Vascular dementia

Second most common form of dementia after Alzheimer’s disease.

Accounts for 10-20% of cases of dementia worldwide.

With Alzheimer’s disease or in combination of both account for 90% of dementia cases.

When vascular abnormalities exist with Alzheimer’s disease the process is ref2242ed to as mixed dementia.

Significant commonality of risk factors with Alzheimer’s disease and include hypertension, diabetes and apoE4 genotype.

Reflects cognitive decline from ischemic, hemorrhagic or oligemic injury to the brain from cardio or cerebrovascular disease.

Ischemia caused by small blood vessel disease from multiple lacuna infarcts and hypoperfused areas from stenosed medullary arterioles.

Linked to cortical and subcortical ischemic changes.

Single ischemic sites in a strategic area of a dominant hemisphere can cause dementia without involvement of a large volume of cerebral tissue.

Volume of tissue loss is not a good predictor of the severity of cognitive impairment.

May be a primary process in dementia but may make other types of dementia worse.

Post stroke form is the most common type.

Hypertension a risk factor.

Diagnosis of probable disease based om whether demementia associated with focal neurological signs and if there is imaging changes of cerebrovascular disease.

Onset is often sudden in association with a TIA or stroke, in contrast to the gradual onset with Alzheimer’s disease.

Multiple strokes affecting large cerebral arteries or a single stroke in a strategic location can result in acute onset of dementia while small vessels in subcortical brain areas can produce gradual onset of symptoms.

The frontal subcortical regions with small arterioles are susceptible to degenerative changes and can occur in poorly controlled diabetes and hypertensive disease.

Approximately 125,000 new cases per year following ischemic stroke in the U.S.

More than 1 million elderly patients suffer with VaD.

Probably the most under diagnosed and under treated form of dementia in elderly individuals.

May be associated with multiple infarcts, single areas of infarct in critical location, small blood vessel disease, hypoperfusion and cerebral hemorrhage.

Commonly progressive impaired cognitive deficits and dementia results from multiple small cerebral infarcts that are staggered.

Aggravated by increased age, diabetes, cardiac arrhythmias, hypertension and congestive heart failure which impair vascular integrity and can increase cognitive difficulties.

Low levels of acetylcholine have been found in the CSF of patients and levels are inversely correlated with the severity of dementia.

Cholinergic impairment is a common feature of cognitive deficits in both vascular and Alzheimer’s disease.

Management focused on preventing strokes with treatment of hypertension, diabetes, atrial fibrillation and treating those with previous history of transient ischemic attack, prior strokes and stopping smoking.

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