Vascular Dementia

Question 1

Three syndromes

Answer 1

• cog deficit following single CVA.
• multi infarct dementia. Can be very extensive. Stepwise cog deterioration btw.
• progressive small vessel dis. Lacunae, WM damage.

Question 2

Px

Answer 2

More acute onset, may follow stroke. Step wise progress.
Emot and personality change 1st.
Then cog incl mem, often fluc.
Dep
Affective lability
Confusion
Behavioural slowing
Anxiety
Seizures
CVS RFs, onset often lniked to an event eg falls, TIAs etc.
Lot somatic complaints often.
Often also have alz pathology too if eld (mixed), makes VD more progressive and unstable.
Unilat limb UMN deifict, plantar reflex ext.

Question 3

Investigation

Answer 3

Dementia screen
Chol, clotting, vascultiis, CRP, complem, ANF, RF, Abs etc. 
ECG, CXR, CT, MRI. 
Echo, carotid doppler. 
Hachinski ischaemic score over 7.

Question 4

Mx

Answer 4

Est cause and tx. RF mx to avoid further strokes.
Daily aspirin
Lifestyle
DM control
Mx HTN
Speech and lang therapy more useful as certain brain areas can be spared.

Question 5

Aetiology

Answer 5

Regional cerebral BF reduc- arteriosclerosis, occlusive neuronald eath, large and small vess, embolus, vasculitis, haemorr.
Oxidative stress
Endoth dam
Chronic hypoperfus
Polio and leukoariosis
Changes in small penet arts and arterioles in WM. WM hyperintensities.