Brain atrophy

Brain atrophy is a process of gradual death of cerebral cells and the destruction of interneuronal compounds. The pathological process can spread to the cerebral cortex or subcortical structures. Despite the cause of the pathological process and the treatment used, the prognosis for recovery is not entirely favorable. Atrophy can affect any functional area of gray matter, leading to a disruption of cognitive abilities, disorders of the sensory and motor sphere. 

[1], [2], [3]

Epidemiology

Most of the reported cases are among the elderly, namely women. The onset of the disease can start after 55 years and after a couple of dozen lead to complete dementia. 

[4], [5], [6], [7], [8], [9]

Causes of the brain atrophy

Brain atrophy is a serious pathology that occurs due to age-related degenerative processes, genetic mutation, the presence of concomitant pathology or exposure to radiation. In some cases, one factor can come to the fore, and the rest are just a background for the development of this pathology.

The basis for the development of atrophy is a decrease with age of the volume and mass of the brain. However, one should not think that the disease concerns exclusively senile age. There is brain atrophy in babies, including newborns.

Almost all scientists unanimously assert that the cause of atrophy is inherent in inheritance, when there are failures in the transfer of genetic information. The surrounding negative factors are considered a background effect, which can accelerate the process of this pathology.

The causes of brain atrophy of an innate character involve the presence of a genetic anomaly of hereditary genesis, a mutation in chromosomes or an infection process during pregnancy. Most often this applies to viral etiology, but bacterial is also often observed.

From the group of acquired predisposing factors, it is necessary to distinguish intoxications of chronic course, especially the negative influence of alcohol, infectious processes in the brain, both acute and chronic, traumatic brain damage and exposure to ionizing radiation.

Of course, the acquired causes can come to the fore in only 5% of all cases, since in the remaining 95% they are a provoking factor against the background of manifestations of the genetic mutation. Despite the focality of the process at the onset of the disease, all encephalon is gradually affected with the development of dementia and dementia.

At the moment, it is not possible to describe pathogenically all the processes that take place in the brain during atrophy, since the nervous system itself and its functionality are not fully understood. However, some information is known, especially about manifestations of atrophy involving certain structures.

[10]

Symptoms of the brain atrophy

As a result of age-related changes in encephalon, as in other organs, processes of reverse development occur. This is due to the acceleration of destruction and slowing of cell regeneration. Thus, the symptoms of brain atrophy gradually increase in severity, depending on the site of the lesion.

At the beginning of the disease a person becomes less active, indifference, lethargy, and personality changes. Sometimes there is an ignoring of moral behavior and actions.

Then there is a decrease in vocabulary, which ultimately causes the presence of primitive expressions. Thinking loses its productivity, it loses its ability to criticize behavior and think over actions. In relation to motor activity, motor skills deteriorate, which leads to a change in the handwriting and a worsening of the semantic expression.

Symptoms of brain atrophy can concern memory, thinking and other cognitive functions. So, a person can stop learning things and forget how they are used. Such a person needs constant monitoring in order to avoid unforeseen emergencies. Problems with orientation in space are due to memory problems.

Such a person can not adequately assess the attitude of surrounding people to him and is often susceptible to suggestion. In the future, with the progression of the pathological process, a complete moral and physical degradation of the personality occurs due to the onset of marasmus.

[11]

Brain atrophy 1 degree

Degenerative changes in the brain are activated with age, but with the influence of additional factors accompanying, the disorders of thinking can develop much faster. Depending on the activity of the process, its severity and the severity of clinical manifestations, it is customary to allocate several degrees of the disease.

Brain atrophy 1 degree is observed at the initial stage of the disease, when the minimum level of pathological abnormalities in the functioning of encephalon is noted. In addition, it should be considered where the disease is initially localized - in the cortex or subcortical structures. This depends on the first manifestations of atrophy, which can be seen from the side.

At the initial stage, atrophy can have absolutely no clinical symptoms. Perhaps the emergence of human anxiety due to the presence of another concomitant pathology, which directly or indirectly affects the functioning of encephalon. Then, periodic dizziness and headaches may appear, which gradually become more frequent and intense.

If a person at this stage see a doctor, then the brain atrophy of 1 degree under the influence of drugs slows down his progression and symptoms may be absent. With age, it is necessary to adjust the curative therapy, selecting other drugs and dosages. With their help, it is possible to slow the growth and appearance of new clinical manifestations.

[12], [13], [14], [15], [16]

Brain atrophy 2 degrees

The clinical picture and presence of certain symptoms depends on the degree of brain damage, in particular from damaged structures. 2 degree of pathology usually already has some manifestations, due to which it is possible to suspect the presence of pathological processes.

The onset of the disease can be manifested exclusively by dizziness, headache or even manifestations of another comorbid illness that affects the work of encephalon. However, in the absence of therapeutic measures, this pathology continues to destroy structures and increase clinical manifestations.

Thus, periodic dizziness is accompanied by a worsening of mental capabilities and the ability to conduct analysis. In addition, the level of critical thinking decreases and self-esteem of actions and speech function is lost. In the future, most often, changes in speech, handwriting increase, and also old habits are lost and new ones appear.

Atrophy of the brain of the 2nd degree as progression causes the deterioration of fine motor skills, when the fingers stop "obeying" a person, which leads to the impossibility of doing any work involving fingers. Also coordination of movements suffers, as a result of which gait and other activity slows down.

Gradually, thinking, memory and other cognitive functions deteriorate. There is a loss of skills in the use of everyday items, such as a TV remote control, a comb or a toothbrush. Sometimes it is possible to notice the copying by man of the behavior and manners of other people, which is caused by the loss to independence in thinking and movements.

[17], [18]

Forms

[19], [20]

Atrophy of the frontal lobes of the brain

In some diseases, at the first stage, there is atrophy of the frontal lobes of the brain with the subsequent progression and spread of the pathological process. This applies to Pick's disease and Alzheimer's.

For Pick's disease, the destructive lesion of mainly neurons of the frontal and temporal regions is characteristic, which causes the appearance of certain clinical signs. With their help the doctor can suspect the disease and, using the instrumental methods, to put the correct diagnosis.

Clinically, damage to these areas of encephalon is manifested by a change in personality in the form of deterioration of thinking and memorization. In addition, from the onset of the disease, one can observe a decrease in intellectual abilities. There is a degradation of a person as a person, which is expressed in the angular character, secrecy, alienation from the surrounding people.

Motor activity and phrases become fanciful and can be repeated as a pattern. In connection with the reduction of the vocabulary, a frequent repetition of the same information is observed during the conversation or after a while. It becomes primitive using monosyllabic phrases.

Atrophy of the frontal lobes of the brain in Alzheimer's disease differs slightly from the pathology of the Pike, since in this case the deterioration of the process of remembering and thinking takes place to a greater degree. As for the personal qualities of a person, they suffer a little later.

[21], [22], [23], [24]

Atrophy of the cerebellum of the brain

Dystrophic lesions can begin with the cerebellum, and, without involving in the process of the pathways. Ataxia and changes in muscle tone come to the forefront, despite the fact that the causes of development and prognosis are more similar to the damage to neurons of the hemispheres.

Atrophy of the cerebellum of the brain can be manifested by the loss of the person's ability to self-service. The defeat of the cerebellum is characterized by disorders of the combined functioning of skeletal muscles, coordination of movements and maintaining equilibrium.

Disorders of motor activity due to cerebellar pathology have several features. Thus, a person loses the smoothness of the hands and feet when performing movements, there appears intentional trembling, which is marked at the end of the motor act, handwriting changes, speech and movements become slower, and chanted speech arises.

Atrophy of the cerebellum of the brain can be characterized by increased dizziness, frequent headaches, the appearance of nausea, vomiting, drowsiness and hearing function impairments. Increases intracranial pressure, possibly the appearance of ophthalmoplegia due to paralysis of the cranial nerves, which are responsible for innervation of the eye, areflexia, enuresis and nystagmus, when the pupil performs involuntary rhythmic fluctuations.

[25], [26], [27], [28]

Atrophy of the substance of the brain

Destructive process in neurons can occur during the physiological process due to age changes after 60 years or pathological - as a result of some disease. Atrophy of the substance of the brain is characterized by a gradual destruction of the nervous tissue with a decrease in the volume and mass of the gray matter.

Physiological destruction is noted in all people in old age, but the course of which can only be slightly medicated, slowing down destructive processes. As for pathological atrophy due to the negative impact of harmful factors or another disease, it is necessary to work on the cause of atrophy to stop or slow down the destruction of neurons.

Atrophy of the substance of the brain, in particular white matter, can develop due to various diseases or age-related changes. It is worth highlighting individual clinical manifestations of pathology.

So, with the destruction of the neurons of the knee, hemiplegia appears, which is a paralysis of the muscles of the body half. The same symptoms occur when the front of the posterior leg is damaged.

The destruction of the posterior region is characterized by a change in sensitivity over half of the body parts (hemianesthesia, hemianopsia and hemiataxy). The defeat of the substance can also cause a complete loss of sensitivity on one side of the body.

Possible mental disorders in the form of lack of recognition of objects, the performance of targeted actions and the appearance of pseudobulbar signs. Progression of this pathology leads to disorders of speech function, swallowing and the appearance of pyramidal symptoms.

[29], [30], [31], [32],

Cortical atrophy of the brain

In connection with age-related changes or as a result of a disease that affects encephalon, it is possible to develop a pathological process such as cortical brain atrophy. Most often, the frontal parts are affected, but the spread of destruction to other areas and structures of gray matter is not excluded.

The disease begins imperceptibly and slowly begins to progress, and the increase in symptoms is observed after a few years. With age and in the absence of treatment, a pathological process actively destroys neurons, which ultimately leads to dementia.

Cortical brain atrophy mainly occurs in people after 60 years of age, but in some cases destructive processes are observed at an earlier age due to a congenital developmental genesis due to a genetic predisposition.

The defeat of the two hemispheres by cortical atrophy occurs in Alzheimer's disease or in other words, senile dementia. The pronounced form of the disease leads to complete dementia, while small destructive foci do not have a significant negative impact on a person's mental capabilities.

The severity of clinical symptoms depends on the location and severity of damage to the subcortical structures or cortex. In addition, the speed of progression and the prevalence of the destructive process should be taken into account.

[33], [34], [35], [36], [37], [38]

Multisystem Brain Atrophy

Degenerative processes are the basis of the development of the Shay-Drageer syndrome (multisystem atrophy). As a result of the destruction of neurons in some areas of gray matter, there are disturbances in motor activity, and control over autonomic functions, for example, arterial pressure or the process of urination, is lost.

Symptomatically, the disease is so diverse that some combinations of manifestations can be distinguished first. Thus, the pathological process is expressed by vegetative dysfunctions, in the form of a parkinsonian syndrome with the development of hypertension with trembling and retardation of motor activity, as well as in the form of ataxia - unsteady walking and coordination disorders.

The initial stage of the disease manifests itself as akinetic-rigid syndrome, which is characterized by delayed movements and has some symptoms of Parkinson's disease. In addition, there are problems with coordination and the genitourinary system. In men, erectile dysfunction can become the first manifestation, when there is no ability to reach and retain an erection.

As for the urinary system, it is worth mentioning urinary incontinence. In some cases, the first sign of pathology may be a sudden fall of a person throughout the year.

With further development, multisystem atrophy of the brain acquires all the new symptoms, which can be divided into 3 groups. The first is parkinsonism, manifested in slow awkward movements and changes in handwriting. The second group includes a delay in urination, urinary incontinence, impotence, constipation and paralysis of the vocal cords. And, finally, the third - consists of dysfunction of the cerebellum, which is characterized by difficulty in coordination, loss of a sense of prostration, dizziness and fainting.

In addition to cognitive impairment, other symptoms are possible, such as dryness in the mouth, skin, changes in sweating, the appearance of snoring, shortness of breath during sleep and double vision.

Diffusive atrophy of the brain

Physiological or pathological processes in the body, in particular, in encephalon can provoke the initiation of neuronal degeneration. Diffuse brain atrophy can occur as a result of age-related changes, genetic predisposition or under the influence of provoking factors. These include infectious diseases, injuries, intoxications, diseases of other organs, as well as the negative impact of the environment.

Due to the destruction of nerve cells, the brain activity decreases, the ability of critical thinking and control over one's actions is lost. In old age, people sometimes change their behavior, which is not always clear to surrounding people.

The onset of the disease can be localized in different areas, which causes a certain symptomatology. As more structures are involved in the pathological process, new clinical signs appear. Thus, the healthy parts of gray matter are gradually affected, which ultimately leads to dementia and loss of personal qualities.

Diffuse atrophy of the brain is initially characterized by the appearance of symptoms similar to the cortical atrophy of the cerebellum, when the gait is broken and spatial sensation is lost. Further manifestations become more, as the disease gradually covers new areas of gray matter.

[39], [40], [41], [42], [43]

Atrophy of the left cerebral hemisphere

Each area of encephalon is responsible for a specific function, so when it is injured, the person loses the ability to perform anything, either physically or mentally.

The pathological process in the left hemisphere causes the occurrence of speech disorders, as motor aphasia. When the disease progresses, speech can consist of separate words. In addition, the logical thinking suffers and the depressive state develops, especially if atrophy is localized mostly in the temporal region.

Atrophy of the left hemisphere of the brain leads to a lack of perception of the full image, the surrounding objects are perceived separately. In parallel, a person's ability to read is violated, the handwriting changes. Thus, analytical thinking suffers, the ability to logically reflect, analyze incoming information and manipulate dates and numbers is lost.

A person can not correctly perceive and consistently process information, which leads to the inability to memorize it. The speech addressed to such a person is perceived separately by suggestions and even words, as a result of which there is no adequate reaction to the appeal.

Atrophy of the left cerebral hemisphere in severe degree can cause complete or partial paralysis of the right side with impaired motor activity due to changes in muscle tone and sensory perception.

[44], [45], [46], [47]

Mixed brain atrophy

Cerebral disorders can occur as a result of age-related changes, under the influence of a genetic factor or concomitant pathology. Mixed atrophy of the brain is a process of gradual death of neurons and their compounds, in which the cortex and subcortical structures suffer.

Degeneration of nervous tissue occurs mostly in women over 55 years of age. Due to atrophy, dementia develops, and that significantly worsens the quality of life. With age, the volume and mass of the brain decrease due to the gradual destruction of neurons.

The pathological process can be observed in childhood, when it comes to the genetic pathway of disease transmission. In addition, there is a concomitant pathology and surrounding factors, for example, radiation.

Mixed brain atrophy encompasses functional areas of encephalon, responsible for controlling motor and mental activity, planning, analysis, and criticizing one's behavior and thoughts.

The initial stage of the disease is characterized by the appearance of lethargy, apathy and a decrease in activity. In some cases, immoral behavior is observed, as a person gradually loses self-criticism and control over actions.

Later, there is a decrease in the quantitative and qualitative composition of the vocabulary, the ability of productive thinking, self-criticism and judgment of behavior are lost, and motor skills are deteriorating, which leads to a change in handwriting. Next, a person ceases to recognize the usual things for him and eventually comes insanity, when there is a virtual degradation of the person.

Atrophy of the parenchyma of the brain

The causes of parenchyma damage are age-related changes, the presence of concomitant pathology, which directly or indirectly affects encephalon, genetic and harmful surrounding factors.

Atrophy of the parenchyma of the brain can be observed due to malnutrition of neurons, since it is the parenchyma that is most sensitive to hypoxia and insufficient intake of nutrients. As a result, cells decrease in size due to compaction of the cytoplasm, nucleus and destruction of cytoplasmic structures.

In addition to qualitative changes in neurons, cells can completely disappear, reducing the volume of the organ. Thus, the atrophy of the parenchyma of the brain gradually leads to a decrease in the weight of the brain. Clinically, parenchyma damage can be manifested by a violation of sensitivity in certain areas of the body, a disorder of cognitive functions, loss of self-criticism and control over behavior and speech function.

The course of atrophy steadily leads to the degradation of the personality and ends with a fatal outcome. With the help of drugs, you can try to slow the development of the pathological process and support the functioning of other organs and systems. Symptomatic therapy is also used to relieve a person's condition.

[48], [49], [50], [51],

Spinal cord atrophy

The reflex spinal cord can carry out motor and autonomic reflexes. Motor nerve cells innervate the muscular system of the body, including the diaphragm and intercostal muscles.

In addition, there are sympathetic and parasympathetic centers, which are responsible for the innervation of the heart, blood vessels, digestive organs and other structures. For example, in the thoracic segment there is a center for pupil dilatation and sympathetic centers for innervation of the heart. The sacral department has parasympathetic centers responsible for the functionality of the urinary and reproductive systems.

Atrophy of the spinal cord, depending on the localization of destruction, can manifest itself by a decrease in sensitivity - with the destruction of neurons of the posterior roots, or motor activity, of the anterior roots. As a result of the gradual defeat of individual segments of the spinal cord, there are violations of the functionality of the organ that is innervated at this level.

Thus, the disappearance of the knee reflex occurs due to the destruction of neurons at the level of 2-3 lumbar segment, plantar - 5 lumbar, and abnormal contraction of the abdominal muscles is observed with the atrophy of nerve cells of 8-12 thoracic segments. Especially dangerous is the destruction of neurons at the level of 3-4 cervical segment, where the motor center of innervation of the diaphragm is located, which threatens human life.

Alcoholic brain atrophy

The most sensitive organ to alcohol is encephalon. Under the influence of alcohol, there is a change in metabolism in neurons, resulting in the formation of alcohol dependence.

Initially, there is a development of alcoholic encephalopathy caused by pathological processes in different areas of the brain, membranes, liquor and vascular systems.

Under the influence of alcohol, cells of subcortical structures and cortices are affected. The destruction of fibers is observed in the brain stem and in the spinal cord. Dead neurons formed islands around the affected vessels with clusters of decomposition products. In some neurons, the processes of shrinkage, displacement and lysis of the nucleus.

Alcoholic brain atrophy causes a gradual increase in symptoms, which starts with alcoholic delirium and encephalopathy, and ends with a fatal outcome.

In addition, there is sclerosis of the vessels with deposition around the brown pigment and hemosiderin, as a consequence of hemorrhages, and the presence of cysts in the vascular plexuses. There may be hemorrhages in the trunk of the encephalon, ischemic changes and degeneration of the neurons.

It is worth highlighting the syndrome of Makiyafav-Binyam, which occurs as a result of frequent use of alcohol in large quantities. Morphologically, the central necrosis of the corpus callosum, its puffiness, as well as demyelination and hemorrhage are revealed.

[52], [53], [54], [55], [56], [57],

Brain atrophy in children

Infrequent brain atrophy occurs in children, but this does not mean that it can not develop if there is any neurological pathology. This fact neurologists should consider and prevent the development of this pathology in the early stages.

To make a diagnosis, they use a survey of complaints, the sequence of symptoms, their duration, as well as their severity and progression. In children, atrophy can develop at the end of the initial stage of the formation of the nervous system.

Brain atrophy in children at the first stage may not have clinical manifestations, which complicates the diagnosis, because parents from the side do not notice deviations, and the process of destruction is already started. In this case, magnetic resonance imaging will help, thanks to which encephalon is layer by layer, and pathological foci are detected.

As the disease progresses, children become nervous, irritable, conflicts with their peers occur, which leads to the solitude of the baby. Further, depending on the activity of the pathological process, cognitive and physical disorders can be added. The treatment is aimed at slowing the progression of this pathology, the maximum elimination of its symptoms and the maintenance of the functioning of other organs and systems.

[58], [59], [60], [61], [62], [63],

Atrophy of the brain in newborns

Most often brain atrophy in newborns is caused by hydrocephalus or edema of the brain. It is manifested by an increased amount of cerebrospinal fluid, thanks to which the protection of encephalon from damage is ensured.

The reasons for the development of dropsy are quite a lot. It can be formed during pregnancy, when the fetus grows and develops, and is diagnosed with ultrasound. In addition, the cause can be various failures in the bookmark and development of the nervous system or intrauterine infections in the form of herpes or cytomegaly.

Also, dropsy and, respectively, brain atrophy in newborns can occur as a result of malformations of the brain or spinal cord, birth trauma accompanied by hemorrhage and the onset of meningitis.

Such a baby should be located in the intensive care unit, as it requires the control of neuropathologists and resuscitators. Effective treatment yet, so this pathology gradually leads to serious violations of the functioning of organs and systems due to their inadequate development.

[64], [65], [66], [67], [68]

Diagnostics of the brain atrophy

When the first symptoms of the disease appear, you should consult a doctor to establish the diagnosis and choose an effective treatment. At the first contact with the patient it is necessary to find out about complaints that are troubling, the time of their occurrence and the presence of already known chronic pathology.

Further, the diagnosis of brain atrophy is the use of an X-ray study, through which encephalon is layer-by-layer to detect additional formations (hematomas, tumors), as well as foci with structural changes. For this purpose, magnetic resonance imaging can be used.

In addition, cognitive tests are conducted, with the help of which the doctor determines the level of thinking and assumes the severity of this pathology. To exclude the vascular genesis of atrophy, dopplerography of the vessels of the neck and brain is recommended. Thus, the lumen of the vessels is visualized, which helps to detect atherosclerotic lesions or the presence of anatomical constrictions.

[69], [70], [71], [72], [73]

Treatment of the brain atrophy

In the genetic genesis of the disease, pathogenetic therapy does not exist, it is only possible to maintain the normal functioning of organs and systems for a certain period. With the help of drugs, the pathological process can slow down its regression, which allows you to lead an active way of life longer.

In the case of age-related changes, the treatment of brain atrophy consists in the use of medicines, ensuring full-fledged care for the person, eliminating irritating factors and protecting from problems.

A person needs the support of close people, and therefore, when the first signs of this pathology appear, do not immediately give a relative to a nursing home. It is advisable to conduct a medication course to maintain the functioning of encephalon and to eliminate the symptoms of the disease.

With a curative purpose, antidepressants, sedatives, including tranquilizers, are widely used, due to which a person relaxes and not so painfully reacts to what is happening. He should be in familiar surroundings, engage in daily activities and preferably sleep during the day.

Effective treatment in our time has not yet been developed, since it is very difficult to deal with the destruction of neurons. The only way to slow the pathological process is the use of vascular drugs that improve cerebral circulation (Cavinton), nootropics (Ceraxon) and metabolic drugs. As a vitamin therapy, it is recommended to use group B to maintain the structure of nerve fibers.

Of course, with the help of medications, you can slow the progression of the disease, but not for long.

Treatment of spinal cord atrophy

The destruction of neurons in both the brain and spinal cord has no pathogenetic therapy in view of the fact that it is extremely difficult to combat genetic, age and other causative factors. When exposed to a negative external factor, you can try to eliminate it, in the presence of concomitant pathology, which contributed to the destruction of neurons, you should reduce its activity.

Treatment of atrophy of the spinal cord mostly based on the attitude of others around them, as it is impossible to stop the pathological process and eventually a person can remain disabled. Good attitude, care and familiar surroundings are the best that a relative can do.

With regard to drug therapy, the treatment of spinal cord atrophy is the use of B vitamins, neurotropic and vascular drugs. Depending on the cause of this pathology, the first thing to do is to eliminate or reduce the effect of the damaging factor.

Prevention

In view of the fact that the pathological process is almost impossible to prevent or stop, the prevention of cerebral atrophy can consist only in the observance of certain recommendations by which it is possible to delay the onset of this pathology in the case of age genesis or to suspend it in other cases.

Prophylactic methods consist in the timely treatment of chronic human concomitant pathology, as exacerbation of diseases can provoke the development of this pathology. In addition, it is necessary to regularly undergo preventive examinations to identify new diseases and their treatment.

In addition, prevention of brain atrophy involves the observance of an active lifestyle, proper nutrition and proper rest. With age, atrophic processes can be observed in all organs, in particular in gray matter. Frequent cause of these diseases is atherosclerosis of cerebral vessels.

Therefore, it is recommended to adhere to certain recommendations for slowing the process of vascular lesions by atherosclerotic deposits. To do this, you need to control the body weight, treat the endocrine system diseases, metabolism, which contribute to obesity.

Also, it is necessary to fight with increased pressure, give up alcohol and smoking, strengthen the immune system and avoid psycho-emotional overstrain.

[74], [75], [76], [77]

Forecast

Depending on the area of the brain that has been most affected by destruction, the prognosis and rate of development of the pathological process should be considered. For example, in Pick's disease, neuronal frontal and temporal areas are destroyed, so that at first personal changes appear (thinking and memory worsen).

Progression of the disease is observed very quickly, as a result - the degradation of the personality. Speech and physical activity acquire a fanciful shade, and depletion of the vocabulary facilitates the use of monosyllabic phrases.

As for Alzheimer's disease, memory impairment is most pronounced here, but personal qualities do not suffer much even at 2 degrees of severity. This is due, for the most part, to gaps in inter-neural connections, than to the death of neurons.

Despite the present illness, the prognosis of brain atrophy is always unfavorable, as it slowly or quickly leads to the onset of dementia and death of a person. The only difference is the duration of the pathological process, and the outcome is the same in all cases.

[78], [79], [80], [81]