Vascular dementia, also known as multi-infarct dementia, is characterized by cognitive decline due to cerebrovascular pathology. The cerebrovascular damage causes chronic ischemia that leads to cognitive decline and it may occur due to a myriad of etiologies, including atherosclerosis, inflammatory conditions, genetic defects, among others.
SIGNS & SYMPTOMS:
The clinical manifestations are variable and depend on the area affected. An important aspect of the symptoms is that they appear (after a subclinical or clinical vascular event such as stroke or TIA) and stay stationary for a period until they suddenly get worse again (stepwise pattern), instead of a progressive linear deterioration as observed in another dementias.
As mentioned before, a wide variety of neurological manifestations can occur that may include cognitive decline, focal motor signs, behavioral changes, urinary incontinence, aphasia, gait disorders, among others.
There is not a single, clear-cut widely accepted diagnostic tool for vascular dementia, with different entities suggesting different criteria.
In general they agree that for a patient to be diagnosed with vascular dementia he must have in his history, physical examination and complimentary tests:
Abrupt onset of neurological decline
History of vascular disease or risk factors
Absence of clinical features that point to another dementia cause
General tests to exclude other causes of dementia should be obtained (CBC, B12 levels, TSH).
Neuroimaging (MRI) may show nonspecific findings (e.g. white matter lesions)
Carotid Doppler and echocardiogram to exclude cardioembolic sources should also be obtained in such patients.
Since vascular dementia is often caused by atherosclerosis, the treatment of conditions that may lead to atherosclerosis is reasonable. Hypertensive patients should have their hypertension treated, diabetic patients should keep their glucose under control, and hyperlipidemic patients should also have that issue addressed.
Regarding pharmacological therapy, the evidence for the use of acetylcholinestesase inhibitors (e.g. donepezil 5-10mg qDay) and NDMA antagonists (e.g. memantine 20mg qDay) for vascular dementia is not clear. However, the use of both may be benefitial in some cases, since some patients with Vascular disease have also Alzheimer disease.
Other measures that are useful for patients with any kind of dementia may also be helpful for patients with vascular dementia. These range from the management of behavioral symptoms with occupational therapy, music and aromatherapy to, in most advanced cases, palliative care and end of life measures.
SOURCES & FURTHER READING:
- Gorelick PB. Risk Factors for Vascular Dementia and Alzheimer Disease. Stroke. 2004;35:2620-2622.
- Orgogozo JM et al. Efficacy and Safety of Memantine in Patients With Mild to Moderate Vascular Dementia. A Randomized, Placebo-Controlled Trial (MMM 300). Stroke. 2002;33:1834-1839.
- Alagiakrishnan K. Vascular Dementia Treatment & Management. Medscape. Updated: Nov 01, 2016.
- Baskys A, Hou AC. Vascular dementia: Pharmacological treatment approaches and perspectives. Clin Interv Aging. 2007 Sep; 2(3): 327–335.
Chui HC et al. Clinical Criteria for the Diagnosis of Vascular DementiaA Multicenter Study of Comparability and Interrater Reliability. Arch Neurol. 2000;57(2):191-196.