofibrate", "Fenofibrate" - medicines with derivatives of fibroic acid in the composition.
- "Leskol", "Simvastatin", "Lovastatin" - drugs from the group of statins, have a lipid-lowering property.
- Antioxidant preparations containing omega-3 fatty acids and vitamin E.
To improve brain activity
An important aspect of the treatment of the disease of discirculatory encephalopathy is the use of blood vessel dilating agents, nootropic drugs and neuroprotective agents necessary to improve trophism of nerve tissues. In general, such a combination of drugs allows you to maintain a certain level of intelligence, memory, thinking, psycho-emotional background.
From the group of vasodilators, it is worth noting Trental, Stugeron, Sermion, Cavinton, Cinnarizine, which are taken in tablet form or administered parenterally. To improve the outflow of venous blood from the brain using "Redergin", "Vazobral."
During the treatment of discirculatory encephalopathy, it is impossible to do without drugs that improve metabolism in the nervous tissue under hypoxia (Piracetam, Mildronate, Encephabol, Nootropil, Neuromultivit). Thanks to the use of nootropic drugs (Semax, Cerebrolysin, Cortexin), the patient increases mental activity, improves memory and ability to perceive information, and stress resistance returns.
Equally important is the continued use of neuroprotectors. The first therapeutic effect of most of the drugs in this group occurs a few weeks after the start of administration. , . , , .
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Symptomatic treatment
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Antidepressants, tranquilizers and sedatives are prescribed to stabilize the emotional background with aggressive behavior, depression, apathy. Medicines of this group can be given to a patient only with the permission of a specialist (tincture of valerian, motherwort, Persen, Sedaten, Relanium, Phenazepam, Prozac, Melipramin). Motor and motor disorders require medical gymnastics and massage.
Forecast
Discirculatory encephalopathy is one of the incurable diseases that inevitably lead to disability, despite the fact that at the initial stages of the pathology a person does not lose working capacity, has a minimum of disability.
At the same time, progressive vascular dementia, the result of which is cerebral ischemia, deprives the patient of the opportunity to take care of himself and engage in everyday life. The decision to assign a disability group is made by an expert medical board based on the results of diagnostic reports on the degree of violation of professional skills and self-care.
Moreover, dyscirculatory encephalopathy cannot be called a hopeless disease. With the early detection of an ailment and timely started therapy, the process of degradation and loss of brain functions can be stopped and a full life can be lived. In the case of severe DEP, the prognosis is less optimistic. Aggravating factors are transferred hypertensive crises and strokes.