Vascular Dementia

01/01/2014 by admin | Psychiatry

Definition

Vascular dementia is an ischaemic disorder characterized by multiple small cerebral infarcts in the cortex and white matter.

It is not a single disease but a group of syndromes relating to different vascular mechanisms. The distinction between vascular dementia and Alzheimer’s dementia is becoming increasingly blurred because vascular risk factors play a role in both diseases.

 

Epidemiology

Accounts for 20-25% of dementia cases

 

Clinical presentation

When >100 mL of infarcts have occurred, dementia becomes clinically apparent.

  • Onset in the 60’s
  • Personality change
  • Labile mood
  • Preserved insight
  • A stepwise deterioration of cognitive function- the deficits should be severe enough to interfere with activities of daily living- not secondary effects of the cerebrovascular event alone.

 

Other features:

Focal neurology, fits, and nocturnal confusion

 

Risk factors

As for any atherosclerotic disease:

Male sex, smoking, hypertension (most important risk factor), diabetes, and hypercholesterlaemia.

 

Investigations

*It is important to identify depression and treat appropriately. Sometimes it is difficult to distinguish between depression and dementia and depression is quite common in dementia. If in doubt, treat.

Conduct a formal screen for cognitive impairment.

 

Treatment

There is no specific treatment other than to attend to the cerebrovascular risk factors (e.g. aspirin, smoking)

 

Prognosis

Death often occurs within 5 years due to ischaemic heart disease or stroke.

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