Impaired activities of daily living and behavioral abnormalities
Introduction
Introduction Daily life decline and behavioral abnormalities: a variety of high-grade cortical dysfunction, involving memory, thinking, orientation, understanding, calculation, judgment, speech and learning ability. Clear consciousness, poor self-control ability, social or motivational decline. Various factors such as intracranial diseases, metabolic diseases, nutritional deficiencies, poisoning, mental and mental illnesses can lead to decreased daily living ability and behavioral abnormalities. In response to this symptom, the primary disease should be actively treated, and the patient's daily living ability should be trained to guide him to restore the corresponding ability and change behavior.
Cause
Cause
1. Brain degenerative diseases: Some cortical and subcortical diseases can cause dementia. Common causes are Alzheimer's disease, Pick's disease, Huntington's disease, Parkinson's disease, Wilson's disease, cortical-striatum- spinal joint. Denaturation and so on.
2. Cerebrovascular disease: cerebrovascular diseases in different parts can cause dementia, such as multiple infarct dementia, carotid occlusion, subcortical arteriosclerotic encephalopathy, thrombotic vasculitis.
3. Metabolic diseases: Some metabolic diseases affect the function of the brain, causing dementia, such as mucous edema, hyperparathyroidism or hypothyroidism, adrenal hyperfunction, hepatolenticular degeneration, uremia, chronic liver dysfunction.
4. Intracranial infection: intracranial infection leads to changes in brain parenchyma and brain function, leading to dementia, such as various encephalitis, neurosyphilis, various meningitis, Kuru disease.
5. Intracranial space-occupying lesions: tumors, subdural hematoma can cause structural and brain function changes, causing dementia.
6. Hypoxia and hypoxemia: including ischemic (cardiac arrest, severe anemia and hemorrhage), hypoxia (respiratory failure, asthma, asphyxia, anesthesia), stasis (heart failure, excessive red blood cells) And various types of hypoxemia of tissue toxicity.
7. Nutritional deficiency encephalopathy: thiamine deficiency encephalopathy, pellagra, vitamin B12 and folic acid deficiency.
8. Toxic diseases: common in carbon monoxide poisoning, lead, mercury and other poisoning, organic poisoning.
9. Craniocerebral trauma: open or closed trauma to the head, boxer dementia, etc.
10. Others: normal pressure hydrocephalus, sarcoma-like disease, etc.
Examine
an examination
Related inspection
EEG examination of brain CT examination blood routine
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.
Diagnosis
Differential diagnosis
(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 and have daily activities such as eating, sleeping, and dressing. If you don't pay attention, you can have personality changes in the early stage, or you can have memory problems. 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 mental decline is usually very insidious. The first symptom is the decrease in work efficiency and the inability to handle 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 movement, abnormal posture, may be associated with personality changes, mental retardation, mental illness and so on. 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 and 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) Cortico-striato-spinal degeneration: clinical manifestations of upper motor neuron spasm, seizures or myoclonic seizures, mental decline, memory, attention, understanding, judgment The ability of force, abstract general thinking is reduced, social adaptability, life self-care ability is also reduced, and with the development of the disease, the symptoms of dementia are becoming more and more serious.
