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 failure in blood circulation. Among all diseases that have neurological symptoms, DEP is the most common.
Not so long ago, this pathology was classified as an "age-related" ailment - 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 over 40 years old. The danger of the disease lies in the fact that its irreversible course leads to a change in thinking, psycho-emotional state. In some cases, physical and mental he alth suffers, and the ability to work is lost. Often such patients need outside help, since taking care of themselves and performing elementary household tasks becomes difficult for them.inscrutable.
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 the nervous 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 a cerebrovascular disease.
Since the development of DEP is based on a violation of the blood supply to the brain, for effective treatment, the elimination of factors that provoke it is of particular importance. The most likely causes of dyscirculatory encephalopathy of the brain are:
- Atherosclerosis. The appearance 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 a limited supply of oxygen.
Other factors that cause DEP are diabetes mellitus, herniated discs, anomalies in the development of the vessels of the head and neck, and serious injuries. In elderly patients, there is often a combination of several factors: 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 that encephalopathy of mixed pathogenesis.
To activate this irreversible pathological process, the influence of a certain factor is necessary. The "push" to the development of the disease can be:
- overweight;
- alcohol and smoking abuse;
- unbalanced diet;
- lack of proper motor activity.
How the disease manifests
Faced with a diagnosis, not only patients should understand what it is - "dyscirculatory encephalopathy of the brain", but also their close relatives. It is important to have an idea in what scenario the pathology will develop, what the patient's family should prepare for and how to behave with him. In encephalopathy, the burden of responsibility and care falls on the shoulders of people from the patient's immediate environment. For them, even communication and living with a patient suffering from DEP can become a difficult task. So, for example, with disculatory encephalopathy of the 2nd degree, contact with the patient becomes difficult. Often he does not understand others, is not aware of what is happening, or perceives everything in his own way. At the same time, motor activity and coherent speech may not be affected for a long time.
Symptoms of the disease represent a whole complex of neurological, intellectual, psycho-emotional, motor disorders, the severity of which determines the degree of discirculatory encephalopathy and predicts the further course of the disease. Doctors distinguish three stages of DEP:
- First. The disease is characterized by the appearance of minorcognitive disorders that do not interfere in any way with employment, leading a habitual lifestyle.
- Second. With dyscirculatory encephalopathy of the 2nd degree, the manifestations of the disease are aggravated, impaired intelligence, motor functions, and mental disorders become more noticeable.
- Third. The hardest stage. At the third stage, the disease is a vascular dementia with a significant decrease in intelligence, mental abilities, and neurological status disorders. At the third stage of dyscirculatory encephalopathy, the patient becomes incapacitated.
Symptoms of the first stage
Basically, dyscirculatory encephalopathy of the 1st degree occurs with minor changes in the emotional state. Clinical signs appear gradually. Surrounding people over and over again pay attention to changes in character, but often do not attach much 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 in depression, but they rarely complain of a bad mood, more often show apathy, despite the fact that patients have no real reasons for worrying.
Mood changes of any kind are ignored, while somatic disorders cause increased anxiety in patients. Sudden mood swings are possible from a depressing feeling to unexpected joy, from crying to angry attacks towards others. Patients with grade 1 dyscirculatory encephalopathy are distracted and forgetful, suffer from insomnia, headaches, feel constant fatigue.
Cognitive impairments include difficulty concentrating, memory impairment, fatigue with minimal mental activity. A person loses his former organization, the ability to plan time, and the fulfillment of duties. At the initial stage of the disease, the first movement disorders are possible. Dizziness, nausea, unsteady gait are not ruled out.
What happens in the second stage
How long can you 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 an increase in 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 consequences of encephalopathy.
Relatives should be aware of all the patient's symptoms. Often in elderly patients orientation in space and time is disturbed. If a person leaves the house on his own, it is advisable to put a note with the address in his pocket, as there is a high risk that the patient will get lost, forget the way home, etc.
The emotional sphere also continues to suffer. If at the first stage the patient had sharp mood swings, then with dyscirculatory encephalopathy of the 2nd degree, their place is steadily occupied by apathy and indifference to others. Movement disorders become even more noticeable. Patients typically walk slowly and shuffle their feet.
It is important to understand that there is noor the line between the third stage of DEP and dyscirculatory encephalopathy of the 2nd degree. Treatment at the last stage of the disease practically does not bring a positive effect, being essentially palliative. The DEP of the third degree is characterized by a complete loss of ability to work and the possibility of independent existence.
Last stage
Only a few specialists try to treat discirculatory encephalopathy. As a rule, at this stage of the disease, the patient can no longer be helped by drugs. All that can be done for him is to provide quality care and care. The patient may completely lack coherent speech, periodically experience neurological symptoms, including movement disorders (paresis, paralysis, convulsions). Patients with end-stage dyscirculatory encephalopathy lose the ability to control bowel movements and urination.
In a state of dementia, a person cannot survive without outside help. 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 responsibility for maintaining the life of a patient with DEP falls on the shoulders of the family. It is especially important to ensure a nutritious diet, regularly perform hygiene procedures and prevent bedsores.
If the patient in the last stage is still able to get up and walk, we must not forget about poor coordination of movements and a high risk of falling. For the elderly with dyscirculatory encephalopathy, seriousfractures can be fatal.
Diagnosis and main principles of therapy
The appearance of dyscirculatory encephalopathy syndrome with severe symptoms indicates the irreversibility of the pathological process and the lack of chances for recovery. The treatment of this disease is largely preventive in nature, so the success of therapy largely depends on the timeliness of the diagnosis. Since the first symptoms of DEP go unnoticed by relatives and the patient himself, detecting pathology at an early stage is not an easy task.
Discirculatory encephalopathy is treated by neurologists. The risk group for this disease includes all elderly people suffering from diabetes mellitus, atherosclerosis, and hypertension. In addition to an 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 levels.
In most cases, consultations of an ophthalmologist, endocrinologist, cardiologist and angiosurgeon are required.
Treatment of dyscirculatory encephalopathy is a set of measures aimed not only at combating the manifestations of the disease, but also at eliminating the causes of the ongoing changes. At the same time, therapy, in addition to medical, includessocial and psychological aspects, since DEP leads to disability and loss of legal capacity.
The primary tactic in the treatment of dyscirculatory encephalopathy is stroke prevention, correction of the course of the underlying disease and maintenance of brain functions by constantly improving blood supply to it. Medicines can give a good result in the initial stages of the disease, but only with the active participation and desire of the patient himself. When diagnosing "dyscirculatory encephalopathy", it is first necessary to eliminate risk factors or, at least, reduce their impact on the patient. Therefore, the first step should be to adjust the diet and lifestyle.
Unfortunately, the patient has little chance of successful recovery with the second degree of discirculatory encephalopathy. The treatment of this disease makes it possible to stop its progression and keep the patient's condition at a level acceptable for independent life.
Treatment without drugs
Non-drug therapy for DEP is based on several components:
- diet food;
- weight loss to the maximum allowable limits;
- quitting alcohol and smoking;
- enough physical activity.
Since overweight is an absolute risk factor for the development of vascular pathologies, it is important to reconsider your diet. The diet for this disease is designed to normalize fat metabolism and stabilize blood pressure. For this reason, the patientrecommended:
- Minimize your intake of animal fats, replacing them with vegetable ones, and get protein mainly from lean fish.
- Reduce the amount of s alt you eat to 5 grams per day.
- Eat foods fortified with calcium, magnesium, potassium, focusing on fresh vegetables and fruits.
- Refuse food fried in oil. Alternative - boiled, stewed, oven-baked treats.
At the early stage of DEP, when the first warning signs of brain dysfunction appear, it may be enough to make the necessary adjustments to lifestyle and nutrition. If the disease does not recede and rapidly progresses, drug therapy is indispensable.
Using drugs
Drug treatment can be pathogenetic, aimed at the underlying disease, and symptomatic, designed to stop the symptoms of discirculatory encephalopathy. Sometimes surgery may be required.
Pathogenetic therapy involves the fight against high blood pressure, vascular damage with atherosclerotic plaques, and metabolic disorders. In order to treat dyscirculatory encephalopathy of the brain, medicines of different groups are prescribed.
Medicines for high blood pressure
To take control of arterial hypertension, use:
- Angiotensin-converting enzyme inhibitors. These drugs are prescribed to patients with high blood pressure, especially in youngage. The most effective means are "Capropril", "Lizinopril", "Kaptopres", "Losartan", "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 the 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 mostly taken at the same time as ACE inhibitors.
- Calcium antagonists. Medicines of this group have a hypotensive effect and stabilize the heart rate, eliminating vasospasm, 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. Medicines such as Furosemide, Veroshpiron, Hypothiazid and others indirectly have a hypotensive effect by removing excess fluid from the body, thereby reducing the volume of circulating blood. Diuretics are prescribed to patients with dyscirculatory encephalopathy in combination with ACE inhibitors, calcium antagonists and beta-blockers.
Medicated cholesterol control
Since atherosclerosis leading 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 physicalexercises will not bring positive dynamics, the patient will be prescribed the following medicines:
- "Acipimox", "Enduracin" - preparations containing nicotinic acid.
- Gemfibrozil, Clofibrate, Fenofibrate are medicines containing fibric acid derivatives.
- "Leskol", "Simvastatin", "Lovastatin" - drugs from the group of statins, have a lipid-lowering property.
- Antioxidant supplements with Omega-3 fatty acids and vitamin E.
To improve brain activity
An important aspect of the treatment of dyscirculatory encephalopathy disease is the use of drugs that dilate blood vessels, nootropic drugs and neuroprotectors necessary to improve the trophism of nerve tissues. In general, such a combination of drugs allows you to maintain intelligence, memory, thinking, psycho-emotional background at a certain level.
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, Redergin, Vasobral are used.
During the treatment of dyscirculatory encephalopathy, it is impossible to do without drugs that improve metabolism in the nervous tissue under hypoxic conditions (Piracetam, Mildronate, Encephabol, Nootropil, Neuromultivit). Thanks to the use of nootropic drugs ("Semax", "Cerebrolysin", "Cortexin"), the patient increasesmental activity, memory and the ability to perceive information improve, resistance to stress returns.
Of no small importance is the long-term use of neuroprotectors. The first therapeutic effect from most of the funds in this group occurs a few weeks after the start of administration. Most often, intravenous infusions are prescribed, but over time, injections are replaced with tablets. To increase the effectiveness of neuroprotective therapy, multivitamin complexes containing B vitamins, ascorbic and nicotinic acids are additionally prescribed.
At the advanced stage of DEP, in exceptional cases, a decision is made about surgical intervention. The operation is possible if the degree of vasoconstriction has reached 70% or the patient has already suffered an acute violation of the blood supply to the brain. To date, three types of operations are performed: endarterectomy, stenting and anastomoses.
Symptomatic treatment
In the second and third stages of dyscirculatory encephalopathy, recovery is unlikely, but this does not mean that the patient cannot be helped. Taking certain medications will help relieve symptoms and improve quality of life.
Antidepressants, tranquilizers and sedatives are prescribed to stabilize the emotional background in aggressive behavior, depression, apathy. Medicines of this group can be given to the patient only with the permission of a specialist (tincture of valerian, motherwort, Persen, Sedaten, Relanium, Phenazepam, Prozac, Melipramine). Movement and motor disorders require therapeutic exercises and massage.
Forecast
Discirculatory encephalopathy is one of the diseases that are incurable to the end, inevitably leading to disability, despite the fact that in the initial stages of the pathology a person does not lose his ability to work, has a minimum of limitations in life.
At the same time, progressive vascular dementia, which results in brain ischemia, deprives the patient of the opportunity to take care of himself and do household chores. 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 impairment of professional skills and self-care.
At the same time, dyscirculatory encephalopathy cannot be called a hopeless disease. With early detection of the disease and timely therapy, the process of degradation and loss of brain functions can be suspended and a full life can be lived. In the case of severe DEP, the prognosis is less optimistic. Aggravating factors are previous hypertensive crises and strokes.
