vascular dementia

Question 1

what is VD?

Answer 1

second most common form of dementia - group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

Question 2

what are the main types of VD?

Answer 2

stroke-related VD- multi or single infarct dementia (stroke doubles risk of developing dementia)

subcortical VD- caused by small vessel disease

mixed dementia- presence of VD + AD

Question 3

what are risk factors for VD?

Answer 3

History of stroke or transient ischaemic attack (TIA)
Atrial fibrillation
Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
A family history of stroke or cardiovascular

very rare inherited case of CADASIL- cerebral autosomal dominant arteriopathy w subcortical infarcts + leukoencephalopathy

Question 4

how do patients with VD present?

Answer 4

several months/years of a history of sudden or stepwise deterioration of cognitive function

Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
The difficulty with attention and concentration
Seizures
Memory disturbance
Gait disturbance
Speech disturbance
Emotional disturbance

Question 5

what can MRI scan show in VD?

Answer 5

infarcts + extensive white matter changes

Question 6

how is diagnosis of VD made?

Answer 6

using NINDS-AIREN criteria for probable vascular dementia

1. Presence of cognitive decline that interferes with activities of daily living, not due to secondary effects of the cerebrovascular event
   - established using clinical examination and neuropsychological testing
2. Cerebrovascular disease
   - defined by neurological signs and/or brain imaging
3. A relationship between the above two disorders inferred by:
   - the onset of dementia within three months following a recognised stroke
   - an abrupt deterioration in cognitive functions
   - fluctuating, stepwise progression of cognitive deficits

Question 7

what is non-pharmacological management of VD?

Answer 7

cognitive stimulation programmes
multisensory stimulation
music and art therapy
animal-assisted therapy

Question 8

what is pharmacological management of VD?

Answer 8

consider AChE inhibitors or memantine if VD + suspected comorbid AD, PDD or LBD

no evidence for aspirin or statins