Progressive dementia

Introduction A syndrome caused by a progressive, progressive brain disease. The course of the disease is progressive. Features are a variety of advanced cortical dysfunction, involving memory, thinking, orientation, understanding, calculation, judgment, speech and learning ability. Clear consciousness, poor self-control ability, social or motivational decline, often accompanied by cognitive impairment, but sometimes earlier than cognitive impairment. Some cortical and subcortical diseases can cause dementia. Common causes include Alzheimer's disease, Pick's disease, Huntington's disease, Parkinson's disease, Wilson's disease, and cortical-striatum-spinal joint degeneration.

Cause

1. Brain degenerative diseases: Some cortical and subcortical diseases can cause dementia. Common causes are Alzheimer's disease, Pick's disease, Huntington's disease, Parkinson's disease, Wilson's disease, cortical-striatum- spinal joint. Denaturation and so on.

2. Cerebrovascular disease: cerebrovascular diseases in different parts can cause dementia, such as multiple infarct dementia, carotid occlusion, subcortical arteriosclerotic encephalopathy, thrombotic vasculitis.

3. Metabolic diseases: Some metabolic diseases affect the function of the brain, causing dementia, such as mucous edema, hyperparathyroidism or hypothyroidism, adrenal hyperfunction, hepatolenticular degeneration, uremia, chronic liver dysfunction.

4. Intracranial infection: intracranial infection leads to changes in brain parenchyma and brain function, leading to dementia, such as various encephalitis, neurosyphilis, various meningitis, Kuru disease.

5. Intracranial space-occupying lesions: tumors, subdural hematoma can cause structural and brain function changes, causing dementia.

6. Hypoxia and hypoxemia: including ischemic (cardiac arrest, severe anemia and hemorrhage), hypoxia (respiratory failure, asthma, asphyxia, anesthesia), stasis (heart failure, excessive red blood cells) And various types of hypoxemia of tissue toxicity.

7. Nutritional deficiency encephalopathy: thiamine deficiency encephalopathy, pellagra, vitamin B12 and folic acid deficiency.

8. Toxic diseases: common in carbon monoxide poisoning, lead, mercury and other poisoning, organic poisoning.

9. Craniocerebral trauma: open or closed trauma to the head, boxer dementia, etc.

10. Others: normal pressure hydrocephalus, sarcoma-like disease, etc.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain nerve examination

First determine if you are demented and then determine the cause of dementia.

1. Cognitive function test and intelligence test: The dementia screening test includes the simple intelligence state test (MMSE) created by Folstein (1975), the Hasegawa Dementia Scale (HDS) created by Hasegawa Kazuo (1974), Pattie et al. 1979) Creative Cognitive Scale (CAS), etc. The common feature of these tests is that the content is relatively simple and can be completed in a short period of time. Generally, it is set as a demarcation point for dementia, so it is quite practical. Take MMSE as an example. If the score is <15 points, this dementia is 15 to 24 points. The Wechsler Adult Intelligence test is only available to patients who have done it before the illness, otherwise it is more difficult.

2. A comprehensive understanding of the medical history: First understand the age of onset, the age of dementia is relatively large, and further understand the onset form and course of disease, trauma and cerebrovascular disease are often acute onset, other causes are mostly chronic Onset. The symptoms of dementia caused by cerebrovascular disease are ups and downs, and can be relieved automatically. Dementia caused by heart disease, hypothyroidism and vitamin deficiency symptoms can be alleviated with the relief of physical symptoms, atrophy caused by senile and other degeneration, and the symptoms of dementia continue. Carrying out and getting worse.

3. Physical examination: Dementia itself has no fixed signs, but the primary disease can often have certain signs. Patients with paralytic dementia may have irregular pupils and two different sizes. Elderly patients with psychiatric diseases often have corneal ring, white hair and skin wrinkles. Lead poisoning can be seen in patients with lead poisoning. Some primary diseases are often accompanied by certain signs of the nervous system.

4. Laboratory examination: patients with suspected organic dementia should be selected for lumbar puncture, blood biochemical test, EEG, brain ultrasound, isotope brain scan, skull X-ray film, cerebral angiography, cerebral angiography Or CT and other inspections.

Differential diagnosis

The symptoms of progressive dementia need to be identified as follows.

First, brain degenerative diseases

(a) Alzheimer's disease early manifested as memory impairment and is increasing. At the beginning, there were only near memory impairments, poor orientation, reduced work efficiency, misconstruction or fiction. On this basis, dementia is getting worse, the calculation power is weak, the judgment is low, the response is slow, the understanding is difficult, and the speech disorder and Aphasia, misuse, loss of recognition, etc. Behavior disorder, stereotyped animals, occasional illusions and delusions, the age of onset is 40 to 60 years old.

(B) Pick's disease (Pick's disease) The age of onset is between 40 and 60 years old, more women than men, the initial prominent symptoms are behavioral disorders, patients are less lazy, and other people's daily life such as diet, sleep, clothing is not Keep an eye out for personality changes or memory impairments in the early stages. The patient loses his wit and works carelessly. In the early stage, there are focal symptoms such as misuse, loss of reading, loss of writing or misrecognition. Intelligent barriers are mainly difficult to abstract thinking, but there is still memory loss. Its dementia develops rapidly, with a short course of disease, and it often causes death or failure in one to several years.

(C) Huntington's disease (Huntington's disease) The occurrence of mental retardation is usually very insidious, the first symptom is the reduction of work efficiency, not well handled for daily affairs. Cognitive slowness, intelligent impairment and memory impairment are evident immediately after the appearance of dance symptoms, without aphasia and loss of recognition. Concentration and judgment are progressively impaired, and the problem-solving inefficiency is poor, and the ability to calculate, near-memory, and hand-eye coordination is poor. Depressive symptoms are very common, and there are also personality disorders. Neurological symptoms are dance-like movements, and a few patients have muscle rigidity.

(4) Parkinson's disease (Parkinsons's disease) Clinical features of tremor, muscle rigidity, decreased movement, abnormal posture, may be associated with personality changes, mental retardation, mental illness and so on. The characteristics of mental retardation are memory, comprehension, judgment, computational power, poor initiality, and difficulty in conducting intelligence tests. On the one hand, it is related to difficulty in performance, and because of physical and mental activity, it is easy to cause judgment. mistake.

(5) Hepatolenticular degeneration There are often some psychiatric symptoms, such as abnormal mood, mental decline, personality changes and hallucinations such as illusory delusions. The emergence of intelligent obstacles can be early or late, mainly showing inattention, calculation, memory, understanding, judgment ability is reduced, and the condition gradually worsens, leading to severe dementia.

(6) Cortico-striato-spinal degeneration Clinical manifestations of upper motor neuron spasm, seizures or myoclonic seizures, mental decline, memory, attention, understanding, judgment The ability of abstract general thinking is reduced, social adaptability, life self-care ability is also reduced, and with the development of the disease, the symptoms of dementia are becoming more and more serious.

Second, cerebrovascular disease

(1) multiple infarct dementia (MID) progressive dementia, repeated neurological signs and systemic atherosclerosis caused by multiple infarctions, the course of disease is more stepwise. Intelligent barriers are mainly the decline of near-memory memory and the decline of work ability, especially for people, place names, dates and figures. The decline in the patient's ability to work is first manifested in reduced efficiency and catheter orientation. For mental work, such as thinking and understanding, I feel slow and difficult. The disease gradually develops, causing the patient's memory, understanding and analysis of comprehensive ability to be more serious, but the patient's judgment is not damaged for a long time, the orientation is relatively complete, to the late stage, the patient's thinking is slow, association is difficult, speech expression The ability also has different levels of obstacles, not only the memory barriers of recent events, but also the memory of distant events, and even the daily life of individuals is difficult to deal with.

(B) Subcortical arteriosclerotic encephalopathy (also known as Binswanger disease or chronic subcortical leukoencephalopathy). The clinical manifestations are progressive dementia and multiple neurological signs. Among the mental symptoms, the most obvious memory impairment is seen. Others have mild mental confusion, personality changes, apathy, loss of interest, delusions, lack of language, slow answering questions, and irrelevant questions. In the late stage, serious judgments and disorientation often occur, and even life cannot take care of themselves. All patients had chronic progressive dementia, which developed slowly in 1 to 2 years and lasted for 12 years. Mild dementia has memory, abstract thinking and computational dysfunction, with or without comprehensive analysis ability, and can still take care of itself; moderate, in addition to the above symptoms, there are time-disordered disorders, partial loss of social and self-care ability Severe severe orientation, memory, abstract thinking, computational and comprehensive analytical dysfunction, with or without language barriers, life can not take care of themselves.

(3) Transient general amnesia (transient general amnesia) is a syndrome with sudden onset of illness and episodes of severe memory impairment as the main clinical phase. Most patients start in the middle or late old age, more men than women. There was no aura before the attack, and the patient's memory structure suddenly and completely ceased to function, causing the patient not to remember the experience at the time of the onset. As the episode continues, the patient cannot remember that the performance of the situation is more pronounced at the same time, and the patient also exhibits a retrograde amnesia with obvious fragments of the date, week, or even the year before the episode. Therefore, there are also orientation disorders.

(D) thrombophlitis (thromboangiitis) also known as Buerger's disease. The clinical manifestations are slow mental activity and a decline in intelligence. Some also have personality changes and euphoria. The decline of intelligent thinking is mainly due to the decline of memory, judgment, social ability, and abstract thinking ability.

Third, metabolic diseases

(1) hypoparathyroidism (hypoparathyroidism) clinical manifestations of fatigue, weakness, emotional instability, irritability and mood changes. There is a clear social withdrawal, attention can not last, memory loss, poor judgment, if not treated in time to develop organic dementia, hand and foot convulsions, seizures.

(B) hyperadrenocorticism (hyperadrenocorticism) also known as Cushing's disease. Physical symptoms and body parts are full moon face, buffalo back, abdomen and thigh skin purple. There are also symptoms of mental symptoms and mental decline. The patient's emotional apathy, weakness, memory, attention, judgment and abstract general thinking ability are poor. As the condition worsens, dementia becomes more and more obvious.

(C) uremic encephalopathy (uremic encephalopathy) manifested as fatigue, weakness, dullness, lack of memory, attention can not concentrate, poor thinking, personality changes, the disease can be increased, coma, severe dementia.

(4) Chronic hepatic insufficiency (chronic hepatic insufficiency) The clinical manifestations are attention deficit, memory loss and work efficiency, slow understanding, slow response, reduced speech, and later developed into coma, severe dementia, such as physical symptoms and nervous system Symptoms and signs are easier to diagnose.

Fourth, intracranial infection

(a) sporadic encephalitis (sporadic encephalitis) In addition to some nervous system symptoms and signs, there are some mental symptoms, such as disturbance of consciousness, hallucinations, delusions, apathy, emotional instability and sports and behavioral disorders, intelligent disorders. Intelligent barriers can have memory loss, fiction, and distraction, with near memory and mechanical memory being particularly affected. In severe cases, it can develop into severe dementia.

(2) Epidemic encephalitis B (epidemi encephalitis B) In addition to some physical symptoms and neurological signs, it is accompanied by mental symptoms, mental dysfunction, illusory delusions, and some personality changes. Intelligent barriers are also common. The performance of abstract summarization is obvious, while comprehension, memorization and computing power are relatively light.

(3) Dementia paralytica (Dementia paralytica) Paralytic dementia is the most common type of chronic meningoencephalitis in the nervous system syphilis. In addition to neurological symptoms and signs, clinical manifestations often have inattention and memory loss in the early stage. Fatigue, slow thinking, very difficult thinking, poor understanding and judgment, and personality changes. The development stage lacks a sense of responsibility and no credit. Memory is significantly reduced, from near memory to far memory, not for simple calculations. In addition, it is obviously impaired in abstract generalization, understanding, reasoning and judgment. Late dementia is becoming more and more serious, and even simple questions cannot be understood. The sporadic pieces of speech are vague and unintelligible. Unrecognizable to family members, indifferent emotions, etc.

(D) AIDS dementia syndrome (AIDS dementia syndrome) clinical manifestations of weakness, burnout, loss of interest, loss of libido as the initial symptoms, the emergence of near memory impairment, attention disorders, speech delay, emotional dull, social withdrawal, disorientation and so on. In the late stage, obvious dementia, silence, paraplegia and incontinence were observed.

Five, intracranial space-occupying lesions

(A) brain tumor (brain tumor) Brain tumors can appear in a variety of different manifestations and varying degrees of mental disorders. Memory impairment is the most common mental symptom. In the early stage, it is near memory loss or near-forgetting. The memory of past experience cannot be reproduced. There may be Coxakov syndrome. Emotional indifference, crying for no reason, emotional instability, and even euphoria. Intelligent barriers are characterized by computational, comprehensible and judgmental deficiencies, low work efficiency, and even inability to work, as well as personality changes, behavioral abnormalities, and sensory impairments.

(B) subdural hematoma (subdural hematoma) Clinical manifestations in addition to its neurological symptoms and signs, there are still inattention, dullness, less movement, memory loss and paroxysmal mental disorders.

6. Hypoxemia and hypoxemia

(1) Pulmonary encephalopathy (pulmonencephalopathy) Clinical manifestations of apathy, muscle tremor, lethargy, lethargy, memory, attention, comprehension, comprehension, and disorientation, may also have symptoms of severe psychosis.

(2) Chronic heart failure (chronic heart failure) In addition to physical symptoms and signs, there are signs of distraction, emotional instability, fatigue, irritability, insomnia, memory loss, poor understanding, poor judgment, etc. .

Seven, nutritional deficiency encephalopathy

(A) thiamin deficiency (athiaminosis) clinical manifestations of confusion, ataxia and ophthalmoplegia. It also shows that active speech and movement are reduced and listless. Contradictory, logical barriers, poor understanding, decreased ability to respond, decreased perception, and memory disorders. Disorientation, inattention, etc.

(B) niacin deficiency (anlacinosis) also known as pellagra. Clinical manifestations of fatigue, insomnia, palpitations, memory loss, emotional instability, irritability, personality changes, disorientation, misconstruction, fiction, late mental activity gradually depleted, slowly reaching dementia state.

(3) Folic acid deficiency Clinical manifestations of fatigue, weakness, dizziness, dizziness, irritability, forgetfulness, insomnia, mental retardation, apathy, incipient disorder, lack of energy, and reduced speech. (4) Vitamin B12 deficiency (vitamin B12deficency) Clinical manifestations of sensory and motor abnormalities, some patients with excitability, irritability, paranoid state, episodes of random orientation, progressive dementia.

Eight, toxic diseases

(1) Carbon monoxide poisoning Clinical manifestations of dizziness, headache, fatigue, decreased efficiency and self-control ability, may have symptoms such as aphasia, disuse, misrecognition, but also apathy, mental retardation, memory loss, disorientation, Fictional and other symptoms.

(B) lead poisoning (lead poisoning) clinical manifestations of difficulty falling asleep, easy to wake up, more dreams, emotional anxiety and irritability, often have low basal body temperature, pulse, low blood pressure "three low" symptoms. Chronic poisoning patients have decreased memory, fatigue, personality changes, slow response, apathy or uneasiness.

(3) Mercury poisoning Clinical manifestations of insomnia, multiple dreams, memory loss. Emotional stress, volatility and irritability, prone to stuttering, lack of confidence, decreased ability to work, understanding, judgment, and reduced ability to abstract conceptual thinking.

(4) Chronic organophosphorus pesticide poisoning Clinical manifestations of headache, dizziness, memory impairment, inability to concentrate, insomnia, multiple dreams, low mood or anxiety, fatigue, fatigue, poor understanding, poor judgment.

Nine, craniocerebral trauma

(1) Boxer dementia (demenia pugilistica) Clinical manifestations of headache, dizziness, emotional instability, inability to concentrate, memory loss, poor comprehension, poor judgment, and low worker efficiency.

(2) Other brain injury Clinical manifestations from mild memory loss, dizziness, inability to concentrate, to severe dementia, sluggishness, apathy, lack of initiative, slow thinking, poor judgment, poor memory , emotional instability, and so on.

Ten, other

(A) sarcoidosis (sarcoidosis) also known as sarcoidosis. Clinical manifestations of some signs of neurological symptoms, but also memory difficulties, personality changes, apathy, lack of judgment, progressive neglect of personal hygiene, acute restlessness and hallucinations caused by lingering dementia.

(B) normal pressure hydrocephalus (normal pressure hydrocephalus) clinical manifestations of progressive mental activity decline, gait instability, urinary incontinence, recent forgotten indifference, slow thinking, reduced speech movements, emotional reactions also diminished, the condition gradually worsened His memory, calculation, and orientation are declining, and even dementia, and finally coma and death.

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