Symptoms of vascular dementia in the elderly

Vascular dementia in the elderly is a common disease among the elderly, and in today's society, the incidence of this disease is still relatively high. Of course, there are many symptoms of vascular dementia in the elderly. Many times, doctors rely on these symptoms of vascular dementia in the elderly to make judgments when examining vascular dementia in the elderly. It is usually quite accurate.

There are many causes of vascular dementia in the elderly, and many of them have not been discovered so far. Therefore, vascular dementia in the elderly is still a relatively serious disease, and patients usually experience symptoms of memory loss. So, let’s introduce in detail the relevant knowledge about vascular dementia in the elderly and the symptoms of vascular dementia in the elderly.

All dementias related to cerebrovascular factors are collectively referred to as cerebrovascular dementia. First of all, it must be pointed out that dementia actually refers to a syndrome in which brain function declines, especially the overall decline of intelligence-related functions, and the decline must reach a certain degree. It usually includes a series of symptoms and signs such as memory, cognition, mood and behavior, and lasts for several months or more than half a year. Vascular factors mainly refer to the blood vessels within the brain, namely the two major systems of carotid artery and vertebral basilar artery. It may be lesions of these blood vessels themselves, or lesions of the large extracranial blood vessels and the heart, which indirectly affect the blood vessels in the brain. Insufficient blood supply causes ischemic and hypoxic changes in brain tissue, and ultimately leads to a comprehensive decline in brain function.

Clinical symptoms

Clinical symptoms can be divided into two categories: one is the mental symptoms that constitute dementia, and the other is the neurological symptoms of brain damage secondary to vascular disease.

Among the mental symptoms that constitute dementia, memory loss is an early core symptom, including short-term memory, long-term memory and immediate memory, but the earliest to appear is the loss of short-term memory, and long-term memory disorders often appear in the later stages. As memory declines, attention gradually becomes inattentive, and calculation ability, orientation, and comprehension abilities all decline to varying degrees. The most common impairments observed by some authors are decreased time orientation, calculation, recent memory, spontaneous writing, and copying abilities. True psychiatric symptoms are relatively rare. Currently, memory and intelligence are mostly tested in the form of scales, such as the Memory Quotient (MQ), the Hasegawa Intelligence Scale (HDS), the Mini-Mental State Scale (MMSE), etc. If the patient has difficulty completing the test due to his/her illness, a social questionnaire such as the Clayton Royal Behavior Rating Scale (CRBRS) can be used to ask his/her relatives or colleagues to indirectly understand the patient's intelligence. When evaluating the results of these scales, full consideration should be given to the subject's condition, age, education level, psychological state, the testing environment, the tester's technical proficiency, etc. It should be emphasized that low scale values ​​do not necessarily mean dementia. Comprehensive considerations must be made and repeated testing should be performed when necessary.

Due to brain damage caused by vascular lesions, various related neuropsychiatric symptoms may occur depending on the location of the brain. Generally speaking, lesions located in the cortex of the left cerebral hemisphere (dominant hemisphere) may cause symptoms such as aphasia, apraxia, dyslexia, book loss, and acalculia; lesions located in the cortex of the right cerebral hemisphere may cause visual-spatial perception disorders; lesions located in the subcortical nerve nuclei and their conduction bundles may cause corresponding motor, sensory and extrapyramidal disorders, and may also cause symptoms of pseudobulbar palsy such as involuntary crying and laughing, and sometimes mental symptoms such as hallucinations, talking to oneself, stupor, mutism, and indifference.

The above symptoms and signs often develop in a step-by-step manner in patients with multiple cerebral infarction dementia. The onset can be sudden or hidden. After each attack, some neuropsychiatric symptoms may be left behind, which are superimposed again and again until the intelligence declines completely and becomes dementia. Dementia caused by large-area cerebral infarction usually develops acutely and is serious. Those who survive by chance will usually be left with severe neurological symptoms and signs, such as paralysis, bedriddenness, aphasia, and loss of ability to live. The dementia that manifests is often quite severe.

The onset of subcortical arteriosclerotic encephalopathy is often insidious, and the limb movement disorders are relatively mild. The condition can be relatively stable for a long time, but it can also rapidly worsen after a stroke, with a significant decrease in intelligence and progressive deterioration.

Thalamic dementia is characterized by mental symptoms, such as amnesia, abnormal emotions, and drowsiness. Due to the concomitant brainstem lesions, difficulty in vertical eye gaze and other midbrain and pons symptoms may occur. Generally speaking, motor symptoms are not obvious or long-lasting.

Watershed infarct dementia is rare in clinical practice and is mainly diagnosed by imaging, with abnormal images appearing adjacent to cerebral arteries on CT or MRI. Clinically, it often occurs after cerebral vascular hypoperfusion secondary to various reasons, such as long-term shock, uncorrected hypotension, heart failure, and inappropriate use of antihypertensive drugs. Clinical symptoms can be mild or severe, depending on the affected brain area. Bilateral lesions are often more severe, and a few may present as dementia.

Generally speaking, the lesions of multi-infarct dementia, thalamic dementia and Binswanger's disease are mostly in the subcortical nerve nuclei and white matter, and their symptoms mostly fall within the range of subcortical dementia. Large-area cerebral infarction dementia and watershed infarction dementia involve both the cortex and the subcortex, and their clinical symptoms and signs are mixed cortical and subcortical dementia.

Therefore, I believe that through the detailed introduction in the above article, everyone should have a great understanding of vascular dementia in the elderly and its symptoms. Through understanding, we can clearly know one thing, that is, the symptoms of vascular dementia in the elderly can generally be divided into two points, one is mental symptoms, and the other is neurological symptoms of brain damage, so the majority of elderly friends must pay attention to these aspects in their future lives.