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.
Accounts for 20-25% of dementia cases
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.
Focal neurology, fits, and nocturnal confusion
As for any atherosclerotic disease:
Male sex, smoking, hypertension (most important risk factor), diabetes, and hypercholesterlaemia.
*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.
There is no specific treatment other than to attend to the cerebrovascular risk factors (e.g. aspirin, smoking)
Death often occurs within 5 years due to ischaemic heart disease or stroke.