vascular dementia

Question 1

pathophysiology of vascular dementia

Answer 1

Brain damage due to cerebrovascular disease: either major stroke, multiple smaller unrecognised strokes (multi-infarct) or chronic changes in smaller vessels (subcortical dementia).

Question 2

features of vascular dementia

Answer 2

stepwise manner

Question 3

what is vascular dementia

Answer 3

it is not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

Question 4

epidemiology of vascular dementia

Answer 4

• VD is thought to account for around 17% of dementia in the UK
• Prevalence of dementia following a first stroke varies depending on location and size of the infarct, definition of dementia, interval after stroke and age among other variables. Overall, stroke doubles the risk of developing dementia.
• Incidence increases with age

Question 5

main subtypes of VD

Answer 5

1) Stroke-related VD – multi-infarct or single-infarct dementia
2) Subcortical VD – caused by small vessel disease
3) Mixed dementia – the presence of both VD and Alzheimer’s disease

Question 6

RFs of VD

Answer 6

History of stroke or transient ischaemic attack (TIA)
Atrial fibrillation
Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
A family history of stroke or cardiovascular

Question 7

when can VD be inheritied

Answer 7

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Question 8

symptoms of VD

Answer 8

• Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
• – hemiparaesis
• – upgoing plantars
• The difficulty with attention and concentration
• Seizures
• Memory disturbance
• Gait disturbance
• Speech disturbance
• Emotional disturbance

Question 9

diagnostic criteria used for VD

Answer 9

NNDS-AIREN

Question 10

what is the diagnostic criteria

Answer 10

1) Presence of cognitive decline that interferes with activities of daily living, not due to secondary effects of the cerebrovascular event
- established using clinical examination and neuropsychological testing

2) Cerebrovascular disease
- defined by neurological signs and/or brain imaging

3) A relationship between the above two disorders inferred by:
- the onset of dementia within three months following a recognised stroke

• an abrupt deterioration in cognitive functions
• fluctuating, stepwise progression of cognitive deficits

Question 11

non pharm Mx of VD

Answer 11

• Tailored to the individual
• Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy
• Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication

Question 12

qs to ask test cognition

Answer 12

name
address for recall
DOB
place
year
name of pM
name of monarch
date of WW1 or WW2
recognition of two ppl
count backwards from 20 to 1

Question 13

Qs to ask in SH

Answer 13

housing
mobility +/- aids
continence/toilet facilities
ADLs
present carers and how they are coping
present social service input

MDT
physiotherapist
OT
dietician
continence advisor
direct nurse liasion
dementia support team
social worker
consider day care, luncheon clubs, respite admission to help carers