Vascular dementia Flashcards
Pathophysiology
- Cerebrovascular disease
* Think of the causes for stroke (Revise stroke and TIA alongside this)
RFs vascular dementia
Past stroke/MI/TIA, smoking, HTN, DM, ^ cholesterol, FHx f CVD, valvular disease, sickle cell, coagulopathies, atrial myxoma…etc
CFs vascular dementia
age
Neurological Sx’s and signs
- Step-wise decline (rather than continuous deterioration) = stepwise increases in severity of symptoms
- 65-75yo
- More acute than AD
- EXAM → Neurological Sx’s and signs (e.g. unilateral spastic weakness of limbs or increased tendon reflexes, extensor plantar response or pseudobulbar palsy
- On examination: focal neurology (UMN signs: rigidity, akinesia, brisk reflexes, pseudobulbar palsy) + signs of CV disease elsewhere
Distinctive features vascular dementia
- Early: Emotional/personality changes → then: cognitive deficits (+ memory)
- Depression w/ episodes of affective lability + confusion common (at night)
- Behavioural slowing + anxiety
- 10% seizures
Ix vascular dementia
- Routine dementia screen (see Alzheimer’s + dementia)
- Serum cholesterol, clot screen, vasculitis screen (ESR, CRP, complement, Anti-nuclear factor, RF, anti-dsDNA Abs, anti-phospholipid Ab’s)
- Syphilis serology (unusual cases: e.g. young strokes)
- ECG, CXR, CT, MRI
- Other: ECH (cardiac/valvular defects or disease)
- Carotid artery Doppler US
Rx vascular dementia
- Find causative factors
- Rx treatable causes
- Daily aspirin
- Change diet, stop smoking, Rx HTN/cholesterol, exercise ^, DM control
Mixed dementia
AD + VD
Pathophysiology and aetiology of lewy body dementia
Mixed picture
• Pathological features of AD + Parkinson’s
• Lewy Bodies – abnormal deposits of protein called alpha-synuclein that build up inside nerve cells in Parkinson’s as well as Lewy Body dementia
• Alzheimer’s changes: e.g. neurofibrillary tangles + beta-amyloid plaque formation
• Axonal loss
CFs lewy body dementia
- VISUAL HALLUCINATIONS → people, animals
- Day-to-day fluctuations in cognitive performance
- Motor signs of Parkinson’s: tremor, rigidity, bradykinesia, shuffling gait
- Recurrent falls + syncope
- Significant depressive episode
- If dementia first or w/in 12 months of Parkinson’s dx then → DLB (But: if people w/ PD develop dementia after 12 months then = PD w/ dementia)
- Anti-psychotic sensitivity!!!! (DON’T GIVE THEM ANTI-PSYCHOTICS → easy exam Q)
Ix lewy body dementia
- Dementia screen tests
- CT/MRI head
- SPECT HMPAO scan (blood flow)
- SPECT FP-CIT
- ApoE genotype testing
Rx lewy body dementia
- AVOID/USE W/ CAUTION: anti-psychotics → irreversible Parkinsonism, impaired consciousness, neuroleptic malignant syndrome
- Rx depression + other psychiatric/behavioural Sx’s
Don’t use anti-psychotics or use carefully because can cause severe adverse effects: worsening of extrapyramidal features and neuroleptic sensitivity reactions)
