Brain atrophy
Introduction
Introduction to brain atrophy Brain atrophy refers to a type of neuropsychiatric disease in which the brain tissue itself produces a qualitative lesion due to various causes. Brain atrophy includes cerebral atrophy and adult brain atrophy. More common in the elderly. The main symptom of atrophy in the clinic is dementia, especially in the elderly, which is prone to Alzheimer's disease. Brain atrophy is a category of traditional Chinese medicine "dementia", "forgetfulness", "dizziness", "sputum syndrome", "tremor" and so on. Chinese medicine believes that although the disease is in the brain, it is closely related to the function of various organs, and the pathological mechanism belongs to the virtual standard. Cerebral atrophy in adults: more than 50 years old, the disease can be several years to decades, more men than women, brain atrophy with diffuse brain atrophy (including cortical atrophy, cerebellar atrophy and cortex, cerebellum, brain stem atrophy And localized brain atrophy (more common in localized brain organic lesions such as trauma, vascular disease, intracranial localized infection, etc.). Due to its complicated etiology, the onset is slow, it is not easy to be detected, the course of disease is long, the progress is slow, and it may gradually increase, affecting the normal life and work of patients. Early detection, active and appropriate control of the condition and further treatment are of great significance. basic knowledge The proportion of patients: 0.01%-0.03% (the incidence rate of the elderly over 60 years old is about 0.1%-0.3%) Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: headache, memory impairment, dementia
Cause
Cause of brain atrophy
Brain atrophy is multifactorial. From genetics, brain trauma, poisoning sequelae, cerebral infarction, encephalitis meningitis, cerebral ischemia, hypoxia, cerebral vascular malformations, brain tumors, stroke, long-term seizures, excessive alcohol and tobacco, malnutrition, thyroid function, Cerebral arteriosclerosis, gas poisoning, alcoholism and other causes damage of brain parenchyma and atrophy, deformation and disappearance of nerve cells. The most important pathogenic factor is caused by long-term chronic ischemia of cerebrovascular.
From the beginning of embryonic development to the leap year, human beings are constantly adapting to material metabolism and energy metabolism in order to obtain nutrients and remove harmful factors that are not conducive to their physiological functions. Changing environment inside and outside the body. The key to accomplishing this function must be rich in oxygen, that is, under effective blood circulation, enough red blood cells carry oxygen and are damaged in function and morphology. When the damage does not cause serious changes in its physiological functions, the aging of healthy people occurs, and if it occurs in the brain tissue of humans, it is the brain atrophy of healthy elderly people. In the elderly, the red blood cell deformability is decreased, and the effective blood perfusion of the microvessels is insufficient. The brain tissue is in a state of chronic ischemia and hypoxia, and the shape and function of the brain cells are bound to be affected, that is, brain atrophy is formed.
At the same time, dyslipidemia plays an important role in causing senile brain atrophy and poor cerebral circulation. Other studies have found that the incidence of hypertension in patients with significant white matter atrophy is significantly higher than that in patients with significant cortical atrophy. Therefore, atherosclerosis and hypertension in small arteriosclerosis have a role in the formation of senile brain atrophy, mainly in the cerebral cortex. The blood is supplied by a large blood vessel branch in the brain. The cortical area is rich in capillary network. When the deformability of red blood cells decreases, the amount of red blood cells passing through the capillary decreases, and sufficient oxygen cannot be delivered to meet the metabolic needs of cortical neurons, that is, cortical atrophy occurs. . White matter is mainly supplied by small and medium arteries, while hypertensive patients are prone to small arterial transparency, fibrinoid necrosis and hardening, resulting in thickening of small arterial wall, decreased elasticity, increased vascular resistance, insufficient blood perfusion, and high fat. Hemorrhage is more serious in the formation of arteriosclerosis. Therefore, it is believed that hypertension and hyperlipidemia may be a cause of white matter atrophy. If the above-mentioned cerebral cortical atrophy and white matter atrophy are the same, it is possible to have both white matter atrophy and cortical atrophy, and over time, patients with mixed brain atrophy will increase.
The lesions of brain atrophy can be seen as flattening of the brain, widening of the sulcus, enlargement of the cerebral ventricles, and reduction of brain weight. More common cerebral cortical atrophy, due to different sites and areas of involvement can be divided into localized and diffuse brain atrophy.
Prevention
Brain atrophy prevention
Many people believe that brain atrophy is an inevitable trend of aging, and it cannot be prevented or cured. In fact, it is not early, early detection, early treatment, and actively taking correct measures to control some risk factors in the bud, and prevention still has certain effects. At the very least, it can delay the occurrence and development of the disease.
Active prevention and treatment of vascular diseases: prevention of brain atrophy, should actively prevent and cure certain systemic diseases, especially diseases affecting vascular health, such as hypertension, diabetes, hyperlipidemia, arteriosclerosis, etc., to achieve early detection, early diagnosis, Early treatment, in order to delay and control the development of the disease. Lightly adjust the lifestyle, improve the nutritional structure, correct bad habits; focus on drugs to control, of course, medication should be gradual and perseverance. Increase social activities: use and retreat, often read and read newspapers, write and calculate, regularly run the brain, constantly promote the activity of brain nerves and sensory information movement, help improve blood circulation in the brain, delay the aging of brain cells To delay the progression of brain atrophy. Actively participate in various social activities, "more than one social exchange will be more physical and mental health", Director Du suggested that the middle-aged and elderly should go to the society, increase the opportunities for outing activities, stimulate the cerebral cortex to have new excitement, so that Delay aging and slow down brain function decline.
Light diet, smooth stool: constipation is one of the most common causes of sudden cardiovascular and cerebrovascular risk events, and cerebrovascular accidents are the most direct and serious damage to brain tissue. Therefore, Director Du believes that it is very important for middle-aged and elderly people to maintain smooth stools. . Usually you can eat more fruits and vegetables, light diet, constipation can be combined with drinking some intestinal tea, senna leaves and so on. In addition, Ginkgo biloba, Salvia miltiorrhiza and other Chinese herbal medicines that promote blood circulation and brain health have certain effects on preventing brain atrophy.
Finally, experts remind people who are or have entered the ranks of middle-aged and older people. They should be regularly checked to find out early whether there are risk factors for brain atrophy, early intervention, early prevention, and delay the occurrence and development of the disease.
Prevention of brain atrophy in the family should be done
1 Strengthen nutrition, improve nutritional status, maintain dietary balance and mental health;
2 read more, read more newspapers, often participate in group activities, moderately participate in exercise;
3 Enhance cognitive activities and strive to restore previous life experiences and abilities;
4 to enhance the patient's orientation force, if the orientation disorder is serious, should avoid going out alone;
5 Promote language communication and assist patients in increasing interpersonal relationships, such as participating in recreational activities and outdoor activities;
6 Keep proper storage of dangerous goods, reduce changes in indoor items, and ensure patient safety;
7 pay attention to cleanliness and maintain the integrity of the patient's skin.
Rehabilitation of senile brain atrophy
Senile brain atrophy is the most common chronic progressive disease in middle-aged and old age. It is caused by one or more causes of insufficient blood supply to the brain and a decrease in brain tissue volume and a decrease in the number of brain cells. Emotional instability, decreased thinking ability, inability to concentrate, and development of dementia, language barriers, and ultimately intellectual loss are clinical features. The disease is more common in patients over the age of 50, the course of disease can be more than a few years or even more than 10 years, more women than men.
Brain atrophy is "aging brain atrophy", which is a manifestation of aging in the brain of the elderly. Regarding treatment and maintenance, the following aspects should be noted:
1. Pay attention to your own maintenance, such as: regular life, pay attention to reasonable diet, exercise properly, avoid smoking, drinking, eat less high-fat diet.
2. Take anti-platelet agglutinators, such as enteric-coated aspirin, or aspirin, or bolivi, to prevent recurrence of cerebral infarction. If you have stomach or duodenal ulcer, change to Pan Shengding.
3. Dizziness, dizziness, application of cerebral vasodilators, such as Fufang Tongmaiyin, Kaikemin, Ginkgo biloba, Danshen dripping pills, etc., to improve brain blood circulation.
Complication
Brain atrophy complications Complications, headache, memory impairment, dementia
Brain atrophy and stroke are serious diseases that impair the health of middle-aged and elderly people. They have lost their independent instinct in their lives and work, and their ability to develop their living ability and body control has declined. Until they are bedridden. According to statistics, the mortality rate of various types of brain atrophy diseases is getting higher and higher. About 15 million people worldwide die from various brain atrophy diseases each year, accounting for more than 50% of the total mortality.
First, forget the loss of time and orientation. It is normal to temporarily forget that today is the number or the direction of disorientation. But senile dementia patients will get lost at their doorsteps, or lose in familiar department stores, and don't remember where they are now. How did you get here and how to get back to where you were.
Second, language barriers. Everyone may encounter a time when they can't find the right words. But often it will be replaced by other appropriate words. It is puzzling that senile dementia patients often forget words or unreasonably combine inconsistent words.
Third, the judgment is significantly reduced. When people are too involved in an activity, they may temporarily forget some other things, such as taking care of the child in time, but will remember it later. Alzheimer's patients will completely forget the children they are caring for, go out for a long time alone, and remember that children need someone to take care of them.
Fourth, the ability to think and summarize is extremely declining. People who can usually deal with digital problems in normal times sometimes have complicated things and have no clue, but generally find a workable solution. Alzheimer's patients not only forget the numbers, but also forget the use of these numbers.
Symptom
Symptoms of brain atrophy Common symptoms Oral incontinence Incontinence Memory disorder Dementia Judgment and disorientation Disorder Intelligent decline Ataxia Epilepsy Complex partial seizure Carotid atherosclerosis Forgetfulness
The clinical manifestations of brain atrophy can be divided into two categories, namely, brain function decline and dementia, which are mainly related to the location and extent of brain atrophy.
Symptoms of brain atrophy, in which diffuse cerebral cortical atrophy is dominated by dementia, mental decline, memory impairment, personality changes, and behavioral disorders. Some are accompanied by hemiplegia and seizures. Focal brain atrophy is mainly characterized by personality changes; cerebellar atrophy is dominated by language disorders and physical ataxia and tremor.
Symptoms of brain atrophy
1, early symptoms of systemic symptoms, patients often have dizziness, headache, insomnia and more dreams, weak waist and knees, hand and foot numbness, tinnitus and deafness; gradually slow response, slow motion, muttered to himself, answering questions. In terms of the body, it often appears as an old-fashioned dragon, with white teeth falling, dry skin, hyperpigmentation, or even hemiplegia, epilepsy, or ataxia, tremors, etc., neurological symptoms may or may not be present.
2, memory impairments Near-memory memory defects occur earlier, such as frequent loss of items, forgetting things that have been promised. As the disease progresses, the memory is completely lost.
3, personality behavior changes personality symptoms are often the early symptoms of the disease, patients become vacant, do not like to interact with people, or manifested as lack of ideals, desires, lack of affection for their loved ones; life habits are weird, impetuous, speech Increase, or repeat; or suspicious selfishness, pay special attention to your health and safety, often entangled by some minor discomfort. All patients' high-level emotional activities, shame, responsibility, glory, and morality all have different degrees of decline, and changes in sleep rhythm can also occur.
4, intelligent decline, dementia performance for understanding, judgment, computing ability and other intellectual activities all down, can not adapt to social life, difficult to work and housework; gradually unable to correctly answer their names, age, eating, not hunger, not after going out Recognize the way home, collecting waste paper debris as a treasure. In the late stage of illness, staying in bed all the time, life can not take care of themselves, do not be close to the person, incontinence, speech vague, slurred speech, no words, no complete dementia.
Clinical classification of brain atrophy:
Brain atrophy can be divided into five types in clinical practice.
1. Cerebral atrophy with cerebral cortical atrophy as the main pathological change: clinically many motor dysfunction, memory loss and slow response.
2. Cerebellar atrophy based on cerebellar pathological changes: gait instability, ataxia, language sputum, cough and so on.
3. Hereditary brain atrophy: divided into autosomal dominant and recessive inheritance, clinically based on pathological changes characterized by spinal cord type, spinal cord cerebellum, cerebellum and surrounding types.
4. Localized brain atrophy: local brain softening caused by brain tissue degeneration caused by local brain tissue lesions or surgery. It can cause localized atrophy in and around the lesion, also called some encephalopathy or brain injury sequelae.
5. Degenerative brain atrophy: cerebral dysfunction caused by different degrees of atrophy and degeneration of the brain, cerebellum and olive bridge, and neurological dysfunction. Dementia is the main manifestation of senile common and frequently-occurring disease. For elderly patients, degenerative brain atrophy is physiologically inevitable, but the time and extent of clinical appearance vary greatly. With age, there is a certain degree of unresponsiveness. Memory loss is mostly physiological, premature, and obvious symptoms should be Pay attention to prevention and treatment.
Examine
Brain atrophy
1. Clinical examination and diagnosis:
In addition to the medical history and observation of symptoms, patients with cerebral atrophy can be found to have varying degrees of dullness or decrease in their various neurogenesis reflexes. Shallow reflexes such as chest and abdomen wall reflexes, cremaster reflexes, anal reflexes, and deep reflexes such as biceps reflexes, ulnar periosteal reflexes, knee reflexes, and Achilles tendon reflexes may also be reduced, and pathological reflexes may occur. Cerebellar atrophy patients, through clinical examination, can be found that can not stand with feet, slow movement, lower limbs tremble, can not walk in a straight line, walking in a drunk state, gait squat, wide stride, pathological reflex with Burst sign (+), finger nose test (+), knee test (+), circle test (+);
2, imaging inspection diagnosis:
Imaging studies such as CT and MR (nuclear magnetic resonance) can be found that brain tissue volume is reduced and ventricles are enlarged. If the brain shrinks, the gap between the cerebral cortex and the skull plate increases, the sulcus widens and deepens, the cerebral palsy becomes flattened, the lateral ventricle and the third ventricle expand, and the density around the anterior and posterior horns of the lateral ventricle decreases. When the cerebellum is atrophic, the cerebellar texture is coarse and heavy, and the reduced size image shows branches and leaves. The low density of the cerebellar space has increased, and the fourth ventricle is enlarged. If there is atrophy of the cerebral corpus callosum in the image, the brain stem becomes thin and narrow, the surrounding cavity is slightly widened, and the olive body becomes flat or narrowed. (For the graphic, please refer to the brain CT/MR atlas)
3, cerebral vascular shape can be seen cerebral arterial variability:
The cerebral blood flow surface can also be found to slow down blood flow and increase vascular resistance.
In summary, the diagnosis of brain atrophy based on medical history, symptoms, clinical examination and imaging methods is not difficult.
Self-checking method
1. Whether you have cerebellar atrophy or not, the following simple self-examination method is recommended. 1. Stand naturally, put your feet together, and finally close your eyes to check if they are stable.
2. On the straight line, the heel walks forward with your toes and observes whether the movement is smooth.
3. Stand on one foot and then close your eyes to see if it is stable.
Diagnosis
Diagnosis and differentiation of brain atrophy
The diagnosis of brain atrophy can be started from the following aspects:
1, symptom diagnosis:
Early manifestations of headache, dizziness, memory loss, decline in time, place, orientation power judgment or even loss (such as unable to find home after going out) thinking is fragmentary, major events are ignored, while small things are entangled, mentally reduced, The spirit is sluggish, the expression is indifferent, the reaction is slow, the lazy words are slow, the movement is slow, and the surrounding affairs are indifferent.
Personality changes are characterized by selfishness, subjectivity, paranoia, anxiety, suspiciousness, irritability, and incoherence. The patient has forgetfulness or mania, and even indecent activities, standing unstable in action, shaking hands and feet, walking, walking in a straight line, incontinence, sexual dysfunction or loss. There are also fantasy, illusion, auditory hallucinations, aphasia, and loss of recognition, which in turn becomes senile vascular dementia.
The brain atrophy is characterized by dizziness, headache, sluggish expression, memory loss, lazy thinking, mental retardation, reduced activity, low speech, slow response to surrounding affairs, aphasia, loss of recognition, auditory hallucinations, visual hallucinations and personality changes. Cerebellar atrophy focuses on dizziness, slow autonomic activity, unstable standing, wide stride, gait paralysis, inability to walk straight, language disadvantage, dysarthria, difficulty swallowing, nystagmus, inaccurate holding, fingertips, etc. Ataxia symptoms. And have orthostatic hypotension, syncope, palpitations, perspiration disorder, difficulty in defecation, sexual dysfunction or obstruction;
2, clinical examination and diagnosis:
In addition to the medical history and observation of symptoms, patients with cerebral atrophy can be found to have varying degrees of dullness or decrease in their various neurogenesis reflexes. Shallow reflexes such as chest and abdomen wall reflexes, cremaster reflexes, anal reflexes, and deep reflexes such as biceps reflexes, ulnar periosteal reflexes, knee reflexes, and Achilles tendon reflexes may also be reduced, and pathological reflexes may occur. Cerebellar atrophy patients, through clinical examination, can be found that can not stand with feet, slow movement, lower limbs tremble, can not walk in a straight line, walking in a drunk state, gait squat, wide stride, pathological reflex with Burst sign (+), finger nose test (+), knee test (+), circle test (+);
3. Image inspection and diagnosis:
Imaging studies such as CT and MR (nuclear magnetic resonance) can be found that brain tissue volume is reduced and ventricles are enlarged. If the brain shrinks, the gap between the cerebral cortex and the skull plate increases, the sulcus widens and deepens, the cerebral palsy becomes flattened, the lateral ventricle and the third ventricle expand, and the density around the anterior and posterior horns of the lateral ventricle decreases. When the cerebellum is atrophic, the cerebellar texture is coarse and heavy, and the reduced size image shows branches and leaves. The low density of the cerebellar space has increased, and the fourth ventricle is enlarged. If there is atrophy of the cerebral corpus callosum in the image, the brain stem becomes thin and narrow, the surrounding cavity is slightly widened, and the olive body becomes flat or narrowed. (For the graphic, please refer to the brain CT/MR atlas)
4, cerebral vascular shape can be seen cerebral arterial variability:
The cerebral blood flow surface can also be found to slow down blood flow and increase vascular resistance.
In summary, the diagnosis of brain atrophy based on medical history, symptoms, clinical examination and imaging methods is not difficult.
The difference with dementia
Most people think that brain atrophy is Alzheimer's disease. To solve this problem, experts explain that brain atrophy and Alzheimer's disease are not the same kind of disease.
Scientific research shows that the outermost layer of the brain is a gray cerebral cortex composed of 14 billion nerve cells, 3.5 mm thick, with a tortuous surface of the cerebral cortex, a depressed sulcus and a raised cerebral gyrus. White medulla. There are also several ventricles in the middle of the brain that are voided. After the death of cranial nerves, the weight of the brain becomes lighter and the volume becomes smaller. The CT examination shows that the brain volume is reduced, the sulcus is widened, the brain is thinner, and the ventricles are enlarged. This is brain atrophy.
The degree of brain atrophy in senile dementia is more serious than that in normal elderly people, especially in the brain parts related to memory function such as hippocampus. However, at present, the extent of brain atrophy alone cannot distinguish the boundaries between normal elderly and senile dementia patients. Clinically, it is found that elderly people with severe brain atrophy have no symptoms of dementia, but brain atrophy is lighter. Even elderly people without brain atrophy have obvious symptoms of dementia. Therefore, CT examination is only used as an auxiliary examination. The diagnosis of senile dementia is mainly based on clinical symptom. Severe memory loss is the main symptom. The clinical manifestations are obviously forgetting symptoms. For example, forgetting before, talking about getting lost, forgetting the placement of items, not knowing family members, not being able to calculate easily, etc., when bedridden is serious, life cannot be taken care of. Incontinence, like a newborn child. Sometimes there are noisy, swearing, tearing clothes and other mental symptoms. Therefore, senile dementia can be diagnosed when there is a special symptom of amnesia and CT examination of the presence of brain atrophy.
Objectively speaking, patients with dementia have memory loss, but those with memory loss are not necessarily dementia. Because with the increase of age, after entering the old age, the tissues, organs and systems of the human body will gradually age, and the memory function of human beings will gradually decline. This is a normal and physiological change of the elderly. However, the memory of some elderly people does not diminish with age aging, which is obviously related to the degree of education, nutrition, life experience, hobbies, cultural literacy, physical quality, and living range. Dementia is a disease. The memory decline in the elderly is a physiological process. There are similarities and fundamental differences between the two.
Therefore, it can be clearly stated that brain atrophy is not Alzheimer's disease. There is a certain similarity between the two, so attention should be paid to the identification when conducting clinical diagnosis.
