Vascular dementia is characterized 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 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 behavioral 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 gray matter and white matter from predominantly vascular causes: that is, infarction, leukoaraiosis, hemorrhage, and small-vessel changes. Mixed dementia (vascular dementia with comorbid Alzheimer 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 neurologic 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
- neuropsychologic testing
- carotid duplex ultrasound
atherosclerotic ischemic disease
Peter Passmore, BSc, MB, BCh, BAO, MD, FRCP (Lond, Glasg), FRCPI
Professor of Ageing and Geriatric Medicine
Queen's University Belfast
PP declares that he has no competing interests.
Dr Peter Passmore would like to gratefully acknowledge Dr David Wilson, Dr Grant Bateman, and Dr Velandai Srikanth, previous contributors to this topic. DW has received educational grants from Shire. GB and VS declare that they have no competing interests.
Roy J. Goldberg, MD, FACP, AGSF, CMD
Kings Harbor Multicare Center
RJG declares that he has no competing interests.
Craig N. Sawchuk, PhD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
CNS declares that he has no competing interests.
Bryan Bernard, PhD
Assistant Professor and Clinical Neuropsychologist
Department of Neurological Sciences
Rush University Medical Center
BB declares that he has no competing interests.
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