Major/Mild Vascular Neurocognitive Disorder

Question 1

criteria A for M/M Vascular NCD

Answer 1

criteria are met for M/M NCD

Question 2

criterion B for M/M Vascular NCD

Answer 2

the clinical features are consistent with a vascular etiology, as suggested by EITHER of the following:

1. onset of the cognitive deficits is temporally associated to one or more cerebrovascular events
2. evidence for decline is prominent in COMPLEX ATTENTION (including processing speed) and FRONTAL EXECUTIVE function

Question 3

criterion C for M/M Vascular NCD

Answer 3

there is evidence of the presence of cerebrovascular disease from history, physical exam and/or neuroimaging considered sufficient to account for the neurocognitive deficits

Question 4

criterion D for M/M Vascular NCD

Answer 4

the symptoms are not better explained by another brain disease or systemic disorder

Question 5

what criteria must be met to diagnose probably M/M Vascular NCD

Answer 5

one of the following is present:

1. clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributable to cerebrovascular disease (neuroimaging supported)
2. the neurocognitive syndrome is temporally related to one or more documented cerebrovascular events
3. both clinical and genetic (ie cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present

Question 6

when is possible M/M Vascular NCD diagnosed

Answer 6

if the clinical criteria are met but neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one or more CVAs is not established

Question 7

what types of vascular etiology may result in a diagnosis of M/M Vascular NCD

Answer 7

may range from large vessel stroke to microvascular disease and so the presentation can be heterogenous

Question 8

what is the usual progression of cognitive decline in M/M Vascular NCD

Answer 8

some may present with stepwise or fluctuating decline in cognition, and intervening periods of stability

others may present with gradual onset with slow progression and rapid development of deficits followed by relative stability, or another complex presentation

Question 9

what progression characterizes M/M Vascular NCD due to small vessel disease

Answer 9

that with gradual onset and slow progression

progression of microvascular disease usually lead to lesions in the basal ganglia, white matter and/or thalamus

gradual progression often punctuated by acute events that leave subtle neurological deficits

Question 10

what cognitive deficits are likely to arise in those with small vessel disease leading to M/M Vascular NCD

Answer 10

disruption of cortical-subcortical circuits, and complex attention–> particularly speed of information processing and executive ability

Question 11

how much cerebrovascular disease must be seen on neuroimaging to justify “major” vascular NCD? “mild” vascular NCD?

Answer 11

mild–> history of single stroke or extensive white matter disease is generally sufficient

major–> two or more strokes, a strategically placed stroke or a combination of white matter disease and one or more lacunes is necessary

Question 12

what other symptoms are commonly associated with M/M Vascular NCD and would raise index of suspicion

Answer 12

personality and mood changes

abulia

depression

emotional lability

*development of late onset depressive symptoms accompanied by psychomotor slowing and executive dysfunction is a common presentation among older adults with progressive small vessel ischemic disease (“vascular depression”)

Question 13

how common is M/M Vascular NCD

Answer 13

second most common cause of NCD after alzheimers

Question 14

what is the population prevalence of M/M Vascular NCD in those 65-70 years old

Answer 14

0.2%

Question 15

what is the population prevalence of M/M Vascular NCD in those older than 80

Answer 15

16%

*in neuropathology series, this icnreases to 44.6% at age 90 or older

Question 16

what % of people go on to be diagnosed with dementia within 3 months following a stroke

Answer 16

20-30%

Question 17

which sex is more likely to develop M/M Vascular NCD

Answer 17

men

Question 18

what neuroplasticity factors may influence neurogcognitive outcomes of vascular brain injury

Answer 18

education

physical exercise

mental activity

Question 19

what are the main risk factors for M/M Vascular NCD

Answer 19

same as for cerebrovascular disease:

HTN
diabetes
smoking
obesity
atrial fibrillation
high cholesterol
high homocystein levels

Question 20

ddx for M/M Vascular NCD

Answer 20

other neurocognitive disorders

• -alzheimers
• -lewy body

other medical conditions

• -brian tumour
• -MS
• -encephalitis
• -toxic or metabolic disorders

other mental disorders

• -delirium
• -MDD

Question 21

how do you distinguish lewy body dementia from M/M Vascular NCD

Answer 21

LBD has core features of fluctuating cognition, visual hallucinations and spontaneous parkinsonism

Question 22

what other NCD frequently co occurs with M/M Vascular NCD

Answer 22

alzheimers

if meet criteria for both, diagnose both

Question 23

what mental disorder frequently co occurs with M/M Vascular NCD

Answer 23

depression