Vascular Dementia

Question 1

What are the characteristic features of vascular dementia?

Answer 1

Stepwise decline
Radiological evidence of infarction
Focal neurological signs, often subtle
Presentation depends on the location of the lesions

Question 2

How does a subcortical pattern of lesions present?

Answer 2

Executive function changes
Associated gait disturbance
Urinary incontinence

Question 3

What is the prognosis of vascular dementia?

Answer 3

The 5 year survival rate is 39%

Mortality is higher cf to AD, presumably due to other atherosclerotic events

Question 4

What is Binswanger disease?

Answer 4

The subcortical subtype of VD where gait disturbance, urinary incontinence, and executive function decline predominate early

Patients have a history of HTN

Question 5

What are some typical neuropsychological findings in patients with VD?

Answer 5

Executive dysfunction: poor planning, shifting sets, cognitive slowing
Apathy
Relatively preserved free recall and long term recall

Question 6

What imaging findings are consistent with vascular dementia?

Answer 6

Bilateral multiple lesions affecting the dominant hemisphere and limbic systemic, multiple lacunar infarct, or periventricular white matter infarcts particularly deep white matter

Question 7

How do you treat VD medically?

Answer 7

Prevent more infarcts

• Antiplatelet therapy with aspirin has evidence behind it
• Control risk factors

Pentoxifylline to increase cerebral blood flow