University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

63

Pages:

2
Author:

Mariam A.

Vascular dementia (VD) Epidemiology  Account for 10 – 20% of dementia.  AD + vascular dementia represents up to 20%. Aetiology  Combination of factors determine the extent of injury and dementia: o Volume of ischaemic damage. o Location. o Number of foci.  Majority caused by atherosclerotic cerebrovascular disease: o Large vessel disease (e.g. stenosis of carotid artery bifurcation). o Small vessel disease (e.g. involvement of penetrating branches of cerebral arteries, resulting in small lucunar infarcts).  Non-atherosclerotic causes of vascular compromise: o Rare familial syndromes with congophilic angiopathy. o Vasculitis. o Thromboembolism secondary to atrial fibrillation, myocardial infarction or cancer. Clinical features  Time course: o Often, but not always sudden. o Variable step-wise course.  Prominent features: o Falls, focal weakness. o Frontal and executive problems. o Cognitive slowing. o Can spare memory and language. o Apathy, delusions, anxiety. Physical findings  Usually motor slowing.  Focal motor signs: o Spasticity. o Asymmetric spasticity. o Asymmetric reflexes. o Extensor plantar reflexes. o Gait disorders.  Changes can be subtle.  Can be normal. Histology  Small vessel disease: o Ischaemic white matter degeneration (Binswanger).    o Lacunar infarction in subcortical and white matter. o Granular atrophy of cortex. Large vessel disease: o Extensive or multifocal infarction. o Critical side infarcts. Hypoperfusion lesions: o Hippocampal sclerosis. o Laminar cortical necrosis. Rare local vascular disorders: o Cerebral vasculitis. o Cerebral amyloidosis. o Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). AD vs. VD  AD: o o o  VD: o o Forgetful, but executive function is mainly intact. No focal signs. Gait is good. Basic memory is fine, but executive function is limited. Gait is not good. Relationship to dementia  Difficulty to assess the degree to which CVD contributes to dementia.  Unreliable epidemiological data. o Co-existing CVD is not uncommon in AD, or other primary neurodegenerative diseases. o Variably reported as either vascular dementia or dementia of Alzheimer’s type.  Most patients with dementia in the setting of severe stroke are probably not included. NINDS-AIREN criteria  Dementia.  Cerebrovascular disease: o Focal neurological signs on examination. o Evidence of relevant cerebrovascular disease by CT or MRI.  A relationship between the above two disorders manifests by: o Dementia onset within 3 months of stroke. o Abrupt deteriorating in cognitive functions. o A fluctuating stepwise course.