What is multi-infarct dementia, pathogenesis and how to diagnose?
Vascular dementia is dementia caused by cerebral vascular damage in general. And multi-infarct dementia is vascular dementia, a special performance, multi-infarct by the recurrent brain tissue caused by cumulative damage to the individual case may rise to 1 attack.
Multi-infarct dementia common in the elderly, is a common cause of senile dementia. The reported incidence varies. Japan reported 60%, 24.6% reported in China 68.6%, indicating that the disease is not uncommon.
Multi-infarct dementia may have different degrees of brain atrophy. Most of brain atrophy also in the clinical dementia as the main performance, it is that multi-infarct dementia is the result of a combination of factors.
Multi-infarct dementia is currently no uniform diagnostic criteria, the following can be used as diagnostic reference.
(1) more than middle-aged disease, hypertension, coronary heart disease, atherosclerosis, hyperlipidemia, diabetes and other risk factors.
(2) episode of stroke.
(3) patients had varying degrees of recent memory loss, facial expressions indifferent, unresponsive, calculation difficulties, disorientation, strong cry strong laugh, pseudobulbar palsy, motor and sensory disorders, such as the pathological signs and symptoms of central nervous system damage .
(4) ct scan or MRI, showing multiple infarct.
How is it treated multi-infarct dementia?
Multi-infarct dementia currently more difficult to completely cure, but treatment can improve symptoms and more. The treatment principles are:
(1) activation of cerebral metabolism, indirectly, the development of dementia. Available cerebral circulation and metabolism enhancers revitalizing agent. Cerebral circulation enhancers is a direct expansion of cerebral vascular drugs, and brain metabolism in revitalizing agent refers to enhanced glucose uptake and metabolism, secondary expansion of the cerebral blood vessels, improve the nutritional metabolism of the drug. The two are closely related and influence each other.
① cerebral metabolism enhancers are: the brain benefits, hydrochlorothiazide, flunarizine, benzyl amine and quack phenol and other ergot preparations. Disable vasodilators alone because it will lead only to dilate blood vessels decrease in blood pressure, so that dementia increased.
② revitalizing agents have brain cells: a new brain compound, chlorine esters wake up, Hite piano, coenzyme q10 , citicoline, cerebrolysin are welcome, Karan tablets.
(2) neural transmission organizations Disorder
① High-calcium pantothenate can promote glucose uptake and metabolism of the brain, increased brain 5 - HT concentration and cerebral blood flow, to improve the neurological symptoms. Dosage of 250 mg 3 times daily after meals.
② amantadine can promote dopamine release and inhibit its reuptake. 100 mg daily after 2 weeks of patients with dementia can increase appetite, flexible stand, dressing, walking, etc., enhance the ability of emotional activity and interest. Side effects include headache, drowsiness, gastrointestinal metabolic disorders. Large doses can cause convulsions.
③ cholinergic drugs mainly refers to the cholinesterase inhibitors (physostigmine, tetrahydro amino pyridine) and acetylcholine prodrug (lecithin, choline chloride, dimethylamine ethanol), can increase acetylcholine function of the system and improve clinical symptoms.
④ neuropeptides can improve the understanding of memory in the elderly, reduce depression and weakness. Usage: acth25μ 250 plus 5% glucose infusion 500 ml, slowly, not a long time use.
⑤ Chinese HJD through the whole brain average blood flow, and memory-related increase of more obvious around the hippocampus, increased blood flow around the ischemic focus and narrow the infarct. Currently, Japan has been for the treatment of multi-infarct dementia.
(3) symptomatic treatment of clinical application of anti-psychotic often, antidepressants, antianxiety drugs. In particular, antipsychotic drugs may be most useful to restore normal sleep - wake cycle, control, impatient and aggressive behavior, improve self-care ability. Common thioridazine, fluphenazine, fluorine gung butanol. Who also used stimulants for depression, such as Ritalin, chlorine esters wake up. To give stability to the anxiety and so on.
(4) In addition to supportive therapy for patients should be given adequate nutrition and living care, but also more contact with patients, more conversation, and allowed more TV and books, newspapers, take part in some social activities and physical exercise, to avoid patients with social isolation to reduce loneliness. |
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