Vascular dementia

Question 1

Second most common cause of dementia

Answer 1

-vascular disease =20% dementias

Question 2

NINCDS-AIREN criteria

Answer 2

• evidence of cerebrovascular disease both on examination and on imaging
• needs onset of dementia within 3 months of a stroke or abrupt deterioration in cognitive function, or fluctuating stepwise course

Question 3

Reflex asymmetry

Answer 3

-most prevalent in 49% of vascular patients

Question 4

3 subtypes

Answer 4

1. cognitive deficits following a single stroke
2. multi-infarct dementia
3. progressive small vessel disease (Biswanger)

Question 5

Cognitive deficits following a single stroke

Answer 5

• more often seen in midbrain and thalamic strokes

- cogntiive deficits may remain fixed or recover either partially or fully

Question 6

Multi-infarct dementia

Answer 6

• multiple strokes lead to stepwise deterioration
• risk factors of CV disease present
• periods of stability between strokes

Question 7

Progressive small vessel disease

Answer 7

• Binswanger disease
• subcortical dementia with a clinical course of slow intellectual decline and generalised slowing
• motor problems are common
• depression can occur
• lacunaes occurs and are seen on MRI plus white matter hyperintensities (leukoariasis)

Question 8

Hachinski Score index

Answer 8

• Abrupt onset (2)
• stepwise progression
• fluctuating course (2)
• confusion
• preservation of personality
• depression
• somatic complaints
• emotional incontence
• history of hypertension
• history of strokes
• atherosclerosis
• focal neurological symptoms and signs (2)
• Score each on e as one. Score below 4 is unlikely, over 7= vascular dementia

Question 9

Risk factors for vascular dementia

Answer 9

• old age, hypertension (50%), IHD
• smoking, ETOH
• hyperlipidemia, AF
• Family history
• APOE4 allele
• polycythemia, sickle cell anaemia, coagulopathies

Question 10

Insight

Answer 10

-retained in VD, lost in AD

Question 11

CADASIL

Answer 11

• cerebroautosomal dominant arteriorpathy with subcortical infarcts and leukoencephalopthy
• form of vascular dementia
• autosomal dominant with high penetrance
• long arm of chromosome 19
• recurrent stroke around the age of 40-50
• history of migraine
• develop subcortical dementia and pseudobulbar palsy

Question 12

MRI in CADASIL

Answer 12

-widespread white matter changes

Question 13

Imaging in vascular dementia

Answer 13

• CT: increased number of infarcts
• MRI: white matter lesions
• SPECT- irregular perfusion deficits
• PET- cerebral blood flow and metabolism reduced
• MRS- absence of phospholipid changes to allow differentiation from AD