Mechanism for the formation of separation ...

The mechanism of separation is associated primarily with hypertension and is as follows. Chronic uncontrolled hypertension leads to secondary changes in the vascular wall lipogialinozu, which develops mainly in the vessels of microcirculation. Developing as a consequence arteriolosclerosis leading to changes in the physiological reactivity of blood vessels. Under these conditions, reduction in blood pressure resulting from the accession of heart failure with reduced cardiac output or as a result of excessive antihypertensive therapy, or as a result of physiological circadian changes in blood pressure leads to hypoperfusion in areas of terminal circulation. The latter include the above-mentioned deep cerebral structures [9,23,26,37]. Acute ischemic episodes in a pool of deep penetrating arteries give rise to small diameter lacunar infarcts in deep brain regions. When unfavorable AH repeated acute episodes lead to the emergence of the so-called lacunar state, which is one of the options multiinfarktnoy vascular dementia [25.29]. In addition to repeated acute disorders, it is assumed, and the presence of chronic ischemia in areas of terminal circulation. Marker of the latter is rezrezhenie periventricular or subcortical white matter leykoareozis that pathology is an area of ??demyelination, gliosis, and expansion of perivascular spaces [9,23,26,32]. In some cases, the adverse flow of arterial hypertension may develop subacute diffuse white matter lesions of the brain to the clinic rapidly progressive dementia and other forms of separation, which is sometimes referred to in the literature, the term Binswanger's disease [30]. Neuropsychological manifestations of the phenomenon of separation leading role in the formation of cognitive impairment in vascular cerebral insufficiency plays a disconnection of the frontal lobes and subcortical structures, which leads to the emergence of secondary dysfunction of the frontal lobes of the brain. The frontal lobes have a very significant difference in cognitive performance. According to the theory of AR Luria, which is divided at present the overwhelming majority of the neuropsychologist, the frontal lobes are responsible for the regulation of voluntary activity: the formation of motivation, the choice of goals, the construction program and monitor its achievement [1012]. In this dorzolateralnaya frontal lobe cortex and its relation to striate complex provides switchable attention that is necessary to change the algorithm work. Orbitofrontal departments involved in the suppression of irrelevant goal motives, thus ensuring stability of attention and the adequacy of behavioral responses. In addition, the orbitofrontal frontal cortex is in close relationship with the hippocampus, providing stability to attention mnestic activity [13.37]. Dysfunction of the frontal lobes of the brain leads to the formation dizregulyatornogo syndrome.