Dementia refers to chronic acquired progressive intellect syndrome. Clinically, it is mainly characterized by slowly appearing intellectual decline, accompanied by varying degrees of personality changes. It is a group of clinical syndromes, not an independent disease.
There are many causes of dementia, mainly divided into degenerative dementia and non-degenerative dementia.
1. Central nervous system degenerative diseases
Alzheimer's disease, frontotemporal dementia, Prion disease (Creutzfeldt-Jakob disease, CJD, which is the main type), Lewy body dementia, Parkinson's disease, Huntington's disease
2. Non-degenerative dementia
(1) Vascular dementia.
(2) Space-occupying lesions: tumors, chronic subdural hematomas, chronic brain abscesses.
(3) Infection: Meningoencephalitis, neurosyphilis, AIDS dementia, Ruan protein disease.
(4) Traumatic brain dementia.
(5) Normal intracranial pressure hydrocephalus.
(6) Endocrine and metabolic disorders ① Endocrine disorders, Cushing’s syndrome, hyperinsulinemia, hypothyroidism, hypopituitarism, hypoglycemia. ② Liver failure, kidney failure, and lung failure. ③ Chronic electrolyte disturbance. ④ Hematoporphyria. ⑤ Vitamin deficiency: lack of vitamin B1, niacin, folic acid, vitamin B12, etc.
(7) Poisoning, hypoxia (alcohol, heavy metals, carbon monoxide, drugs, hypoxia, etc.).
(8) Paraneoplastic syndrome.
The occurrence of dementia is slow and hidden. Memory loss is the main core symptom. Near memory, impairment appears in the early stage, and the ability to learn new things is significantly reduced. In severe cases, there is even no way to go home. With the further development of the disease, distant memory is also impaired. Thinking slowly and poorly, understanding and judgment of general things are getting worse and worse, attention is gradually impaired, and disorientation of time, place, and characters may appear, and sometimes they cannot write or recognize characters.
Another early symptom of dementia is a decline in the ability to learn new knowledge and master new skills. His abstract thinking, generalization, comprehensive analysis, and judgment abilities are progressively diminishing. Impairment of memory and judgment can cause certain obstacles, and the patient loses time, place, character, and even his own recognition ability. Therefore, they often do not distinguish between day and night, do not know the way home, or roam without purpose.
In terms of emotions, patients may experience emotional instability early and gradually become indifferent and slow as the disease progresses. Sometimes emotions lose control and become superficial and changeable. Appears anxious, depressed, passive, or indifferent, or furious, easy to cry and laugh, unable to control.
Some patients may change their personalities first. It usually shows decreased interest, poor initiative, and social withdrawal, but it can also show disinhibited behaviors, such as impulsivity, naive behavior, and so on. The patient's social function is impaired, and the work he is familiar with cannot be completed. In the late stage of life, he cannot take care of himself, and his motor function is gradually lost, and he even needs help from others for dressing, bathing, eating, and urinating, and defecation. Even mania, hallucinations, etc. appear.
Objective evidence indicates that there is short-term or episodic memory impairment. For patients with suspected dementia, check blood routine, serum calcium, phosphorus, blood sugar, kidney, liver, and thyroid function, blood vitamin B12 and folic acid, and syphilis serum screening. Nervous system imaging examinations can also be done according to clinical needs to determine the cause. Physical examination is also very important. Most patients with dementia caused by intracranial diseases often have signs of localization of the nervous system.
Tian Jinzhou, Han Mingxiang, Tu Jinwen, etc. Diagnosis, syndrome differentiation, and therapeutic evaluation criteria for vascular dementia. "VIP", 2000
Zhang Zhenxin, Wu Chengbin, Tang Muni, etc. A study on the prevalence of dementia subtypes in Beijing, Xi'an, Shanghai, and Chengdu, China. "Chinese Journal of Modern Nervous Diseases", 2005
Tian Jinzhou, Han Mingxiang, Tu Jinwen, etc. Vascular Dementia Diagnosis, Syndrome Differentiation and Efficacy Evaluation Criteria (for Research). "CNKI", 2002
Zhang Juntian. Pathogenesis and treatment strategies of Alzheimer's. "WanFang", Nian Wang Rui, Yang Qinfei, Tang Yipeng, etc. Improvement of the "vascular dementia" model in rats. "Chinese Journal of Pathophysiology", 2000