CC BY
0ABOUT VASCULAR DEMENTIA (VAD)
TAMTA BODOKIA
Medical Center Batumi Georgia
MARIAM KEKENADZE
Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery (NHNN), The First University Clinic of Tbilisi State Medical University Tb.
MARIAM KATCHARAVA
Shota Rustaveli State University, Batumi, Georgia
ANA CHIKHRADZE
Shota Rustaveli State University, Batumi, Georgia
SHORENA VASHADZE
Faculty of Natural Sciences and Health Care of Batumi Shota Rustaveli State
University, Batumi, Georgia
Abstract. Vascular dementia (VaD) is the second commonest dementia after Alzheimer's disease (AD). 1.2.3. Epidemiological studies of this condition suffer from many shortcomings related to definition of the disease, diagnostic criteria and assessment of subjects. The prevalence of VaD increases linearly with age and varies greatly from country to country, ranging from 1.2 to 4.2% of people over 65 years old, even after adjustment for age and sex.
The incidence of VaD is more homogeneous than prevalence and is estimated at 6-12 cases per 1,000 persons over 70 years per year.
Unlike Alzheimer's disease, in which brain function steadily declines, the symptoms of vascular dementia worsen much more dramatically after each stroke or microstroke.
The major risk factors for VaD appear to be hypertension, diabetes melitus , heart disease and stroke.
Keywords: Vascular dementia, Epidemiology, Risk factors, Survival, Prevention
Vascular dementia is caused by damaged blood vessels in the brain, which can be the result of stroke or other conditions that affect blood flow to the brain. Symptoms can include problems with memory, speaking and decision-making.
Atrial fibrillation (AF) is the most common clinically-significant arrhythmia in the world.[1] It is estimated that, in the US alone, approximately 2.5 million people have AF, with the condition being 1.5 times more common in men than in women.[8.9.10.11.12] Despite the decline in morbidity and mortality from cardiovascular diseases in general due to advances in prevention and treatment, AF has not followed a similar trend. Over the coming years, the incidence of AF is expected to increase.[13.14.]
The aim of the topic is to identify vascular dementia in patients with cerebral pathology. Score of 7 or more indicates vascular dementia, while a score of 4-7 indicates increased risk of vascular dementia 4 and less - vascular dementia is less likely
Material and methods
330 patients with cerebral blood flow disorder were tested at Adjarian Oncocenter 20222023. Among them 150 female and 150 male. Patients were divided by groups according to scale of stroke developed by National health Institute. Plasminogen Activator ( t-PA) was most effective during acute stroke. This scale is reliable and valid, helps to determine the localization of vascular damage and may be correlated with ischemic stroke outcomes. The neurological examination covers six main areas: 1. Level of consciousness 2. Vision function 3. Motor function 4. Inattention 5. Speech
function 6. Language, speech. This tool facilitates the consultation process in order to determine the severity of the disease and the possible location of the stroke as soon as possible. In order to evaluate the quality of life, we used the modified Rankin scale. Of the examined (during acute stroke), the level of consciousness was changed in 35%, vision disorders in 12%, motor function in 86%. Inattention - in 5%, speech function 13% violated
The diagnosis of vascular dementia is based on the Hatchinsky Ischemia Scale. The Hachinski ischemic score (HIS) is known to be a simple clinical tool, currently used for differentiating major types of dementia, such as primary degenerative, vascular or multi-infarct, and mixed type [1, 2]. Though there have been developments of newer tools for differentiating types of dementia, HIS has continuously and widely been used for such purpose [1,2. 3, 4]. There were many studies on the utility of HIS in the differentiation of dementia types, but investigations on the usefulness of HIS in the community dwelling elderly population are sparse.
Cerebrovascular factors are known to be the cause of vascular cognitive impairment and have negative effects on cognitive function [5, 6]. Cerebral infarction in itself, without the interaction with AD pathology, contributes to the likelihood of dementia [7]. When AD and IVD coexist as a mixed type of dementia, the cognitive symptom may be worse than when AD exists by itself [6]. Therefore vascular factors affect cognitive decline of both forms of dementia and it is important to assess vascular factors of elderly people.
According to our research, after ischemic stroke, 31% of patients need help to take care of themselves, 20% need help while walking, and 71% have limited professional abilities and need long-term follow-up. Non-modifiable risk factors were identified in our study: age, (40+60), migraine history - 5%, heredity - 35%. And among the modifiable risk factors: arterial hypertension in the anamnesis 65%. Diabetes mellitus 35%, heart diseases - arrhythmia 15%, hypercholesterolemia, transient disturbance (transient ischemic attack) 5%, facial nerve paresis (Bell Palsy) 1%. And lifestyle-related - excessive alcohol intake 5%, tobacco use 35%, obesity 45%, low physical activity -55%.
Among those examined, a mild form of vascular dementia is noted (20%), moderate vascular dementia in a case of stroke (45%), and severe vascular dementia in a case of a stroke (35%).
Thus, patients with cerebral pathology have a high rate of vascular dementia the major risk factors for VaD appear to be hypertension, diabetes melitus, heart disease and stroke.
Hospitalization of patient should not be oriented only for treatment of stroke but also about identifying Risk factors.
REFERENCES
1. Shorena Vashadze. ABOUT STROKE: Print version was published: EXPERIMENTAL & CLINICAL MEDICINE N 4 (2016) 2021/11/1 Journal EXPERIMENTAL AND CLINICAL MEDICINE GEORGIA Pages 40-42 https://j ournals.4science.ge/index.php/j ecm/article/vi ew/615
2. Shorena Vashadze. STROKE AND LEUKOCYTES: Print version was published: EXPERIMENTAL & CLINICAL MEDICINE N 5 (2013) 2021/11/1. Journal. EXPERIMENTAL AND CLINICAL MEDICINE GEORGIA. Pages 12-13
3. Mahon S .Parmar P .Barker-Collo S . et al. Determinants, prevalence, and trajectory of long-term post-stroke cognitive impairment: results from a 4-year follow-up of the ARCOS-IV Study. Neuroepidemiology. 2017; 49: 129-134
4. Obaid M .Douiri A .Flach C .Prasad V .Marshall I Can we prevent poststroke cognitive impairment? An umbrella review of risk factors and treatments. BMJ Open. 2020; 10e037982
5. Georgakis MK .Duering M .Wardlaw JM .Dichgans M.WMH and long-term outcomes in ischemic stroke: a systematic review and meta-analysis. Neurology. 2019; 92: e1298-e1308
6. Chinta V .Askandar S .Nanda A et al. Atrial fibrillation and deterioration in cognitive function.Curr Probl Cardiol. 2019; 44100386
7. Prystowsky EN .Padanilam BJ .Fogel RI Treatment of atrial fibrillation. JAMA. 2015; 314: 278288
8. Nasrallah IM .Pajewski NM .Auchus AP et al. Association of intensive vs standard blood pressure control with cerebral white matter lesions. JAMA. 2019; 322: 524-534
9. Wardlaw JM .Chappell FM .Valdés Hernández MDC et al.White matter hyperintensity reduction and outcomes after minor stroke.Neurology. 2017; 89: 1003-1010
10. Jochems ACC .Arteaga C .Chappell F et al.Longitudinal changes of white matter hyperintensities in sporadic small vessel disease: a systematic review and meta-analysis.Neurology. 2022; 99: e2454-e2463
11. Sachdev PS Lo JW Crawford JD et al.STROKOG (Stroke and Cognition consortium): an international consortium to examine the epidemiology, diagnosis, and treatment of neUrocognitive disorders in relation to cerebrovascular disease. Alzheimers Dement. 2016; 7: 1123
12. D'Souza CE Greenway MRF Graff-Radford J Meschia JF Cognitive impairment in patients with stroke. Semin Neurol. 2021; 41: 75-84
13. Ball EL Shah M Ross E et al. Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: a systematic review and meta-analysis. Int J Stroke. 2022; 18: 543554
14. Ball EL Sutherland R Squires C et al. Predicting post-stroke cognitive impairment using acute CT neuroimaging: a systematic review and meta-analysis. Int J Stroke. 2021; 17: 618-627
