Vascular Dementia

WHAT IS IT?

Vascular [glossary_exclude] dementia [/glossary_exclude] (previously called “multi-infarct dementia”) refers to cognitive changes (dementia) that occur secondary to cerebrovascular disease.

WHAT CAUSES IT?

Both macrovascular (large infarcts) and microvascular (subcortical ischemia do to small vessel disease) can be responsible for this condition.

Cerebrovascular disease is ultimately the cause of vascular dementia (source)
Cerebrovascular disease is ultimately the cause of vascular dementia (source)
WHY IS IT A PROBLEM?

As is the case with any infarction/ischemia in the brain, irreversible damage can be done to the tissues. This manifests as dementia, and can also lead to focal neurological signs/deficiencies within the patient

WHAT MAKES US SUSPECT IT?

Risk factors

Older age, hypertension, diabetes, past history of stroke, atrial fibrillation

*Any risk factors for stroke/cerebrovascular disease 

Initial Presentation

Common Chief Complaints:

  • Memory impairment
  • Cognitive decline
  • Mood impairment
  • Weakness/paralysis

History Of Present Illness:

Executive dysfunction is one of the earless signs.

Stepwise-progression: this condition is characterized by a stepwise progression of symptoms (that are intuitively associated with the stepwise progression of the vascular disease.  

Physical Exam Findings

Mental status exam can show

  • Decreased memory

Motor exam may show patterns of weakness

HOW DO WE CONFIRM A DIAGNOSIS?

Diagnosis ultimately requires a clinical diagnosis of dementia in the presence of proven cerebrovascular disease (that can not be fully attributed to other causes)

HOW DO WE RULE OTHER DIAGNOSES OUT?

Blood tests can be used to rule out:

  • Vitamin deficiency: B12/folate deficiency

CT/MRI can be used to rule out:

  • Structural causes of cognitive impairment
MRI can show evidence of past vascular damage in the brain. This (in the absence of other pathology) is consistent with a diagnosis of vascular dementia (source)
MRI can show evidence of past vascular damage in the brain. This (in the absence of other pathology) is consistent with a diagnosis of vascular dementia (source)
HOW DO WE TREAT IT? 

This condition is treated by controlling the factors that contributed to the cerebrovascular disease:

  • Controlling hypertension
HOW WELL DO THE PATIENTS DO?

Prognosis depends on the extent of the damage, however

WAS THERE A WAY TO PREVENT IT? 

Preventing the cerebrovascular disease (avoiding hypertension, diabetes, atherosclerosis, etc) can sometimes prevent vascular dementia from occurring.

FURTHER READING

DynaMed

UpToDate

 

Page Updated: 07.15.2016