4c. Vascular Dementia

Question 1

How is vascular dementia also called?

Answer 1

Binwanger’s disease

Question 2

What are risk factors of VD? (4x)

Answer 2

1. Hypertension
2. Obesitas
3. Diabetis
4. Smoking

Question 3

What are 4 symptoms of VD?

Answer 3

1. Dementia
2. A temporal relationship between the start of the cognitive changes and the vascular event
3. Evidence in physical examination and on brain imaging
4. The interference with daily functioning has to be a consequence of both motor and cognitive changes

Question 4

What are large and small vessel diseases?

Answer 4

1. Large vessel disease: strategic infarcts or multi-infarcts (multi-infarct dementia).
2. Small vessel disease: lacunar infarcts, white matter lesions, microhemorrhages.

Question 5

What do you see on a MRI scan in VD patients?

Answer 5

Either big cerebrovascular accident resulting in damage to a big part of the brain or more subtle white matter changes or small lacunar infarcts.

Question 6

What 3 clinical features can be distinguished on the level of neurology?

Answer 6

1. Motor slowing
2. Dysartria
3. Hemiparesis

Question 7

What 2 domains are mostly impaired in a NPA in VD patients?

Answer 7

Right-side: often neglect.

If more diffuse:

1. Cognitive deficits: EF, fatigue, language/speech
2. Mood: it can be a direct consequence of the brain damage, but often it’s reactive to the changes, since there is much more insight in the disease process (compared to AD). This insight can lead to mood problems/depression.

Question 8

What are 2 heriditary vascular dementias?

Answer 8

1. CADASIL = Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy
2. HCHWA-D (Katwijkse ziekte) = Hereditary Cerebral Hemorrhage With Amyloidosis – Dutch type

Question 9

Where does CADASIL lead to? (2x)

And where is it caused by?

Answer 9

1. Arteriopathy = damage to the blood vessels, leading to infarcts and …
2. … Leukoencephalopathy = white matter disease

Caused by:
A mutation on the NOTCH3 gene, which caused dementia and in 40% migraine with aura

Question 10

Where is HCHWA-D caused by?

And of what consequence?

Answer 10

Caused by: a mutation on the bètaPP gene, leading to really high mortality.

Consequence of: amyloidosis = amyloid that sticks to the blood vessels in the brain and eventually they will break and there will be a bleeding