Vascular dementia is characterised by a chronic progressive multifaceted impairment of cognitive function.
Loss of brain parenchyma is predominantly from cerebrovascular causes such as infarction and small-vessel changes.
Vascular dementia is the second most common cause of dementia in older people.
A large overlap exists with Alzheimer's dementia and many patients have a mixed form of dementia.
Early aggressive treatment of vascular risk factors is suggested in order to prevent further cerebrovascular disease. Supportive care and management of behavioural and psychological symptoms are also important. Treatments aimed at improving cognitive symptoms have shown no clear benefit.
Vascular dementia is a chronic progressive disease of the brain bringing about cognitive impairment. The executive functions of the brain such as planning are more prominently affected than memory. Motor and mood changes are often seen early. The underlying damage occurs to both grey matter and white matter from predominantly vascular causes: that is, infarction, leukoaraiosis, haemorrhage, and small-vessel changes. Mixed dementia (vascular dementia with comorbid Alzheimer's disease) is common.
History and exam
Key diagnostic factors
- history of stroke(s)
- difficulty solving problems
- slowed processing of information
- poor attention
- retrieval memory deficit
- frontal release reflexes
- focal neurological signs
- impaired gait and balance
- age >60 years
- cigarette smoking
- diabetes mellitus
- alcohol misuse
1st investigations to order
- erythrocyte sedimentation rate
- blood glucose level
- renal and liver function tests
- vitamin B12
- thyroid function
- CT or MRI brain
Investigations to consider
- syphilis serology
- lupus anticoagulant, antiphospholipid, and antinuclear testing
- neuropsychological testing
- carotid duplex ultrasound
atherosclerotic ischaemic disease
- Alzheimer's disease (AD)
- Mild cognitive impairment (MCI)
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- Ethical considerations in dementia diagnosis and care: an AAN position statement
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