What happens in the brain and what forms there are
Nerve cells are very sensitive to lack of oxygen. When the lumen of a vessel is blocked by a blood clot or plaque, a section of tissue dies and the functions for which it was responsible are lost. With chronic hypertension, small vessels deep in the brain suffer: their walls thicken, blood flow decreases, and the white matter—the pathways between parts of the brain—is gradually damaged. Because of this, thoughts move more slowly, the ability to hold several things at once is lost, and the gait changes.
- Multi-infarction - after several large strokes
- Subcortical (small vessel disease) - slow damage to white matter
- Dementia after one stroke in a significant area
- Mixed - a combination of vascular damage and Alzheimer's disease
- Posthemorrhagic - after a cerebral hemorrhage
Causes and risk factors
The main factor is long-term high blood pressure, which destroys small blood vessels in the brain long before complaints appear. It is joined by diabetes, atherosclerosis of the carotid arteries, cardiac arrhythmias with the risk of thromboembolism, smoking and physical inactivity. A significant part of these factors are controllable: their correction reduces the risk of both new strokes and further cognitive decline.
- Arterial hypertension, especially untreated
- Previous stroke or transient ischemic attack
- Diabetes and obesity
- Atrial fibrillation
- High cholesterol and atherosclerosis of the carotid arteries
- Smoking, alcohol abuse
- Age over 60 years
How it manifests itself
Attention and speed of thinking are usually the first to suffer: a person takes a long time to “get involved” in a conversation, loses track, cannot plan the day or count money. Emotional instability, tearfulness, outbursts of irritation, and apathy appear. Characteristic neurological signs are an unsteady mincing gait, weakness in the limbs, speech and swallowing disorders, and frequent urination. Memory may suffer later, and cues often help remember, unlike in Alzheimer's disease.
- Slowness of thinking, difficulty switching between tasks
- Forgetfulness of recent events
- Difficulty with planning and counting
- Personality changes, apathy or irritability
- Unsteadiness of gait, frequent falls
- Speech and swallowing disorders
- Night confusion, sleep disturbance
Diagnostics
The doctor questions the person and his loved ones in detail: it is important when the changes began and whether they progressed in stages. Neuropsychological testing is carried out and the neurological status is assessed. Brain imaging is mandatory: MRI is better at showing small infarcts and white matter lesions, CT is more accessible and suitable for excluding hemorrhage and tumors. Additionally, neck vessels, heart rhythm and metabolism are assessed, and reversible causes of memory impairment are excluded.
- Neuropsychological scales for assessing memory and attention
- MRI or CT scan of the brain
- Doppler ultrasound of the brachiocephalic arteries
- ECG and Holter monitoring to search for arrhythmia
- Lipid spectrum, glycated hemoglobin, general blood test
- Vitamin B12 and thyroid hormones to rule out reversible causes
Treatment, care and prevention
There is no medicine that brings back dead cells, so the main task is to prevent new vascular events. The doctor selects ongoing therapy to lower blood pressure, correct cholesterol and sugar, and, if indicated, antithrombotic drugs. Treatment of arrhythmia and narrowing of the carotid arteries is discussed separately. Non-drug measures are no less important: feasible physical activity, communication, daily routine, training of household skills. Relatives are helped by organizing a safe space and clear routine. All prescriptions are made by a doctor; self-medication and “vascular drip courses” without indications do not replace basic therapy.
- Monitor blood pressure daily, target usually below 140/90 mmHg. Art.
- Constantly taking prescribed medications, without breaks for rest
- Quitting smoking and limiting alcohol
- Walking and feasible exercises, physical therapy for gait disorders
- Cognitive training, reading, social activity
- Control of vision and hearing: their decrease exacerbates confusion
- Safe life: handrails, no thresholds and slippery carpets