Vascular dementia

Question 1

Define vascular dementia (and RF, aetiology)

Answer 1

dementia caused by thromboembolies or narrowing of arteries

RF - CVD RF- age, male, obesity, lack of exercise, smoke, AF, DM, HTN, CVA hx

Question 2

Sx of vascular dementia

Answer 2

Suddent onset (especially after CVA) + STEPWISE deterioration
usually emotional and minor personality changes 1st 
then cognitive decline

with - focal neurological signs -reflecting sign of infact- UMN
co morbid depression
relatively PRESERVED personality

eg-
AD-mum isnt herself anymore
VD - mum is a little different and not using her arm much

Question 3

Ix of vascular dementia

Answer 3

same as general dementia
Cognitive Assessment:
Screening à AMTS, GPCOG
· AMTS (score <7 suggests cognitive impairment)
· GPCOG (GP Assessment of Cognition)
Detailed à Addenbrooke’s (ACE-R), MMSE, MoCA
· ACE-R = 100 questions

o Dementia/delirium screen:
TFTs (hypothyroid à cognitive decline) LFTs (Korsakoff’s) U&Es and dipstick (infection, diabetes)HbA1c (diabetes) Vitamin B12 and folate
+ ECG MRI/CT

Question 4

Mx of vascular dementia

Answer 4

Biological - daily aspririn of relevant CVA/AF risk
reduce RF -exercise, alcoho, HTN, stop smoke, treat AF, control DM

psychosocial–
explain diangosis well - and deliver like bad news
Optimise health
identify further wishes (advanced directive, LPA’s, etc

follow up every 6m- personaliy or with named care manager
General -always wear ID, dosset box for medication,
carers
social support

LEGALLY HAVE TO INFORM DVLA and INSURERS (for any dementia)