Vascular Dementia

Question 1

BisWagner’s disease

Answer 1

Cognitive impairment with ischemia affecting small vessels or periventricular region

Sparing of subcortical u fibers

Results in leukoencephalopathy and dementia

Question 2

Leukoaraiosis

Answer 2

Benign white matter abnormalities observed in elderly not associated with dementia

Nonspecific loss of density of no specific white matter presumably due to diffuse microvascular ischemia

Same as periventricular white matter disease and white matter hypertensity

Question 3

Multi infarct dementia

Answer 3

Dementia in the context of

multiple cerebral infarct with subsequent cerebral volume loss

Temporally concurrent, stepwise progression of cog impairment

Involves lesions of the
cerebral cortex, subcortical white matter, deep gray matter structures

Question 4

Strategic infarct

Answer 4

Vascular dementia can occur due to a single strategic infarct

Common locations of strategic infarct

Lesions of the vasculature supplying left angular gyrus, Caudate nucleus, Globus pallidus, thalamus

Question 5

Lacunar infarct

Answer 5

Multiple lacunar states can produce dementia

Perforating arteries supplying thalamus or subcortical and brainstem structures

Question 6

Cerebral amyloid angiopathy

Answer 6

Pathophysiologic process involving amyloid deposition in blood vessels resulting in repeated hemorrhage
Ischemic infarction

Cognitive loss amyloid the deposition onset after 55

Question 7

Cadasil

Cerebral autosomal dominant arteriopathy with the cortical infarct and leukoencephalopathy

Answer 7

Hereditary non-atherosclerotic or arteriopathy affecting Small vessels and resulting in diffuse white matter disease and smaller lacunar infarct

Patient present with migraine, seizures, depression, TIA, stroke.

Onset middle adulthood

Question 8

Subcortical ischemic vascular disease or small vessel disease

Answer 8

A variety of processes and subcortical micro vascular in parks and ischemia

Small vessel disease affects the supportable white matter and nuclei via pathology of the penetrating arteries as well as the small vessels of the white matter

Question 9

Metabolic and toxic states

Answer 9

Siri roll white matter disease can result from a metabolic disorders such as folate deficiency, vitamin B 12 deficiency, hypoxia,

toxin exposure
Such as chemotherapy radiation therapy, drug abuse, carbon monoxide poisoning

Question 10

Mixed dementia

Answer 10

Coexisting pathophysiology of cerebrovascular disease in another dimension disorder such as AD or Lewy body disease, uncertain causal attribution for the cognitive impairment

Cerebrovascular disease and AD have additive and independent effects in producing dementia, resulting in an earlier expression of cognitive impairment and dementia that would be seen in patients with either AD or CVD alone

Question 11

Strategic infarct syndromes

Answer 11

Left angular gyrus infarct
Caudate nucleus Globus pallidus in thalamus infarct
Thalamus infarct
PCA infarct
ACA infarct

Question 12

Left angular gyrus infarct leads to what kind of deficits

Answer 12

Gertzman syndrome, constructional dysfunction

Question 13

Caudate nucleus, Globus pallidus and thalamus infarct would lead to what kind of deficits

Answer 13

Disrupt dorsolateral prefrontal subcortical circuits underlying executive in motor functions

Question 14

Thalamus infarct would lead to what kind of Neuropsychological deficits

Answer 14

A lot!

Executive dysfunction, language, memory, initiation, inhibition, modulation of mood and emotional behavior

Question 15

Single PCA infarct and deficits

Answer 15

Determined by laterality of lesion. Memory deficits are common

Question 16

Single ACA infart and deficit

Answer 16

Determined by laterality ablation. Neurobehavioral syndromes are common

Question 17

Apoe e4 associated with

Answer 17

Increased risk of cerebral amyloid angiopathy which can lead to VD

Question 18

Vascular dementia prevalence

Answer 18

17.4% in 70+

Prevalence rates double every five years

Question 19

Most vascular dementia cases belong to what type

Answer 19

Mixed dementia with mixed pathology

Only 3% of all dementia cases had pure pathology

Question 20

Early symptoms in vascular dementia

Answer 20

Executive functions
Attention
Processing speed slowing

Question 21

Which part of the brain is often disrupted in vascular cognitive impairment pathology

Answer 21

Deep frontal white matter
Frontals of cortical circuitry
Basal ganglia
Thalamus

Question 22

Lacunar states affecting. Basal ganglia thalamus and related white matter result in what kind of deficits

Answer 22

Dysarthria
Impaired gait
Pseudo bulbar palsy
Lots of initiation

Question 23

Progression of cognitive deficits in vascular dementia

Answer 23

It depends. If it involves a single strategic infarct, answer is abrupt
If dementia occurs in the context of multi infarct dementia, amor stepwise progression would be expected
If it is small vessel disease or subcortical ischemic vascular disease, onset is insidious and progressive course of impairment may be observed

Question 24

Is it hard to determine progression presentation and onset?

Answer 24

Yes, because of the many different pathophysiological processes

Question 25

Neuropsychological findings and vascular dementia

Answer 25

Typically, problem-solving and reasoning tasks depending on speed of processing an executive functions will show the earliest decline

Attention deficit early on

Processing speed deficits ubiquitous
Language is generally preserved early on except word fluency due to speed of processing executive function.

Visual spatial is often affected

Memory deficits likely to appear as a later occurrence after declines in processing, verbal fluency, and executive functions

Executive functions are the earliest deficits observed

Sensory motor deficits, gait disturbance is dysarthria, extraparametal signs, UTI common

Emotion and personality frequently reported psycho motor slowing and depression. Pseudo bulbar palsy may occur

Question 26

Treating vascular dementia

Answer 26

Reduce risk factors for hypertension, hyper cholesterol, diabetes, aFIB, other cardiovascular risk factors

Question 27

Other ways to help reduce risk for vascular dementia

Answer 27

Smoking cessation
Weight reduction
Dietary modification
Limiting alcohol consumption
Increasing physical activities

Question 28

Medication’s for treating vascular dementia

Answer 28

Cholinesterase inhibitors

donazepil, galantamine can help delay cognitive decline