Vascular dementia
Vascular dementia, also known as multi-infarct dementia (MID) and vascular cognitive impairment (VCI), is dementia caused by problems in the supply of blood to the brain, typically by a series of minor strokes. Vascular dementia is the second most common form of dementia after Alzheimer’s disease in older adults. Early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable and treatable.
Signs and symptoms
Dementias present similarly to one another and are very difficult to differentiate clinically. Patients suffering from Vascular dementia present with cognitive impairment, usually following one or many strokes. The symptoms may progress gradually or step-wise after each small stroke. Some people may appear to improve between events and decline after more silent strokes.
Vascular Dementia and Depression
Vascular dementia peaks between the 4th and the 7th decades of life and 80% of patients will have a history of elevated blood pressure. Vascular dementia patients develop progressive cognitive, motor and behavioral signs and symptoms and tend to have better free recall compared with Alzheimer’s disease patients but significant deficits in planning and execution of various tasks. Many patients also develop mood symptoms such as depression and if the frontal lobes are affected, which is often the case, patients may present as apathetic. This is often accompanied by problems with attention, orientation and urinary incontinence.
Causes
Risk factors for vascular dementia include age, hypertension, smoking, lack of exercise, elevated blood cholesterol, diabetes mellitus, cardiovascular disease, and cerebrovascular disease. Other risk factors include a person’s geographic origin (the disease is more common in Asian countries), genetic predisposition, and prior strokes.
Treatment
The goal of treatment is the prevention of further cerebrovascular lesions. Studies now convincingly show that treatment of elevated blood pressure can slow or stop the progression of vascular dementia.
Important points
Cholinesterase inhibitors such as Donepezil, Rivastigmine, Galantamine that are prescribed for Alzheimer’s disease have not shown to be helpful for Vascular dementia and could be even harmful by interfering with the cardiovascular function.
Behavioral and mood symptoms are particularly important in this patient group and tend to be resistant to conventional antidepressant medications, which could lead to hospital admission and placement in permanent care.
Treatment of elevated blood pressure can slow disease progression
As with most medical conditions, a timely evaluation by a physician specializing in diagnosis and treatment of memory disorders is the best approach to assuring the optimal outcome of a memory problem.
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