Vascular/Mixed Dementia ☺️

Question 1

Epidemiology
Pathophysiology
Risk factors

Answer 1

2nd most common dementia

• reduced blood flow to brain which eventually damages and kills brain cells
• AD damage synergistic with vascular damage

Vascular risk factors

• STROKE/TIA
• AF
• HTN, DM, cholesterol, DM, smoking, obesity
• FHx of stroke/CVD
• Asian, Afro Caribbean

Question 2

Signs and symptoms

Answer 2

Stepwise progression in cognitive symptoms
-depends on region affected

Amnesia
Aphasia
Apraxia - shuffling, poor balance, falls

Seizures
Focal neurological abnormalities

Question 3

Differentials you want to rule out

-reversible causes

Answer 3

Drugs - medication review (BZ, opioids, anticholinergics, antipsychotics, antidepressants, alcohol)

Endocrine - hypothyroid, Addisons

Mental - depression

Nutritional - B12 (ataxia, memory loss, gait abnormalities), thiamine deficiency (Wernicke’s enceph, Korsakoff psychosis)

Trauma - subdural haemorrhage

Malignancy - brain tumour

Infection - syphillis

Question 4

Management - medical

Answer 4

Vascular optimisation
Prevention of further TIAs - aspirin
HTN - ACEi/ARB or CCB
Cholesterol - atorvastatin
DM - optimise HbA1c 
Symptomatic carotid stenosis - endarterectomy
Physical activity 

AD management - Cholinesterase inh

• donepezil, galantamine, rivastigmine
• memantine

Question 5

Diagnosis

Answer 5

Stepwise cognitive decline that interferes with ADLs
CVD defined by neuro signs/brain imaging
Onset within 3 months of a stroke

Question 6

Management

-supportive

Answer 6

Tailored to individual

• cognitive stimulation programmes, music/arts therapy
• home adaptations
• physio for movement difficulties
• SALT input for speech and swallow