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Srpski arhiv za celokupno lekarstvo
2013, vol. 141, br. 3-4, str. 247-255
jezik rada: srpski
vrsta rada: prikaz
objavljeno: 13/11/2013
doi: 10.2298/SARH1304247P
Vaskularna demencija - istine i kontroverze
aKlinički centar Srbije, Klinika za neurologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet
bUniverzitet u Beogradu, Fakultet za specijalnu edukaciju i rehabilitaciju
cUniverzitet u Beogradu, Medicinski fakultet

e-adresa: aleksandrapavlovic@hotmail.com

Projekat

Depresija izazvana vaskularnim bolestima mozga: primena neurovizualizacionih metoda u prevenciji, ranom otkrivanju i lečenju (MPNTR - 175022)
Neuroendokrina kontrola sekrecije hormona rasta kod čoveka - novi izazovi. Kontrola energetske homeostaze kod čoveka u različitim patološkim stanjima. Kliničko-patološka korelacija i genetska osnova tumora hipofize i neuroendokrinih tumora (MPNTR - 175033)

Sažetak

Vaskularna demencija (VaD) je posle Alchajmerove bolesti druga po učestalosti demencija, koja se zaživotno dijagnostikuje kod oko 20% svih dementnih bolesnika. Petogodišnje preživljavanje obolelih od VaD je 39%, u odnosu na 75% zdravih osoba istog životnog doba. Zbog toga je veoma važno pravovremeno i tačno postaviti dijagnozu VaD. Faktori rizika za nastanak VaD su istovetni onima za moždani udar, te postoje značajne mogućnosti za prevenciju vaskularnog kognitivnog pada. Kognitivni pad se ispoljava naglo ili postepeno tokom tri meseca od moždanog udara, ali je moguće i tzv. šunjajuće napredovanje intelektualnog propadanja. U neurološkom nalazu se mogu naći piramidalni i ekstrapiramidalni znaci, pseudobulbarna paraliza, poremećaji hodanja i inkontinencija urina. Neuropsihološki profil obuhvata teškoće promene kognitivnog seta, pogoršanje fonemske fluentnosti, oštećenje verbalnog učenja, perseverativnost, teškoće kopiranja složenog crteža, a kod kortikalno lociranih lezija i smetnje govora i praksije. Osnova dijagnoze je, pored anamneze, neurološkog pregleda i neuropsihološkog ispitivanja, nalaz na snimcima mozga skenerom i/ili magnetnom rezonancijom. Kontrola vaskularnih faktora rizika je najznačajnija mera u prevenciji VaD. Savremene preporuke za lečenje bolesnika sa VaD ističu da donepezil može biti koristan za poboljšanje kognitivnog stanja bolesnika sa VaD na nivou klase IIa preporuka, nivoa dokaza A, dok memantin može biti koristan kod bolesnika s mešovitom VaD, s elementima Alchajmerove bolesti.

Ključne reči

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