Vascular Cognitive Impairment/LATE Flashcards
1
Q
List two trials that showed tx HTN prevents dementia and what it showed
A
SPRINT MIND 2019
- SBP goal <120 vs <140
- Intensive group sig reduced risk of MCI and combined rate of MCI or probable dementia
Syst Euro
- 50% reduction in dementia in patients treated with CCB
2
Q
What 4 vascular risk factors contribute to dementia risk later on?
A
- Hypertension
- Obesity
- Dyslipidemia
- Diabetes
3
Q
What are the 4 types of vascular dementia?
A
- Cortical-subcortical - multiple large infarcts
- Subcortical ischemic - lacunar infarcts, small vessel disease
- Post stroke - immediate and or delayed <6 mos post stroke and doesn’t reverse
- Mixed dementia
4
Q
Diagnostic and management approach for vascular dementia
A
- Imaging - MRI preferred over CT
- Standard diagnostic criteria to diagnose (VASCOG, DSM5, AHA)
- Tx HTN according to HTN Canada - >140/90 tx, high risk patients for intensive as per SPRINT
- Stroke prevention
- ASA if covert infarcts
- CHEI and memantine for tx
5
Q
DSM 5 diagnostic criteria for VAD
A
- Meet criteria for mild or MNCD
- Onset of deficits related to CV event OR evidence for decline prominent in complex attention (incl processing speed) and frontal executive function
- Evidence of cerebrovascular disease from hx, px or neuroimaging
- Not due to another brain disease or disorder
6
Q
Describe features of Balint syndrome, area of brain and most common aetiology, ddx
A
- Optic ataxia
- Oculomotor apraxia
- Simultagnosia
Area = bilateral parietal and occipital areas
Due to ischemic infarcts
Ddx: PRES, PCA, AD
7
Q
What does LATE stand for?
A
Limbic predominant age related TDP-43 encephalopathy
8
Q
What are 2 clinical features of LATE?
A
- Amnestic dementia syndrome
- Evolves to incorporate multiple cognitive domains
- Older when cognitive symptoms occur
- More gradual cognitive decline
