What happens in the brain
With long-term hypertension and diabetes, small arteries that supply the deep parts of the brain thicken and lose elasticity. The blood supply to the white matter deteriorates, areas of its rarefaction appear, small deep infarctions - lacunae, and sometimes microhemorrhages. These changes disrupt connections between parts of the brain, so the speed of thinking, attention, planning and walking are primarily affected. Similar small lesions on MRI can also be found in older people without complaints, so the diagnosis is made only with a combination of symptoms and changes in the images.
- White matter lesions - leukoaraiosis
- Lacunar infarctions
- Microbleeds
- Consequences of strokes
- Combination of vascular changes with Alzheimer's disease
Causes and risk factors
The main cause is arterial hypertension, especially long-term and poorly controlled. Diabetes mellitus, high cholesterol, smoking, obesity and physical inactivity play a significant role. Atherosclerosis of large vessels of the neck and head and atrial fibrillation increase the risk of strokes, which accelerate the progression of the disease. Most of these factors can be corrected, so prevention is effective at any age.
- Arterial hypertension
- Diabetes mellitus
- Elevated LDL cholesterol
- Smoking and alcohol abuse
- Atrial fibrillation
- Age over 60, immobile
Symptoms
Changes are developing gradually. At first, a person notices that he thinks more slowly, it is more difficult to concentrate and switch between tasks, and he gets tired faster. Later, the gait changes - the steps become small, instability appears, and the urge to urinate becomes more frequent. Apathy, decreased mood, and emotional instability may appear. In later stages, vascular dementia develops with loss of independence.
- Slowness of thinking, difficulty concentrating
- Decreased memory and planning
- Small step, unsteadiness when walking
- Frequent urge to urinate
- Apathy, depression
- Episodes of sudden deterioration after mini-strokes
Diagnostics
The neurologist evaluates memory, attention and thinking using tests such as the Montreal Cognitive Rating Scale, walking and balance. The main method of confirmation is MRI of the brain, which shows lesions in the white matter, lacunae and the consequences of strokes. Ultrasound of the neck vessels reveals stenoses, ECG and Holter - rhythm disturbances. Tests for cholesterol, glucose, glycated hemoglobin, vitamin B12 and TSH help find risk factors and rule out other causes of memory problems. Rheoencephalography is not used to make a diagnosis.
- Neuropsychological testing
- MRI of the brain
- Duplex scanning of the brachiocephalic arteries
- ABPM, ECG, Holter according to indications
- Lipid spectrum, glucose, HbA1c
- Vitamin B12, TSH
Treatment and prevention
The main goal is to stop further damage to blood vessels. The most important thing is to consistently control the pressure: the doctor determines the target values individually, most often below 130/80 with good tolerance. Statins reduce cholesterol and the risk of stroke, antiplatelet agents are prescribed according to indications, and for atrial fibrillation - anticoagulants. Treat diabetes, quit smoking. Regular walking, mental and social activity, and a Mediterranean diet support cognitive function. Nootropics and drugs to “improve cerebral circulation” do not have convincing evidence of effectiveness and do not replace primary treatment.
- Daily blood pressure monitoring and taking prescribed medications
- Statins as prescribed by a doctor
- Antiplatelet agents or anticoagulants according to indications
- Quitting smoking, limiting alcohol
- Walk at least 150 minutes per week
- Reading, communication, learning new things