Decreased intelligence

Introduction Intelligent decline is a common symptom. If it is called dementia after the age of 18, it is called mental retardation before the age of 18, and it can occur in both children and adults. The incidence increases with age. According to statistics, the prevalence of dementia in people over 65 years old is 4% to 6%, and the prevalence rate of elderly people over 80 years old can be as high as 20%. Intelligent decline is a syndrome, which is only a symptom in many diseases. Therefore, its cause is complicated and complicated. Some of the causes of mental decline are curable or can be controlled. Therefore, it is very important to confirm diagnosis and treatment at an early stage.

Cause

Common causes of mental decline include: senile dementia, cerebrovascular disease, poisoning (such as gas, alcohol, heavy metals, organic compounds, etc.), vitamin B12 deficiency, intracranial tumors, chronic subdural hematoma, brain trauma, intracranial Infection (such as tuberculosis, bacteria, viruses, etc.), hypothyroidism or hypoparathyroidism, long-term hypoglycemia, hydrocephalus, epilepsy; and very many diseases, such as white matter malnutrition, hepatolenticular degeneration, Huntington Hereditary diseases such as diseases; in addition, there are demyelinating diseases such as multiple sclerosis and concentric sclerosis, and degenerative diseases such as progressive supranuclear palsy and cortical basal ganglia degeneration. The most common of these are Alzheimer's disease and vascular dementia.

an examination

Related inspection

International standard intelligence test cerebrospinal fluid bacterial culture cerebrospinal fluid syphilis serum complement binding reaction cerebrospinal fluid occult blood test cerebrospinal fluid free myelin basic protein

diagnosis:

1. Mental retardation

Because there are individual differences in the mental and physical developmental speeds of infants and young children, in addition to the reference to normal child development standards, it is necessary to combine the detailed parenting history, family environment, social environment and other factors to make a comprehensive judgment. Diagnostic criteria for mental retardation in the Second Edition of Chinese Mental Disorders Classification and Diagnostic Criteria:

First, the onset of illness before the age of 18;

Second, the IQ is less than 70;

Third, there are varying degrees of social adaptation difficulties.

Diagnostic criteria for mild mental retardation:

First, IQ 50 ~ 69;

Second, there is no obvious speech disorder;

Third, the ability to learn can not successfully complete primary education, can learn certain life skills.

Diagnostic criteria for moderate mental retardation:

First, IQ 35 ~ 49;

Second, can master the language of daily life, but the vocabulary is poor;

Third, can not adapt to the study of ordinary schools, but can learn to take care of themselves and simple labor.

Diagnostic criteria for severe mental retardation:

First, IQ 20 ~ 34;

Second, the speech function is seriously impaired, and effective language communication cannot be carried out;

Third, life can not take care of themselves.

Diagnostic criteria for very severe mental retardation:

First, the IQ is less than 20;

Second, the lack of speech function;

Third, life can not take care of itself.

The cause of the disease is diagnosed. It is necessary to know whether the parents of the patients have bad habits, whether the mother has a viral infection during pregnancy, or other chronic diseases, mental illnesses, etc., whether there is acute or chronic poisoning, history of exposure to radioactive materials, and the tendency of endemic disease. And medication, etc. Detailed physical examinations, neurological examinations, chromosome examinations, and other related auxiliary examinations should also be performed.

Brain organic diseases, schizophrenia, and childhood autism should be excluded.

2, dementia

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

Differential diagnosis:

First, brain degenerative diseases

(1) Alzheimer's disease

Early manifestations of memory impairment and 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.

(2) Pick's disease

The age of onset is between 40 and 60 years old. Women are more than men. The initial prominent symptoms are behavioral disorders. The patients are less lazy. They dont pay attention to other peoples daily life such as diet, sleep, and clothing. They can have personality changes in the early days. There may be memory impairments. 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.

(3) Huntington's disease

The occurrence of intelligent decline is usually very insidious. The first symptom is that work efficiency is reduced and it is not handled well 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 exercise, and abnormal posture can be associated with personality changes, mental retardation, and mental illness. 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) Cortic-striatum-cortical-striato-spinal degeneration

The clinical manifestations are upper motor neuron spasm, seizures or myoclonic seizures, mental decline, memory, attention, understanding, judgment, abstract general thinking ability, social adaptability, life self-care ability, The development of the disease, the symptoms of dementia are also becoming more and more serious.

Second, cerebrovascular disease

(a) multiple infarct dementia (MID)

Progressive dementia, focal neurological signs and systemic atherosclerosis caused by repeated infarction were predominant, and the course of disease was mostly aggravated. 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 (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

It is a syndrome with sudden onset of illness and a major clinical phase with paroxysmal severe memory impairment. 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.

(4) Thrombotic vasculitis (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.

(a) hypoparathyroidism (hypoparathyroidism)

Clinical manifestations are fatigue, weakness, emotional instability, and emotional 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.

(two) adrenal hyperfunction (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.

(3) uremic encephalopathy (uremic encephalopathy)

The performance is fatigue, weakness, lack of desire, memory loss, concentration can not be concentrated, lack of thinking, personality changes, aggravation can lead to coma, severe dementia.

(4) chronic hepatic insufficiency (chronic hepatic insufficiency)

Its 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 neurological symptoms and signs are easier to diagnose.

Fourth, intracranial infection

(a) sporadic encephalitis

In addition to some neurological symptoms and signs, there are some mental symptoms, such as disturbance of consciousness, hallucinations, delusions, apathy, emotional instability and movement and behavioral disorders, and intellectual disabilities. 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 signs of the nervous system, there are also 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.

(c) paralytic dementia (dementia paralytica)

Paralytic dementia is the most common type of chronic meningoencephalitis in the nervous system syphilis. In addition to the symptoms and signs of the nervous system, clinical manifestations often have inattention in the early stage, memory loss, fatigue, slow thinking, and very serious thinking. Laborious, 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.

(4) AIDS dementia syndrome (AIDS dementia syndrome)

Clinical manifestations of weakness, burnout, loss of interest, loss of libido are the starting symptoms, and later, near memory impairment, attention disorder, speech delay, emotional dullness, social withdrawal, and disorientation. In the late stage, obvious dementia, silence, paraplegia and incontinence were observed.

Five, intracranial space-occupying lesions

(1) brain tumor (brain tumor)

Brain tumors can present 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)

In addition to its neurological symptoms and signs, clinical manifestations include inattention, dullness, less movement, memory loss, and paroxysmal psychosis.

6. Hypoxemia and hypoxemia

(a) pulmonary encephalopathy (pulmonoencephalopathy)

Clinical manifestations of apathy, muscle tremors, lethargy, lethargy, memory, attention, comprehension, comprehension, and disorientation, may also have symptoms of severe psychosis.

(2) Chronic heart failure

In addition to its physical symptoms and signs, clinical manifestations include attentional distraction, emotional instability, fatigue, weakness, irritability, insomnia, memory loss, poor understanding, poor judgment and other symptoms.

Seven, nutritional deficiency encephalopathy

(a) Thiamine deficiency (athiaminosis)

Clinical manifestations are blurred, 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.

(2) 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, emotional apathy, initial dysfunction, lack of energy, reduced speech and so on.

(4) Vitamin B12 deficiency (vitamin B12deficency)

Clinical manifestations of sensation and motor abnormalities, some patients with excitability, irritability, paranoid state, episodes of random orientation, progressive dementia.

Eight, toxic diseases

(a) carbon monoxide poisoning (carbon monoxide poisoning)

Clinical manifestations of dizziness, headache, fatigue, decreased efficiency and self-control ability, may have symptoms such as aphasia, disuse, loss of recognition, but also apathy, mental retardation, memory loss, disorientation, fiction and other symptoms.

(2) Lead poisoning

Clinical manifestations are difficult to fall asleep, easy to wake up, more dreams, emotional anxiety, and often have "three low" symptoms of low basal body temperature, pulse, and low blood pressure. 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 (chronic organophosphorus pesticide poisoning)

Clinical manifestations of headache, dizziness, memory impairment, inability to concentrate, insomnia, multiple dreams, low mood or anxiety, excitement, fatigue, weakness, comprehension, poor judgment.

Nine, craniocerebral trauma

(a) boxer dementia (demenia pugilistica)

Clinical manifestations of headache, dizziness, emotional instability, inability to concentrate, memory loss, poor understanding, poor judgment, and low worker efficiency.

(2) Other brain injury

Clinical manifestations range from mild memory loss, dizziness, inability to concentrate, to severe dementia, sluggishness, apathy, lack of initiative, slow thinking, impaired understanding, poor memory, and emotional instability.

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)

The clinical manifestations are progressive mental activity decline, gait instability, urinary incontinence, near-forgotten indifference, slow thinking, reduced verbal movements, decreased emotional reactions, and gradually worsened the memory, calculation, orientation, and dementia. Finally coma died.

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