Cognitive dysfunctions of the brain are specific abnormalities that lead to personality disorder, since they interfere with the cognitive activity of a person. They are found in adults and children. How does cognitive impairment occur, for what reasons and how to recognize them? Let's try to figure it out.
What are cognitive impairments, their types and mechanism of development
What are cognitive impairments? These are abnormalities in the normal functioning and functioning of the brain. They occur for various reasons in adults, and can also appear in a child. The human brain is a complex mechanism that regulates all physiological and mental processes in the body. Cognitive or cognitive functions include:
Any violations of them can provoke a change in personality and make an animal out of a reasonable person, which is guided only by instincts. How do such violations develop? First of all, this is due to a violation of the connection between the cerebral cortex and subcortical structures. Depending on the localization of damage, the following disorders are distinguished:
Depending on the degree of damage, the following cognitive disorders are distinguished:
Brain activity is a very complex mechanism. Any violation of it contributes to the appearance of deviations that greatly affect human behavior.
Causes of development, main symptoms
Why do cognitive impairments occur in children and adults? Depending on their nature of origin, there are:
- functional (temporary);
- organic (associated with the occurrence of an irreversible pathological process).
Functional disorders are predominantly temporary. They are often associated with the following phenomena:
Such abnormalities in brain activity can occur at any age. For example, impaired cognitive functions in children can provoke an unfavorable environment at home or at school, death or illness of friends, close relatives, and other emotional upheavals. They are temporary and go away by themselves when irritating factors disappear.
Organic disorders are associated with pathological processes in the brain. There are several reasons for this condition:
How to detect early signs of cognitive impairment so that appropriate treatment can be started on time? You should pay attention to the following symptoms:
- impairment of memory and ability to remember;
- decreased attention;
- fatigue from the simplest mental (intellectual) activity.
In the presence of such disorders (especially in children), it is necessary to undergo an examination so as not to start the disease and start treatment on time.
In a more severe course (at a moderate stage), the following symptoms are observed:
In the very last stage, which is called dementia, the following unpleasant symptoms are added to the above:
- personality disorder;
- the inability to perform the simplest self-care functions (for example, the inability to go to the toilet, wash, eat);
- change of character;
- mental deviations (a person forgets who he is, does not recognize the people around him).
The sooner cognitive impairments are identified, the better they respond to medication and psychological interventions. Dementia is progressive and refractory to treatment.
Diagnostics, methods of treatment and prevention
How to determine if a person has cognitive impairments? To do this, the patient must undergo a special examination, which includes the following procedures:
Only after identifying the cause of the deviations, the necessary treatment is prescribed. It is based on the use of drugs. So persistent brain damage in dementia is treated with the following medications:
- Donepezil.
- Galantamine.
- Rivastigmine.
- Memantine.
- Nicergoline.
They are prescribed only by a doctor. He also determines the dosage and duration of therapy. With minor impairments of cognitive functions, medications are used that improve blood circulation, as well as neuroprotectors. These are such drugs:
In addition to drugs, a special anti-cholesterol diet is prescribed in order to improve blood flow and supply the brain with oxygen. It consists in the rejection of fatty meats, dairy products and the use of fresh vegetables and fruits, seafood. It is also important to take B vitamins, exclude alcoholic beverages and coffee from the diet.
Once cognitive impairments have appeared, they are rarely completely cured. You can only pause the process.
To do this, you need to change the way of life. Therefore, to suspend negative phenomena in the brain, one should adhere to the following rules:
If you adhere to the correct lifestyle, then brain abnormalities will not come very soon. This is important for maintaining a person's well-being and intellectual performance.
Cognitive impairment can manifest itself at any age for one reason or another. They are capable of delivering a lot of trouble to a person and his loved ones, since they lead to personality disorder and slow degradation. If such deviations are found, it is important to consult a doctor for help as early as possible in order to prevent complications.
Many people know that impaired blood circulation in the vessels of the neck and head is one of the main risk factors for the development of acute stroke, which has serious consequences for the health and life of patients. Meanwhile, much more often dyscirculatory problems cause changes that are not obvious at first glance: a progressive decrease in memory and the ability to concentrate, as well as other disorders of cognitive function.
Why cognitive impairments develop in vascular diseases of the brain, how they are manifested, diagnosed and treated: we will analyze in our review and video in this article.
The brain has begun to cope with its work worse - perhaps this is a sign of illness
The essence of the problem
The most complex brain functions associated with:
- the process of rational cognition of the surrounding world;
- purposeful interaction with available objects, phenomena and living beings;
- perception (collection, receipt) of information;
- processing and analysis of the received data;
- memorization and storage in memory;
- exchange of information;
- construction and sequential execution of sequential actions, assessment of their results.
Thus, cognitive impairment is associated with a decrease in these functions relative to the initial level (individual norm).
Note! Each person has their own level of development of cognitive abilities, due to genetic characteristics. So, someone can boast of a phenomenal memory, while someone has difficulty memorizing a simple quatrain. There are no generally accepted norms for assessing cognitive function.
There are more than twenty pathologies accompanied by impaired cognitive functions. Vascular diseases occupy an important place among them.
Common causes of cognitive decline are:
- ischemic stroke (heart attack) the brain of certain localizations (see);
- multi-infarction condition;
- chronic ischemia of nerve tissues - discirculatory encephalopathy, vascular dementia;
- consequences of subarachnoid or intraventricular hemorrhage;
- dysmetabolic (mixed vascular-dysmetabolic) encephalopathy - hepatic, renal, hypoglycemic, etc.
Unfortunately, most chronic vascular diseases cause irreversible cognitive impairment. In some cases (for example, with successful treatment of acute cerebrovascular accident, correction of metabolic disorders), their full or partial recovery is possible.
What disorders are more common with CVD?
So, what kind of cognitive impairment is provoked by a violation of the tone of the cerebral vessels? Depending on the severity, they are divided into light, medium and heavy.
Mild degree
A mild degree of impairment is characterized by the preservation of indicators of psychometric scales at the level of the average age norm. However, patients notice a decrease in the ability to memorize, concentrate and analyze information and often express anxiety about this.
Note! Deterioration of short-term memory and absent-mindedness are one of the first symptoms of chronic cerebrovascular diseases, which are accompanied by impaired cerebral vascular tone.
Despite the complaints of patients, mild cognitive disorders:
- invisible to others;
- do not cause difficulties in everyday life and at work;
- do not affect the quality of life of patients.
Moderate degree
Moderate disorders are accompanied by the appearance of complaints of high fatigue during mental stress, a pronounced decrease in memory, attention and learning ability.
With this form of cerebral circulatory insufficiency, signs of a disorder of cognitive function:
- are reflected in the patient's complaints;
- visible to others;
- hinder the performance of complex intellectual tasks.
Note! According to statistics, this form of pathology is determined in 12-17% of the elderly population of the world.
Severe degree
A severe degree of cognitive impairment, which was provoked by a violation of the vascular tone of the brain, is called vascular dementia. It occurs in 15-20% of all cases of cognitive decline, ranking three times after dementia in Alzheimer's disease and other degenerative diseases of the nervous system.
Dementia is an acquired mental disorder that is accompanied by a pronounced decrease in intelligence and complete social maladjustment of the patient.
The disease is accompanied by a complex disorder of cognitive functions, including:
- memory- the ability to perceive and reproduce the information received;
- Attention;
- speech;
- gnosis- the ability to recognize objects by perception with the help of the senses;
- praxis- the ability to perform purposeful movements;
- thinking;
- ability to plan;
- ability to make decisions;
- ability to control own labor and the actions of others.
Note! In contrast to mental retardation, which manifests itself from birth, the signs of dementia increase gradually, more often in old age.
It is manifested by a slowdown and rigidity of all mental processes. Patients experience difficulties even when performing simple household tasks (grocery shopping, cooking). Mnestic disorders are primarily expressed in a decrease in the ability to learn, later there is a violation of memory for past and current events.
More than 50% of patients are faced with emotional "incontinence" - weakness, tearfulness, irascibility. Many of them have clinical manifestations of depression.
In addition to cognitive disorders, the clinical picture of vascular dementia is often accompanied by the development of neurological deficits. The main syndromes of brain tissue damage are presented in the table below.
Table: Neurological syndromes in severe cognitive impairment:
| Syndrome (localization of the lesion - see the photo) | Manifestations |
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In addition, paralysis and paresis of the extremities, impaired control of pelvic functions (urinary incontinence, fecal incontinence) are possible. Patients with vascular dementia often lose self-care skills and need constant care.
Methods for the diagnosis of cognitive impairment
Cognitive disorders are diagnosed by a neuropathologist.
The standard instruction is to use the following minimum survey scope:
- Collection of complaints and anamnesis (from the words of the patient and relatives).
- General neurological examination.
- Neuropsychological testing.
- Instrumental data (CT / MRI (see)).
- Screening tests:
- "5 words";
- Schulte test;
- clock drawing test;
- a short scale for assessing mental status.
Treatment principles
The main role in the correction of cognitive disorders in CVD is assigned to the elimination of vascular risk factors. All patients are advised to follow a rational diet, give up bad habits, and be physically active. The control of blood pressure, glucose and cholesterol concentration in the blood is of no small importance.
If cognitive impairment occurs after an acute cerebral stroke, the appointment is indicated:
- antiplatelet agents(Thrombo-Ass, Ticlopidine, Clopidogrel, Dipyridamole);
- indirect anticoagulants;
- antihypertensive drugs.
To improve cognitive function, it is important to regularly train your memory by memorizing poetry and solving crosswords.
Additionally, medications can be prescribed:
- Piracetam;
- Galantamine;
- Donepizil;
- Vinpocetine;
- Gliatilin, etc.
The selection of a specific drug is determined by the severity and nature of cognitive impairments, the presence of concomitant pathologies, the patient's tolerance of certain drugs.
With rare exceptions, cognitive impairment is a problem in old age. To avoid loss of memory, attention, learning ability and almost complete lack of independence in old age, it is important to lead a healthy lifestyle, eat right, be physically active and regularly exercise the brain.
Good results in the prevention of a decrease in cognitive functions are also obtained by timely treatment of circulatory disorders in the cerebral vessels.
Introduction
Cognitive function- the most complex functions of the brain, with the help of which the process of rational cognition of the world is carried out and purposeful interaction with it is ensured.
The process of rational cognition of the world and purposeful interaction with it includes four main interacting components, each of which is associated with a certain cognitive function:
perception of information- gnosis
information processing and analysis- attention, generalization, identification of similarities and differences, formal-logical operations, the establishment of associative links, making inferences (intelligence)
memorization and storage of information- memory
exchange of information, construction and implementation of an action program- speech and praxis (purposeful physical activity)
Memory- the ability of the brain to assimilate, store and reproduce information necessary for current activity; memory function is associated with the activity of the entire brain as a whole, but structures of the hippocampus circle are of particular importance for the process of memorizing current events.
Gnosis- the function of perception of information, its processing and synthesis of elementary sensory sensations into holistic images; primary disorders of gnosis (agnosia) develop with pathology of the posterior parts of the cerebral cortex, namely the temporal, parietal and occipital lobes.
Speech- the ability to exchange information using statements; speech disorders (aphasia) most often develop with pathology of the frontal or temporo-parietal regions of the brain; at the same time, the defeat of the temporo-parietal divisions leads to all sorts of disorders of speech understanding, and with pathology of the frontal lobes, the ability to express one's thoughts with the help of speech statements is primarily impaired.
Praxis- the ability to acquire, maintain and use a variety of motor skills; violations of praxis (apraxia) most often develop with pathology of the frontal or parietal lobes of the brain; at the same time, the pathology of the frontal lobes leads to a violation of the ability to build a motor program, and the pathology of the parietal lobes leads to improper use of one's body in the process of a motor act with a preserved program of movements.
Attention- selection of the necessary information, ensuring the selectivity of various programs of their activities, maintaining proper control over their behavior; attention accompanies any activity as a constituent element of various mental (perception, memory, thinking) and motor processes; unlike cognitive processes (perception, memory, thinking, etc.), attention has no special content - it appears as if inside these processes and is inseparable from them; attention, on the one hand, is a complex cognitive process, on the other, a mental state, as a result of which activity improves; attention is generated by activity and accompanies it, behind it there are always interests, attitudes, needs, orientation of the personality.
Intelligence- the ability to compare information, find commonalities and differences, make judgments and conclusions; intellectual abilities are provided by the integrated activity of the brain as a whole.
Before proceeding to the consideration of the syndrome of "mild cognitive impairment", it is necessary to consider such a concept as "age-related cognitive dysfunction".
Age-related cognitive dysfunction
In 1994, the International Psychogeriatric Association at WHO proposed the term “ age-related cognitive decline"(Eng. Agging-associated cognitive decline) to determine the weakening of memory and attention age-related. The studies carried out to date convincingly indicate that normal aging is characterized by involutive processes of both the central and peripheral nervous systems. On the part of the central nervous system, the aging process is manifested by a decrease in the volume and mass of the brain, and the number of synaptic connections. Along with a decrease in the number of cerebral receptors, mediator cerebral insufficiency also occurs. With age, the number and density of dopamine D2 receptors in the striatum decreases and the concentration of dopamine in the subcortical formations of the brain decreases. The consequence of this are the clinical manifestations of normal aging, well known to geriatricians: impoverishment of facial expressions, some general slowness, bent, senile posture, some shortening of the stride length. In addition to motor symptoms, when dopamine levels decrease, dopamine-sensitive cognitive symptoms develop. Thus, studies carried out to date have shown that with age, the speed of reaction decreases, it becomes more difficult to assimilate and implement a new action program, the level of attention and the volume of working memory decrease. These changes are not pathological in nature, are recognized by patients and do not lead to impaired adaptation of the elderly. It is important to note that during normal aging, the decline in memory and other cognitive abilities is almost stationary. For the differential diagnosis between physiological age-related cognitive dysfunction and the initial signs of pathological deterioration of higher cerebral functions, an analysis of the nature of memory impairments is essential. During normal aging, forgetfulness is associated mainly with a decrease in the activity of memorizing and reproducing, while the primary mechanisms of memory remain intact. In contrast, in Alzheimer's disease, the very ability to assimilate new information is impaired. Therefore, the external organization of the memorization process, combined with prompts during reproduction, largely compensates for age-related forgetfulness, but is ineffective in Alzheimer's disease, including in its early stages. These data formed the basis for the method of differential diagnosis of normal and pathological aging, first proposed by Grober and Buschke.
Diagnostic criteria for aging-related cognitive decline, developed by the International Psychogeriatric Association WHO (1994):
inclusion criteria
:
cognitive impairment reflected in the complaints of the patient or his immediate environment
gradual development of violations and their presence for at least 6 months
disorders in one of the following areas: memory, attention, thinking, speech, visual-spatial orientation
neuropsychological test results are at least one standard deviation below the norm developed for this age group
exclusion criteria
:
presence of moderate cognitive impairment according to ICD-10 criteria
the presence of somatic pathology that can lead to cognitive impairment
organic pathology of the brain
severe emotional and behavioral disorders: depression, anxiety, delirium, etc.
substance use
According to the specified criteria, the syndrome of "age-related cognitive decline", not associated in an obvious way with any established somatic, neurological or mental illness, can be talked about in cases of deterioration of one or more cognitive abilities that deviate from the average statistical indicators for this age group, exceeding them, but not reaching severity of dementia.
Thus, the syndrome of "age-related cognitive decline" occupies an intermediate position between normal aging and pathological changes caused by organic brain damage... According to epidemiological data, the prevalence of “age-related cognitive decline” is at least 40% among people over 50 years old. However, in everyday clinical practice, it is very difficult to draw the line between “physiological” and “pathological” deterioration of cognitive abilities in old age, and often it is not possible at all.
Moderate cognitive impairment (disorder)
Cognitive impairments that go beyond the age norm, but do not reach the degree of dementia, are observed in 11-17% elderly and old people.
According to the ICD-10 criteria, the syndrome of mild cognitive impairment (MCI; English mild cognitive impairment, MCI) can be exposed subject to the presence of:
decreased memory, attention, or learning ability
patient complaints of increased fatigue when performing mental work
impairment of memory and other higher brain functions that do not cause dementia and are not associated with delirium
organic nature of these disorders
Diagnostic criteria for the syndrome of mild cognitive impairment (MCI) according to J. Touchon, R. Petersen (2005):
cognitive impairment according to the patient and / or his immediate environment (the latter is preferable)
signs of recent deterioration in cognitive ability compared to the individual's normal for a given individual
objective evidence of cognitive impairment obtained using neuropsychological tests (a decrease in the results of neuropsychological tests by at least 1.5 standard deviations from the average age norm)
there are no violations of the patient's usual forms of daily activity, however, there may be difficulties in complex activities
no dementia - the result of the short mental status assessment is at least 24 points
The clinical features of MCI syndrome are diverse and are determined by the nature of the underlying disease, which is the cause of the disorders.
R. Petersen et al. there are three main clinical variants of MCI syndrome:
amnestic option, in which the clinical picture is dominated by memory impairment
MCI with multiple cognitive impairment, which is characterized by the simultaneous deterioration of several cognitive functions
MCI with a predominance of impairments in any one cognitive sphere with preserved memory
O.S. Levin, L.V. Golubeva (Department of Neurology, Russian Medical Academy of Postgraduate Education, Moscow) distinguish four clinical variants of MCI (taking into account the nature of mnestic disorders and the possibility of interaction of cognitive functions):
amnestic type with a characteristic defect in episodic memory associated with impaired memorization (defect in reproduction, mediated memorization and recognition); in the test for free and directed verbal associations, a decrease in semantically mediated speech activity is also possible
dysregulatory (frontal) type, characterized by a predominance of dysfunction of the frontal lobes, which may be associated with a primary pathology of the frontal cortex or is secondary to the pathology of deep structures (subcortical-frontal syndrome); with this type, a secondary decrease in memory with a reproduction defect, but preserved recognition and mediated memorization, is possible; also characterized by a decrease in speech activity (especially a decrease in the number of phonetically mediated associations)
combined (multifunctional) type MCI characterized by a combination of hippocampal-type amnestic syndrome (with impaired reproduction and recognition) with impaired regulatory or other cognitive functions
MCI with a predominant impairment of some other cognitive sphere such as visual-spatial or speech (dysphasic) disorders
It should be emphasized that the majority of patients with MCI show impairment of several cognitive functions, while in its pure form, the monofunctional type of MCI is observed relatively rarely. Therefore, when distinguishing various types of RBM, we are talking about the relative dominance of one or another type of violation. It should also be noted that the most universal type of cognitive impairment is memory impairment, which is detected in about 85% of patients with MCI, and determining its nature plays a key role in differentiating different types of MCI.
The diagnosis of MCI is essentially syndromic. The statement of the presence of cognitive disorders that go beyond the age norm is insufficient for understanding the nature of the disease and developing therapeutic tactics. MCI syndrome is not the result of only age-related changes in the brain or dysmetabolic cognitive disorders that develop as a result of somatic pathology - MCI syndrome is polyetiological and can develop as “preclinical” manifestations of a number of neurological diseases, most often MCI syndrome is either a manifestation of the onset of Alzheimer's disease and vascular cerebral failure, or a combined vascular-neurodegenerative process. Therefore, patients with MCI syndrome are subject to thorough clinical and instrumental examination in order to identify the possible cause of the disorders.
MCI syndrome in most cases is progressive condition... According to epidemiological data, 10–15% of MCI cases transform into dementia within one year, and after 4 years of follow-up, dementia develops in 55–70% of patients with MCI syndrome. In some cases, however, mild cognitive impairment remains stationary for a very long time. Cases of reversible MCI syndrome are also common. The risk of progression of cognitive impairment and the development of dementia is higher in older age groups, with poor results of neuropsychological tests, in the presence of atrophy of the hippocampus on MRI of the brain, as well as in people with a family history of dementia.
Diagnosis of MCI syndrome
Diagnosis of MCI syndrome is based on:
on the patient's subjective complaints about a decrease in memory and mental performance (or complaints from relatives or closest circle)
on the data of objective research methods
In about half of patients with active complaints of memory loss, the use of simple screening scales does not confirm the presence of cognitive impairment. The most common cause of subjective complaints about memory loss in the absence of objective evidence is emotional disorders in the form of increased anxiety or decreased background mood(including depression). Therefore, all patients with complaints of memory loss should carefully evaluate the emotional sphere.
Neuropsychological methods are used to objectify cognitive impairments:
a set of neuropsychological techniques should be simple enough to provide the diagnosis of MCI syndrome at the stage of primary neurological consultation, but at the same time sufficiently sensitive to relatively minor cognitive disorders
in clinical practice, simpler methods are usually used that have proven themselves in screening diagnostics of dementia - a short scale for the study of mental status (English - Mini-Mental State Examination) and a clock drawing test
to clarify the diagnosis, it is often necessary to dynamically monitor the patient and repeated clinical and psychological studies - the increase in the severity of cognitive impairment over time is one of the most reliable signs of the pathological nature of cognitive disorders
the use of clinical scales that contain descriptions of the most typical cognitive, behavioral and functional symptoms characteristic of the early stages of Alzheimer's disease and other neurogeriatric diseases - the Clinical Rating Scale for Dementia (CRSD) and the General Impairment Scale (ACN)
The diagnosis of MCI is essentially syndromic, therefore, patients with MCI syndrome are subject to thorough clinical and instrumental examination in order to identify the possible cause of the disorders:
initial signs of a neurodegenerative process
cerebrovascular insufficiency
other neurological diseases
At the same time, a possible beginning Alzheimer's disease will be indicated by:
predominance of memory disorders in the clinical picture
rapidly progressive nature of the disorder
absence of focal neurological symptoms
hippocampal atrophy on MRI of the brain
An important stage in the differential diagnosis of MCI syndrome is exclusion of the secondary nature of cognitive impairment in relation to systemic metabolic disorders.
The search for the cause of RBM should be carried out systematically and must include the following steps:
exclusion of the relationship of RBM with side effects of drugs(especially those with a sedative or anticholinergic effect)
exclusion of diseases that cause cognitive deficits, which are potentially reversible with specific therapy, - for example, hydrocephalus, endocrinopathies (diabetes mellitus, hypothyroidism, thyrotoxicosis), diseases of the lungs and heart (especially those occurring with heart and respiratory failure), toxic and dysmetabolic encephalopathies (for example, associated with vitamin B12 or thiamine deficiency, liver and kidney diseases) , some systemic (systemic lupus erythematosus, sarcoidosis, vasculitis) or infectious diseases (neurosyphilis, neuroborreliosis, etc.); to identify these diseases, additional laboratory or instrumental examination may be required
differentiation of MCI associated with vascular brain damage(cerebrovascular type MCI) from early stage Alzheimer's disease (Alzheimer's type MCI) and age-related cognitive dysfunction
In favor of cerebrovascular insufficiency they say the connection of disturbances with previous strokes, the presence of focal neurological symptoms, as well as postischemic cysts and pronounced changes in the white matter on MRI of the brain.
It is advisable to distinguish at least three main variants of cerebrovascular MCR:
post-stroke MCI(found in about half of stroke patients and can significantly complicate the rehabilitation process)
MCI that occurs as a manifestation of discirculatory encephalopathy, usually associated with a predominant pathology of small cerebral vessels
MCI arising against the background of stenosing atherosclerosis of the main cerebral arteries and often associated with microembolization of cerebral vessels
For the diagnosis of cerebrovascular type MCI, an important diagnostic value may be:
the presence of risk factors for cerebrovascular disease (arterial hypertension, hyperlipidemia, diabetes mellitus, heart rhythm disturbances, smoking, etc.)
anamnestically, clinically or instrumentally confirmed signs of damage to cerebral vessels (for example, ultrasound or angiography data) and / or brain matter (for example, focal neurological symptoms detected during examination, or CT and MRI data of the brain)
the presence of uneven (stepwise) progression with alternating periods of sharp deterioration, partial regression and relative stabilization
Treatment of MCI syndrome
Treatment of mild to moderate cognitive impairment has two main goals:
secondary prevention of dementia, slowing the rate of progression of cognitive disorders;
reducing the severity of existing disorders in order to improve the quality of life of patients and their relatives.
Treatment principles for MCI syndrome:
individuality
focus on those pathogenetic factors impairments of cognitive functions, which are determined during clinical and instrumental research in each case
main groups of pharmacological drugs, which can be used for the most common pathogenetic variants of MCI syndrome (associated with incipient Alzheimer's disease, cerebrovascular insufficiency, or a combination of both pathogenetic factors):
- acetylcholinesterase inhibitors(reminil, rivastigmine) - are the first choice drugs for the treatment of Alzheimer's disease; theoretically, the sooner acetylcholinesterase inhibitors are prescribed, the greater the expected effect; however, given the pharmacoeconomic aspects of therapy with acetylcholinesterase inhibitors, the possibility of systemic side effects, their appointment is advisable only if the doctor is fully confident in the pathological nature of the disorders and in the nosological diagnosis, which is not always achievable with mild cognitive impairment at the MCI stage
- antagonists of NMDA receptors for glutamate(akatinol) - have a symptomatic nootropic effect have a neuroprotective effect
- vasoactive drugs- pathogenetically justified is the effect on microcirculation both in the neurodegenerative process and in cerebrovascular insufficiency; in domestic practice, they are traditionally prescribed in courses of 2-3 months 1-2 times a year, however, given that MCI syndrome marks certain stages of a chronic progressive brain disease, it is likely that from a pathogenetic point of view, prolonged, possibly permanent use is more justified of these drugs
- dopaminergic drugs(pronoran) - with the aim of influencing mainly the cognitive symptoms associated with age-related changes
- peptidergic drugs(for example, cerebrolysin) - a non-specific multimodal positive effect on neuronal metabolism and neuronal plasticity processes
- drugs with neurometabolic action- preparations of Ginkgo biloba, piracetam, pyritinol, etc.
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Cognitive personality disorders are specific disorders that occur in the cognitive sphere of an individual and include the following symptoms: a decrease in memory, intellectual performance and a decrease in other cognitive processes of the brain in comparison with the personal norm (baseline) of each individual. The most complex processes occurring in the brain are called cognitive or cognitive functions. With the help of these processes, a rational comprehension of the surrounding world, interconnection and interaction with it, characterized by purposefulness, is carried out.
Cognitive functions include: perception (reception) of information, processing and analysis of data, their memorization and subsequent storage, data exchange, development and implementation of an action plan. The causes of cognitive disorders can be many ailments that differ in the mechanisms and conditions of occurrence, the course of the disease.
Causes of Cognitive Disorders
Cognitive impairments are functional and organic in nature. Functional disorders in the cognitive sphere are formed in the absence of direct brain damage. Overwork, stress and constant overstrain, negative emotions - all this can be the cause of functional cognitive disorders. Functional disorders of the cognitive sphere can develop at any age. Such disorders are not considered dangerous and their manifestations always disappear or significantly decrease after the elimination of the cause of the violations. However, in some cases, the use of drug therapy may be required.
Organic states in the cognitive sphere arise from damage to the brain as a result of disease. They are more common in older people and usually have more stable features. However, proper therapy, even in these cases, helps to improve the condition and prevents the growth of disorders in the future.
The most common causes of organic pathologies in the cognitive sphere are considered: insufficient blood supply to the brain and age-related decrease in brain mass or atrophy.
Insufficient blood supply to the brain can occur as a result of hypertension, cardiovascular disease and strokes. Therefore, timely diagnosis of the listed diseases and their correct treatment is very important. Otherwise, serious complications can arise. Blood pressure, blood sugar and blood cholesterol levels should be given special attention. Vascular cognitive disorders are also distinguished, which develop as a result of chronic cerebral ischemia, repeated strokes, or a combination thereof. Such pathologies are divided into two variants: disorders arising as a result of pathology of small vessels, and disorders due to pathology of large vessels. The neuropsychological features of the detected conditions, reflecting their relationship with disturbances in the work of the frontal lobes of the brain, will indicate the vascular etiology of cognitive disorders.
Vascular cognitive personality disorders are now quite common in the practice of neurological pathologies.
With atrophy of the brain, due to age-related changes, more pronounced pathologies of cognitive functions are formed. This pathological condition is called and is considered a progressive disease. However, the rate of increase of pathologies in the cognitive sphere can vary significantly. Mostly, the symptoms are characterized by a slow increase, as a result of which patients can maintain independence and independence for many years. Adequate therapy is of great importance for such patients. Modern methods of therapy help to achieve improvement in the patient's condition and long-term stabilization of manifestations.
Also, the causes of pathologies in the cognitive sphere can be other diseases of the brain, cardiovascular failure, diseases of internal organs, metabolic disorders, alcohol abuse or other poisoning.
Symptoms of Cognitive Disorders
The disorder of cognitive functions is characterized by specific symptoms, which depend on the degree of severity of the pathological process, and which parts of the brain it affects. The defeat of individual areas causes impairment of individual cognitive functions, however, a disorder of several or all functions is more common.
Disorder of cognitive functions causes a decrease in mental performance, memory impairment, difficulty in expressing one's own thoughts or comprehending someone else's speech, and a deterioration in concentration. In severe disorders, patients may not complain about anything due to the loss of criticality to their own state.
Among the pathologies of the cognitive sphere, the most common symptom is memory impairment. First, there are progressive disturbances in remembering recent events, and gradually distant events. Along with this, mental activity may decrease, thinking may be impaired, as a result of which it cannot correctly assess information, the ability to generalize data and draw conclusions worsens. Another equally common manifestation of cognitive impairment is a deterioration in concentration. Individuals with such manifestations find it difficult to maintain vigorous mental activity, to concentrate on specific tasks.
The concept of moderate cognitive personality disorders usually means a disruption in the work of one or more cognitive processes that go beyond the boundaries of the age norm, but at the same time do not reach the severity. Moderate cognitive impairment is mainly considered a pathological condition, the result of which transformations at this stage are not limited to only age-related involutive processes.
According to a number of studies, the syndrome of mild cognitive disorders is observed in 20% of individuals over 65 years of age. Also, studies indicate that dementia develops in 60% of individuals with this pathology within five years.
Moderate cognitive impairments in 20-30% of cases are persistent or sluggishly progressive, in other words, do not transform into dementia. Such disorders can go unnoticed by individuals for quite a long time. However, if several symptoms are found in a short time, then it is worth contacting specialists for advice.
The presence of a disorder of the cognitive sphere is indicated by the following symptoms: difficulty in performing ordinary counting operations, difficulty in repeating information just received, disorientation in unfamiliar areas, difficulty in remembering the names of people new to the environment, obvious difficulties in finding words in ordinary conversation.
Moderate cognitive impairments, identified in the early phases of their development, are quite successfully corrected with the help of drugs and various psychological techniques.
In order to assess the severity of cognitive impairments, special neuropsychological testing is used, which consists in answering a number of questions and performing some tasks by the patient. In accordance with the test results, it becomes possible to determine the presence of deviations of certain cognitive functions, as well as their severity. Test items can be in the form of simple mathematical actions such as adding or subtracting, writing something on paper, repeating a few words, identifying the items shown, etc.
Mild cognitive impairment
The pre-dementia state is a mild cognitive disorder. In other words, mild impairments of cognitive functions are pathologies of higher brain functions, which are characterized, first of all, by vascular dementia, passing through a number of stages in its development, determined by a sequential increase in symptoms - starting with mild impairments of the functions of the cognitive sphere, mainly memory, and ending with severe impairments - dementia.
According to the recommendations of the international classification of diseases, the diagnosis of mild cognitive impairment is possible in the presence of the following symptoms: impairment of memory function, attention or a decrease in the ability to learn,
when doing mental work, there is high fatigue. At the same time, a disorder of memory function and disruption of the work of other brain functions does not lead to atrophic dementia and is not associated with. The listed disorders are of cerebrovascular origin.
The clinical manifestations of this disorder correspond to persistent cerebrasthenic syndrome, which in fact refers to psychopathological conditions reflecting a violation of various areas of the psyche, including cognitive functions. However, despite this, the cerebrasthenic syndrome is characterized by the external safety of patients, the absence of severe disturbances in mental, critical and prognostic processes, the illusion of instability, patency of asthenic disturbances.
The diagnosis of this disorder is based on the results of clinical examinations and the findings of an experimental psychological study.
Mild cognitive impairment is differentiated from organic disorders in that cognitive impairments do not occur in conjunction with emotional (affective instability), productive (! Paranoia), and behavioral disorders (inadequacy).
Cognitive disorder in children
The development of cognitive functions for the most part depends on the provision of the human body with vitamins and other useful substances.
Today, unfortunately, the problem of hypovitaminosis in children is becoming quite acute. The consumption of refined food products, products of long-term storage, products that have been subjected to prolonged temperature processing, leads to the impossibility of replenishing the required amount of essential micronutrients only with the help of the diet.
According to studies of the vitamin and mineral state of the body of children carried out in recent years, it can be concluded that the lack of ascorbic acid (vitamin C) among the child population of the country reaches almost 95%, approximately 80% of children have a deficiency of thiamine (vitamin B1), riboflavin (vitamin B2 ), pyridoxine (vitamin B6), niacin (vitamin B4 or PP) and folic acid (vitamin B9). Cognitive functions are the most complex and today not fully comprehended phenomenon. However, a whole range of studies conducted to assess individual cognitive processes, for example, such as reproduction, memory, clarity of mental perception, intensity of thought processes, ability to concentrate, learning, problem solving, mobilization made it possible to trace a clear relationship between the cognitive functions of children and their provision with certain micronutrients. ...
Today, cognitive impairment is one of the most important problems in psychiatry and neurology. Such pathologies, unfortunately, are observed in approximately 20% of subjects of childhood and adolescence.
The prevalence of speech and language disorders, which include writing and reading disorders, ranges from 5% to 20%. Autism spectrum disorders reach almost 17%. Lack of attention in conjunction with increased activity is observed in approximately 7% of individuals of childhood and adolescence. Developmental disorders, emotional disorders, mental retardation syndromes and behavioral disorders are also widespread. However, the most common developmental disorder of learning skills, motor processes, mixed specific developmental disorders can be noted.
Cognitive disorders in children are most often found due to past diseases characterized by dysgenesis of the cerebral cortex, congenital metabolic disorders affecting the nervous system, degenerative diseases, and lesions of the nervous system during the period of fetal formation.
The lesions of the nervous system in the perinatal period include: brain hypoxia, trauma received during childbirth, intrauterine infection. Therefore, to this day, the diagnosis of the initial phases of cognitive disorders in children remains an important problem. Its early results contribute to a more timely prescription of appropriate therapy and the prevention of early disability in children. Today, the diagnosis of children's pathologies in the cognitive sphere is possible only with the help of a comprehensive clinical examination, clinical and psychopathological examination, psychometric, neuropsychological research methods.
Cognitive disorders treatment
Disorders of the cognitive sphere in our time are perhaps one of the most common neurological symptoms, since a significant part of the cerebral cortex is directly related to the provision of cognitive processes, therefore, almost any disease that involves the brain will be accompanied by cognitive impairment.
Cognitive personality disorders combine disorders of the five main brain processes: gnosis, memory, speech, thinking, and praxis. Often, a sixth is added to these five processes - attention. Today, the question remains open whether attention has its own content or is still a derivative. The problem of cognitive impairment is, first of all, a problem of the aging population.
Cognitive impairments are mild, moderate, and severe.
Mild cognitive disorders are detected only after careful neuropsychological examination and, as a rule, do not affect everyday life, although sometimes they can give rise to subjective anxiety in the individual.
Moderate cognitive disorders go beyond the age norm, but so far they do not lead to restrictions in everyday activity and only affect its complex forms. Individuals with moderate pathologies of the cognitive sphere, as a rule, retain independence and autonomy.
Severe cognitive impairment has a significant negative impact on daily life. Patients experience significant difficulties in their daily activities, profession, activity, social sphere, and at later stages - in self-care. Dementia is a severe cognitive pathology.
The choice of a therapeutic strategy depends on the cause of the onset of cognitive impairment and the severity of such impairment. If possible, treatment should be carried out, which will be aimed at correcting the pathological processes occurring in the body. For the purpose of directly treating disorders of cognitive processes, centrally acting acetylcholinesterase inhibitors are used.
Psychotherapy methods are also used to treat personality disorders. So, for example, in their book A. Beck and A. Freeman "Cognitive psychotherapy of personality disorders" highlighted the problems of diagnosis and an individual approach in the treatment of personality disorders using methods of cognitive psychotherapy, revealed the impact of cognitive structures on the formation of personality disorders, attitudes and attitudes that characterize each of such violations, reconstruction, transformation and reinterpretation of structures.
In the early stages of development of impairment, cognitive psychotherapy of personality disorders is considered in many respects "insight therapy", which has in its arsenal introspective methods designed for the personal transformation of the patient.
Cognitive therapy aims to help patients learn about their cognitive structures and the ability to modify their own behavior or thoughts. Studying the structures and patterns of cognitive processes and teaching adaptive responses to negative thoughts and self-deprecating positions are ultimately key goals of psychotherapy. You should strive for consistent transformations, and not for immediate results. Setting sequentially more difficult tasks, sequential small steps, evaluating responses and responses from the perspective of desired transformations, gradual adaptation to stress factors and anxiety, psychotherapeutic support allow the patient to make an attempt to change himself.
When cognitive impairments appear, most of them will progress relentlessly. That is why the main task in the preventive measures of cognitive disorders is to slow down, stop the further course of the destructive process.
To prevent the progression of impaired cognitive processes, you should regularly take medications (acetylcholinesterase inhibitors). It is also necessary to try to maintain the broken processes. To this end, you should perform various exercises aimed at training certain functions (for example, in case of memory impairments, you need to learn poems). In addition, it is also necessary to avoid the influence of stressful situations, since during anxiety, cognitive disturbances become even more pronounced.
Doctor of the PsychoMed Medical and Psychological Center
The information provided in this article is intended for informational purposes only and cannot replace professional advice and qualified medical assistance. If you have the slightest suspicion of the presence of cognitive impairments, be sure to consult your doctor!
Sometimes we forget where we left the keys. Looking for them around the apartment all day, we are surprised at our absent-mindedness and inattention, not even suspecting that these may be the first symptoms of a malfunction of the brain. The so-called cognitive impairment often affects the elderly. But it also happens that young people and even children suffer from them.
Cognitive Disorders. What it is?
First, let's look deeper into our brains. "Gray cells" perform many duties assigned to them, thanks to their active work, we physically move and develop mentally. Cognitive functions of the brain are important in the life of every person, without which we could not cognize the world around us. First of all, with their help, we perceive, understand and process the information received in the process of cognition. This is one of the manifestations of higher nervous activity, without which a person would never be a person.
Based on this, we can conclude that cognitive disorders are impairments to the cognitive function of an individual. This is not only forgetfulness, but also a deterioration in efficiency, intellectual work. If you find these symptoms in yourself or in someone close to you, see your doctor immediately. After all, at first, mild forgetfulness can gradually develop into a loss of the ability to think clearly and reason, you will not remember the elementary events of the day. Then there will be disorientation in space, partial amnesia, and the ability to serve oneself in everyday life will disappear.
Risk factors
Even if you are still far from retirement, you are not immune from this nuisance, which can suddenly fall on your head, namely, on what is in the middle of it - the brain. The main risk factors for impaired cognitive functions are severe traumatic brain injury and poisoning - in this case, the disease will be temporary, from several days to 2-3 years.
A person can get a more severe form of the disease with Parkinson's, Alzheimer's, vascular diseases. In this case, the disorder of cognitive functions will be progressive. Vascular diseases are the main and most common cause of the loss of the ability to learn about the world around us.
First, arterial hypertension, atherosclerotic vascular lesions, and stroke are dangerous in this regard. Secondly, the cause of cognitive disorders can be various kinds of circulatory and metabolic disorders during diabetes mellitus, liver and kidney failure. Thirdly, the risk factor for the development of the disease is the insufficient intake of vitamins E and B 12 into the body during alcohol or drug abuse.
The main symptoms
Problems at work will be the first alarming signs. At first, you are simply too lazy to work, you feel tired, your brain literally refuses to think and analyze. New data is not accepted, it becomes difficult to draw conclusions. In more severe forms, speech functions are violated: a person cannot formulate a thought, it is difficult for him to find words and just speak.
Cognitive impairments are a major blow to memory. First, you forget recent events, and then the memories from adolescence and childhood lose their clarity and are completely erased from the brain. Another symptom, but less common, is attention deficit disorder. The person is unable to concentrate on the assigned tasks and goals. He constantly loses the thread of the conversation, asks again, asks to repeat this or that phrase.
All these manifestations indicate that you need to immediately contact a neurologist. Only a qualified specialist can make an accurate diagnosis and prescribe the correct and effective treatment.
Mild cognitive impairment
It is a pathology of the brain that is characterized by vascular dementia. If not treated in time, the disease goes through several stages of development: starting with minor memory impairments and ending with complete dementia. With a mild form of the disease, the patient cannot keep his attention on one object for a long time, is unable to spend a long time doing mental work, and feels increased fatigue.
All of these disorders are directly related to cerebrasthenic syndrome, which is one of the types of psychopathological conditions. The indicator of the development of brain activity is within the normal range or slightly deviates from it. Mild cognitive impairment is usually noticed only by the patient himself; other people attribute the manifestations of the disease to simple absent-mindedness or increased fatigue at work. It is easy to cure, in contrast to the most severe cognitive impairments, which imply the dementia of the patient, his complete disorientation in life.
Moderate cognitive impairment
Between mild and severe disorders, doctors diagnose a moderate form of the disease. Cognitive functions in a person become less pronounced, weaker than the norm for his age implies, but they have not yet turned into dementia - dementia. The patient will find that it is difficult for him to count, to memorize the phrases and even words just uttered by the interlocutor, to navigate the terrain. Detected early on, such disorders can be easily treated with ordinary medications. Treatment of cognitive disorders is prescribed by a neuropathologist, taking into account the consultations of a psychiatrist and other narrow specialists.
Moderate impairment occurs in 20% of people over 65. Moreover, 60% of these patients develop dementia in the next few years. In a third of cases, moderate cognitive impairment is sluggish. People do not even notice any irregularities and deviations for a long time.
If a child is sick
Oddly enough, but even children can experience all the inconveniences and hardships of this disease. Usually, in the smallest patients, elementary vitamin deficiency becomes the cause of disorders. Eating canned, sugary and other unhealthy foods, the child ignores vegetables and fruits, healthy cereals, meat and fish. As a result, they do not receive all the vitamins they need. As a result, children develop cognitive disorders: poor performance at school, inability to repeat or reproduce what they see, heard or read, lack of concentration and intense thinking in the lesson.
Today this disease is very common among schoolchildren and adolescents. 20% of children suffer from the total mass. Parents need to pay attention to the school performance of their son or daughter, and if there is a noticeable deterioration, then adjust the student's daily diet, include more healthy and micronutrient-rich food in the menu. If cognitive impairments are the consequences of injuries and diseases, then you cannot do without the help of a doctor.
Treatment
Cognitive therapy for personality disorders is directly related to the cause of the disorder. In any case, it should be aimed at correcting pathological changes in the activity of the brain. In addition to the fact that doctors treat the underlying disease, to improve cognitive functions, they can prescribe drugs with neuroprotective properties: Semax, Glycine, Cerakson, Cavinton, Nootropil and others.
Be sure to prescribe drugs for hypercholesterolemia. This prevents the development of cognitive impairments, and serves to prevent their further progress. If the patient has severe dementia, then Nicergoline, Galantamine, Memantine, Donepezil may be prescribed. Cognitive psychotherapy for personality disorders also helps to alleviate the patient's general condition. He is advised to follow a cholesterol-free diet: eat seafood, vegetables and fruits, milk and cottage cheese. Smoking and drinking alcohol should be completely eliminated.
Neurologists' opinion
They argue that doing a crossword puzzle is a very useful activity for cognitive impairment. Such leisure is gymnastics for the brain. Solving, remembering, comparing, we not only prevent the development of deviations, but also treat them if they have already shown themselves. Also, doctors advise reading poetry and teaching them by heart, drawing, knitting, tinkering. These sessions will rehabilitate your gray cells and complement your general therapy.
Neurologists say: if you have the mildest symptoms of the disease, then you can safely take the drug "Glycine" according to the instructions. Also drink vitamin complexes, ginkgo-biloba and Nootropin, only in this case the dosage is determined by a specialist. In addition, cognitive therapy for anxiety disorders can help improve the condition and prevent disease. Remember that self-medication often ends up worsening the problem or even death. Therefore, at the first sign of cognitive impairment, see a specialist right away.
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