Vascular dementia (multi-infarct dementia)

• What is Vascular Dementia (Multi-infarct Dementia)
• Statistics on Vascular Dementia (Multi-infarct Dementia)
• Risk Factors for Vascular Dementia (Multi-infarct Dementia)
• Progression of Vascular Dementia (Multi-infarct Dementia)
• Symptoms of Vascular Dementia (Multi-infarct Dementia)
• Clinical Examination of Vascular Dementia (Multi-infarct Dementia)
• How is Vascular Dementia (Multi-infarct Dementia) Diagnosed?
• Prognosis of Vascular Dementia (Multi-infarct Dementia)
• How is Vascular Dementia (Multi-infarct Dementia) Treated?
• Vascular Dementia (Multi-infarct Dementia) References

What is Vascular Dementia (Multi-infarct Dementia)

Vascular dementia is a type of dementia caused by multiple small or large strokes in the brain.

Statistics on Vascular Dementia (Multi-infarct Dementia)

Vascular dementia is the second most common type of dementia, after Alzheimer’s disease. The incidence of vascular dementia increases with increasing age. Overall, dementia affects about 10% of those aged over 65 years with 20% of those over 80 years suffering from severe dementia.

Risk Factors for Vascular Dementia (Multi-infarct Dementia)

The most common cause of vascular dementia is the blockage of small arteries supplying areas of the brain. In classical stroke, large blood vessels are blocked, resulting in the death of brain tissue supplied by that artery. In vascular dementia, the vessels blocked are very small, resulting in the death of small areas of brain tissue on the outer surface of the brain called the cerebral cortex. As this area is responsible for higher thought processes, small areas of damage result in the disordered thought seen in vascular dementia.

The predisposing factors for vascular dementia, therefore, are similar to the risk factors for stroke. These include:

• Hypertension
• Hypercholesterolaemia
• Smoking
• Diabetes mellitus
• A personal or family history of vascular disease

Symptoms of Vascular Dementia (Multi-infarct Dementia)

Patients with multi-infarct vascular dementia will typically describe a history of multiple episodes of sudden neurological deterioration. These may be sudden episodes of weakness in an arm or leg, loss of vision, or loss of speech. Patients may recover slightly from these episodes but will usually not regain full function. There is an associated, progressive loss of memory. Patients may also report difficulties with problem solving, orientation, perception, judgement and concentration.

How is Vascular Dementia (Multi-infarct Dementia) Diagnosed?

In any case of suspected dementia, it is important to exclude reversible (treatable) causes of dementia. Tests may include:

• Blood tests: for chemical or hormone imbalances;
• Brain imaging: with CT or MRI. These can exclude other causes of dementia such as brain tumours. Past strokes may also be visible on these scans.

Prognosis of Vascular Dementia (Multi-infarct Dementia)

The symptoms of vascular dementia are very similar to those of Alzheimer’s disease, with which it may be confused. The patient with vascular dementia will typically experience a step-wise progression of their neurological symptoms. With the recurrence of mini-strokes, the patient will notice a subtle reduction in their level of function. The patient will continue to experience these mini-strokes unless steps are taken to reduce their risk factors. Following a large number of mini-strokes, patients may become unable to manage daily self-care tasks, and require admission to a care facility.

How is Vascular Dementia (Multi-infarct Dementia) Treated?

The treatment of vascular dementia involves the following steps:

1. Investigation for, and treatment of, any reversible cause of dementia.
2. Control the risk factors: this can be done by improving diabetes control with regular assessment and medication review, management of high blood pressure, quitting smoking and reduction of cholesterol using diet and medications.
3. Acetylcholinesterase inhibitors (eg. galantamine, donepezil): these drugs work by increasing the level of a chemical (acetylcholine) within the brain of patients suffering from vascular dementia. The effectiveness of these drugs in the treatment of vascular dementia has been proven in a number of recent clinical trials. The drugs do not cure the underlying disease process, but instead increase levels of acetylcholine to minimise cognitive symptoms caused by the disease.

More information

For more information on dementia, including Alzheimer’s disease and other types of dementia, information for carers of dementia patients and supportive care, as well as some useful tools and videos, see Dementia.

 

Vascular Dementia (Multi-infarct Dementia) References

1. Amar K, Wilcock G. Vascular dementia. BMJ. 1996; 312(7025): 227-31. Full text
2. Braunwald E, Fauci AS, Kasper DL, et al. Harrison’s Principles of Internal Medicine (16th edition). New York: McGraw-Hill Publishing; 2005. Book
3. Evans JG, Williams TF, Beattie BL. Oxford Textbook of Geriatric Medicine (2nd edition). Oxford: Oxford University Press; 2000. Book
4. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. Book
5. Goldman HH. Review of General Psychiatry (5th edition). Baltimore, MD: McGraw-Hill; 2000. Book
6. Sadock BJ, Sadock VA, Kaplan HI (eds). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (8th edition). Philadelphia, PA: Lippincott Williams & Wilkins; 2005. Book
7. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. Book