Vascular Dementia

Question 1

Aetiology

Answer 1

Vascular Dementia (up to 20% of cases)

Occurs as a result of reduced blood supply to the brain due to infarcts caused by thrombo-emboli or arteriosclerosis

It can be cause by a wide variety of cerebrovascular disorders, including large or multiple small infarcts, cerebral amyloid angiopathy, and cerebral autosomal dominant ateriopathy with subcortical infarcts and leukoencephalopathy

Small vessel disease is common in older people, often alongside Alzheimer’s

Risk factors: same as stroke disease older age, males, smoking, high BP, DM, high cholesterol, AF

Question 2

Symptoms

Answer 2

• Sudden onset
• Stepwise increases in the severity of symptoms

NOTE: subcortical ischaemic vascular dementia may present insidiously with gait and attention problems and changes in personality

-Each step represents a sudden deterioration as an infarct occurs

Sudden onset

Stepwise increases in the severity of symptoms

NOTE: subcortical ischaemic vascular dementia may present insidiously with gait and attention problems and changes in personality

Each step represents a sudden deterioration as an infarct occurs
- Focal neurological signs (e.g. hemiparesis, visual field defects)

1st: Labile emotion and minor personality changes
2nd:Cognitive deficit

in AD “mum just isn’t herself anymore”

in VD “mum is a little different and is using her left arm much less”

Question 3

Management

Answer 3

Prevent further cerebrovascular disease by optimal control of major risk factors in those with a history of stroke or TIA

Reduce risk factors (exercise, less alcohol, treat HTN, stop smoking, treat AF, control DM)

Daily aspirin (if indicated due to CVA/AF risk)

Pharmacological treatment

• AChEi ONLY offered if comorbid with Alzheimer’s, Parkinson’s disease dementia or DLB