Chapter 7

Question 1

Name the main risk factor for Vascular Dementia.

Answer 1

Hypo/hypertension, cardiovascular disease, diabetes, smoking, age, low education, lacunar strokes / white matter lesions, sex (being male).

Question 2

Describe the two possible results of hypertension (leading to VaD).

Answer 2

Hypertension leading to arteriosclerosis, leading to (1) occlusion or (2) hypoperfusion. Respectively, either a complete infarct (lacunar state) or incomplete infarction (damage to white matter; Binswanger’s disease).

Question 3

Describe how a cholinergic deficit can develop as a result of hypertension (and diabetes) and how this influences neuronal blood supply.

Answer 3

Areas of the basal forebrain (NBM, cholinergic system) are penetrated by small arteries that are vulnerable to hypertension. Moreover, the functioning of cholinergic neurons is dependent on proper nutrition (glucose!), which is affected by diabetes. A decrease in glucose metabolism results in a decrease in blood flow, as acetylcholine is important for vasodilatation.

Question 4

Describe the main symptoms of VaD.

Answer 4

Abrupt onset with stepwise deterioration (fluctuating course), nocturnal restlessness, pyramidal and extrapyramidal symtpoms, executive dysfunctions, disinhibited behaviour, motor disturbances (similar to parkinson’s disease), various memory impairments (forgetfulness, rather than amnesia; working memory), reduced psychomotor speed, impairment in attention, apraxic and freezing gait, postural instability.

Question 5

Which functional circuits are mainly affected in VaD?

Answer 5

ARAS, frontostriatal and frontohippocampal circuit.