Vascular Dementia

Question 1

Who does VaD affect?

Answer 1

-2nd most common form of dementia in the West
-Most common form in parts of Asia
-Incidence increases with age
-It is thought to account for around 17% of dementia in the UK

Question 2

What causes VaD?

Answer 2

-A group of syndromes of cognitive impairment caused by different mechanisms resulting in ischaemia or haemorrhage 2’ary to CVD
-Multiple infarcts, single strategic infarct or small vessel disease
-Main subtypes are:
–Stroke-related VaD - includes both multi-infarct dementia (result of a series of small strokes) and single-infarct (a large stroke)
–Subcortical VaD (small vessel disease of Binswanger’s disease)
–Mixed dementia - VaD and Alzheimer’s changes seen

Question 3

What risk factors are there for VaD?

Answer 3

-History of CVD
-AF
-HTN
-DM
-Hyperlipidaemia
-Smoking, obesity
-CHD
-FH of stroke / CVD

Question 4

How does VaD present?

Answer 4

-Progressive disease where deteriorations may be sudden or gradual but occur in a stepwise manner
-Presenting features suggesting a vascular cause include:
–focal neuro abnormalities eg visual disturbance, sensory/motor symptoms, EP signs
–inattention and reduced concentration
–seizures
–gait disturbance, falls
–bladder symptoms
–emotional issues
-NICE diagnostic criteria:
–Presence of dementia
–CVD defined by the presence of neuro exam / brain imaging
–A relationship between the two disorders inferred by:
—onset of dementia within 3 months of a recognised stroke
—an abrupt deterioration in cognitive functions
—fluctuating, stepwise progression of cognitive deficits

Question 5

What signs might a VaD patient have on examination?

Answer 5

Diagnosis requires:
-Full history and examination
-formal cognitive impairment eg MOCA, AMTS, MMSE, Addenbrooke’s, GPCOG
-Medication review
-Other reversible causes must be excluded
-MRI shows vascular changes

Question 6

What are the differential diagnoses for VaD?

Answer 6

Same as Alzheimer’s

Question 7

How would you investigate a patient with VaD?

Answer 7

Same as Alzheimer’s

Question 8

What treatment would you discuss with a patient with VaD?

Answer 8

-Same general measures as Alzheimer’s
-Alzheimer’s medications have no use in treating vascular dementia
-Antipsychotics should not be used due to increased risk of adverse events
-Smoking, obesity and diet should be managed with lifestyle advise
-HTN controlled with antihypertensives