Epidemiology
- A common cause of dementia (15% of cases).
- More common with age and males.
- Higher mortality than alzheimer’s (a diagnosis of dementia after a stroke is an independent predictor of mortality (usually around 5 years).
Subtypes and clinical features
- Vascular dementia usually has a classical ‘step-wise’ progression although there is a degree of gradual decline caused by small vessel disease.
- Multi-infarct dementia (MID)– Multiple mini-strokes lead to the step-wise cognitive decline. Between strokes there may be complete stability. Cardiovascular risk factors/ disease are usually present.
- Strategic infarct dementia– This is a single stroke event that has managed to cause cognitive decline either due to its location or size (often midbrain/lacunar strokes). The cognitive impairment may partially or completely recover after the event.
- Small Vessel disease (Binswanger disease)- Multiple microvascular infarcts of perforating vessels leads to preogressive lacunae and white matter leukoariosis on MRI. (Subcortical dementia- gradual intellectual decline; generalised slowing and motor problems).
- Hypoperfusion injury
- Haemorrhagic
- Other
Clinical Features/Diagnosis
- Onset may follow a CVA and is more acute than Alzheimers. The Hatchinski score may help to support the diagnosis of vascular dementia:
- Emotional and personality changes may be early, followed by cognitive defects.
- Depression and affective lability and confusions are not uncommon, especially at night.
- Behavioural slowing is common too.
- Executive function will usually be lost at some stage (goal formation, initiation, planning etc).
- Memory impairment is less severe than in AD.
- Psychomotor problems are common.
Management
- Establish and treat any causative factors e.g. hypertension. Aspirin might help if started early.
- Whilst anticholinesterase drugs e.g. donezapil/galantamine are unlicensed for vascular dementia, they may be beneficial
Notes on Medicine/Surgery 