Vascular Dementia

Question 1

Outline the clinical features of vascular dementia

Answer 1

1) Stepwise fluctuating decline
2) Earliest deficit executive function
3) Subcortical infarcts
- early amnesia, dysarthria, parkinsonism
- stooped posture w/increased tone

4) Cortical infarcts
- early amnesia, apraxia, aphasia, agnosia, acalculia
- normal posture
- late dysarthria

Medial frontal –> executive function, avolition, apathy
Medial temporal –> anterograde amnesia
Left parietal –> apraxia, aphasia, agnosia
Right parietal –> hemineglect, visuospatial

Question 2

Outline the genes involved in vascular dementia

Answer 2

NOTCH13 (Chr19) [same as ApoE4!!!]

- predisposes to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Question 3

Outline the pathology seen in vascular dementia

Answer 3

1) Multiple cortical or subcortical infarcts

2) Subcortical white matter infarcts (Binswanger disease)

Question 4

Outline the Hachinski Ischemic Score

Answer 4

≥7 = multi-infarct dementia

1) Stepwise deterioration (1)
2) Fluctuating course (1)
3) Sudden onset (2)

4) Nocturnal confusion (1)
5) Relatively spared personality (1)
6) Depressive disorder (1)
7) Somatic complaints (1)
8) Emotional incontinence (1)

9) Hx HT (1)
10) Hx stroke (2)
11) Evidence atherosclerosis (1)

12) Focal neurological symptoms (2)
13) Focal neurological signs (2)