Atherosclerosis is a disease that results in abnormal function of various organ systems throughout the body due to proliferation and degenerative changes in the arterial walls. Cerebral atherosclerosis is part of systemic atherosclerosis, and vascular dementia (VaD) refers to chronic, progressive brain dysfunction, mental disorders and focal damage caused by atherosclerosis of cerebral arteries and microscopic arterial vitreous changes, and other chronic encephalopathy symptoms.
Cerebral arteriosclerosis is one of the most common neurological pathologies, and the morbidity and mortality rate has been high in Western countries. Over the years, with the improvement of the living standard of the general public and the change of diet and living habits, the incidence rate in our population has also been increasing year by year, and the age of onset has advanced, which has become a matter of concern.
Through a large number of experiments, pathological anatomy and clinical biochemical research, the generation of atherosclerosis is related to the following factors.
1, hypertension factors: hypertension can cause mechanical damage to the vessel wall, affecting the permeability and nutritional status of the wall, especially in the most obvious hemodynamic factors of the vascular parts, such as the carotid sinus, the bifurcation of the internal and external carotid arteries, the siphon of the internal carotid artery, the middle cerebral artery and the branch of the anterior cerebral artery, the basilar artery, the traffic artery are good sites for atherosclerosis and mechanical damage to the vessel wall.
2, smoking: cigarettes contain a large amount of nicotine (nicotine), which has the effect of raising adrenaline, promoting platelet aggregation and endothelial cell contraction, causing small arteries to form atherosclerosis due to hypoxia and metabolic disorders, so it becomes a factor that cannot be ignored in atherosclerosis.
3, hyperlipidemia: clinically referred to hyperlipidemia is high triglycerides and hypercholesterolemia. The causes of hyperlipidemia are complex and related to the composition of the diet, intake, the level of lipid metabolism in the body, and the composition of plasma lipoproteins (such as high-density lipoprotein and low-density lipoprotein). According to the study, low-density lipoprotein in blood can enter the subendothelial layer through the endothelial gap of blood vessels, stagnate under the endothelium for a long time and form atherosclerotic lesions, and the involvement of cholesterol can accelerate the appearance of atherosclerosis during the progression of atherosclerosis.
4, mental and psychological factors: long-term mental and psychological burden caused by social, economic, family or work reasons, as well as irregular life, can cause vasospasm, blood pressure rise, metabolic disorders, accelerating or aggravating the formation of atherosclerosis. In addition, factors such as heredity, diabetes, poisoning and infection all play a role in the different periods of atherosclerosis.
Once formed, atherosclerosis mainly affects the metabolic process of nerve cells and further affects the transmission of nerve bioelectrical signals and higher neural activities. Under the condition of long-term blood supply deficiency and hypoxia, the central nervous tissue generally atrophies to different degrees, so in the middle and late stages of cerebral atherosclerosis, patients will show signs of cerebral organic mental symptoms and dementia.
I. Clinical manifestations
Because of the wall thickening and lumen narrowing of small cerebral arteries and microembolism of the brain, transient ischemic attack (TIA) often occurs, leaving behind focal signs of the nervous system such as hemiparesis and aphasia; while vascular dementia mostly occurs around 50 years old, and can occur in both men and women. Symptoms of Korsakoff’s syndrome are sometimes present. Attention is often difficult to concentrate, comprehension and judgment are also progressively reduced, and interest in daily work and hobbies gradually disappear. As the disease progresses, there are difficulties in associating thoughts and even incoherence, and language expressions become verbose and less logical. Emotional disorders and emotional abnormalities are another characteristic of patients. Some patients may have obvious depression, anxiety, fear and suspicion, as well as childishness, euphoria and strong crying and laughing. Some patients may experience impulsive and aggressive behavior. The symptoms fluctuate from mild to severe, but self-awareness and personality remain intact in the early and middle stages, hence the name “vascular-related cognitive impairment (VCI)”. In contrast, geriatric psychosis can be differentiated from the former by the presence of personality breakdown in the early stages. Because the lesion can cause significant damage to a particular lobe, frontal lobe syndrome, parietal lobe syndrome, and cerebellar syndrome may be present in addition to the clinical manifestations described above. A small number of patients have extrapyramidal symptoms such as resting tremor and increased muscle tone due to basal ganglia involvement.
Second, auxiliary examination
Patients with hyperlipidemia are prone to cerebral arteriosclerosis, and the degree of arteriosclerosis is relatively heavy, so all patients diagnosed with vascular dementia need to do this test. In general, serum cholesterol >6.0 mmol/L, triglycerides >1.2 mmol/L, HDL <2.2 mmol ldl="">5.8 mmol/L. Morphologically, CT or MRI may show signs of symmetrical brain atrophy, and the ventricular system is often symmetrically enlarged. There are also foci of lacunar or lamellar cerebral infarction consistent with vascular distribution, and the subcortical white matter often has degenerative changes that appear around the ventricles, also known as Bingswanger’s white matter encephalopathy. Transcranial Doppler (TCD) often shows a wave pattern of decreased blood flow, increased blood flow velocity, and vascular hypoelasticity or stenosis. EEG is mostly normal in the early stages, and the alpha rhythm tends to slow down only when the disease worsens, and more theta or low-amplitude waves begin to appear in the frontal region. When dementia further appears, the alpha rhythm decreases or disappears, and theta and delta waves increase diffusely.
III. Treatment and prognosis
Cerebral atherosclerosis is a multifactorial chronic degenerative disease, and its remarkable feature is that it develops slowly and insidiously, with no clinical symptoms for a long time, and once patients present with symptoms for consultation, the disease has often progressed to a certain extent. According to the literature, atherosclerosis can occur in adults at the age of about 20 years, and only after the age of 40 years does it gradually become significantly more serious. Therefore, the prevention of atherosclerosis should begin in youth, not in middle and old age, as many people traditionally believe. Scientific prevention should start from youth to cultivate good living habits, strengthen physical exercise, pay attention to the perfect combination of mental and physical labor, maintain an optimistic mood, do not smoke, do not drink alcohol. Avoiding exposure to harmful physical and chemical factors, reasonable diet intake and weight control can effectively prevent the premature occurrence of atherosclerosis.
If there is already the occurrence of atherosclerosis and dementia formation, in addition to the above measures, certain drug control is needed.
(1) Lipid-lowering drugs: There are many kinds of lipid-lowering drugs, including statins, niacin and linoleic acid preparations with good cholesterol-lowering effect, fenofibrate and polyene-containing ethyl ester capsules with good triglyceride lowering effect; there are also statin preparations with good cholesterol control effect, such as pravastatin, lovastatin, simvastatin and atorvastatin. There are also herbal preparations of Lipitor. The duration of these drugs varies, and some of them will rebound after discontinuation. Therefore, when using them, we need to consider whether to apply them for a long time or choose them for certain components, otherwise they will not achieve the expected effect. Generally fenofibrate 250mg 1 time a day, after meals is appropriate; pulse 1 pill 3 times a day, statins 10-20mg 1 time a day, lipitor 0.1-0.2 3 times a day; or niacin 0.5-1.5 3 times a day.
(2) Improving cerebral metabolism drugs: for early mental retardation, you can give Olanzapine 400mg 3 times a day, Nimotropin 30mg 3 times a day, Nicergoline preparation Pelecan 2.5mg 2 times a day, Meclofenoxate hydrochloride 100-200mg 3 times a day.
(3) Drugs against certain psychiatric symptoms: For patients with hallucinations and delusions, schizophrenic states and thought disorders, chlorpromazine 200-800mg/day, fenadine 10-80mg/day, clozapine 100-400mg/day can be chosen. However, the extrapyramidal symptoms of clozapine are milder than those of clozapine. Due to the long half-life of these drugs in the body, the practice of multiple daily doses has been changed in favor of 1-2 daily doses, which are comparable and more convenient. For patients with symptoms such as anxiety, depression and sleep difficulties, they can choose Telden, antidepressants SSRI and Valium, such as Telden 25-100mg twice a day, fluoxetine or paroxetine 10-20mg once a day, Lola 0.5-1mg twice a day; if the patient mainly shows apathy, withdrawal, rigidity and disobedience, they can choose trifluoperazine, fluphenazine and sulpiride. Generally, trifluoperazine 5-20mg twice a day, fluphenazine 2-10mg 3 times a day, sulpiride 50-400mg twice a day, etc.
(4) Other treatment: measures and means to normalize neurohumoral function can also regulate metabolism and improve the function of the vascular system, such as climate therapy, air therapy, water bath, physical therapy, body therapy, etc., are also recommended means.
Arteriosclerotic encephalopathy generally progresses slowly and has a longer course compared with other encephalopathies, and the clinical symptoms are relatively mild, so the symptoms can be improved easily with drug therapy.