Updated: 7/28/2019

Vascular Dementia

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Snapshot
  • A 68-year-old man presents to his neurologist for a follow-up visit. He experienced his second ischemic stroke approximately 6 months ago and has minimal neurological deficits. He continues to take his aspirin, maximum intensity statin, and lisinopril. He is accompanied by his wife, who said he has been having trouble with planning or solving complex tasks. Physical examination is notable for impaired executive functioning. An MRI brain demonstrates cortical ischemic changes.
Introduction
  • Definition
    • dementia caused primarily by cerebrovascular disease
  • Epidemiology
    • incidence
      • second most common cause of dementia
        • Alzheimer disease is the most common cause
  • Etiology
    • cerebrovascular disease
    • impaired cerebral blood flow
  • Pathogenesis
    • cerebral infarction results in improper brain functioning
  • Associated conditions
    • Alzheimer disease
    • depression
Presentation
  • Symptoms
    • cognitive decline
      • impaired executive function (most prominent finding)
      • "stepwise cognitive decline"
Imaging
  • MRI brain
    • indication
      • more sensitive for detecting ischemic changes
Studies
  • Cognitive screening tests
    • e.g., Montreal cognitive assessment (MoCA)
Differential
  • Alzheimer disease
    • differentiating factor
      • episodic memory is prominently found
        • impaired recollection of previous experiences
  • Dementia with Lewy bodies
    • differentiating factors
      • fluctuating cognition
      • visuospatial dysfunction (prominent finding)
      • REM sleep behavior disorder
      • visual hallucinations
Treatment
  • Risk factor management is also important in managing vascular dementia
    • e.g., strict blood pressure management, improving blood glucose control, implementing a statin, and initiating aspirin
  • Medical
    • acetylcholinesterase inhibitors
      • indication
        • recommended for vascular dementia
      • medications
        • donepezil
        • galantamine
        • rivastigmine
Complications
  • Depression
  • Impaired activities of daily living
 

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