Vascular Diseases and Vascular Dementia

Vascular dementia is caused by progressive atherosclerosis leading to multiple small strokes and subsequent brain damage and dementia. Approximately forty percent of all cases of dementia are attributed to vascular dementia.

 

Vascular dementia is caused by the buildup of fat deposits in the walls of arteries leading to atherosclerosis (hardening of the arteries), and resulting in a restriction of blood flow to the brain, which can lead to strokes.

Common causes of vascular dementia include:

The onset of vascular dementia often goes unnoticed in the early stages, particularly when the first strokes that eventually lead to dementia are very minor. Sometimes, symptoms such as cognitive and intellectual impairment and difficulty carrying out everyday tasks may become apparent only in the mid-to-late-stages of vascular dementia. In addition, symptoms may even improve, or at least stabilize for a while, until the next stroke.

Symptoms of vascular dementia vary according to the severity of the strokes, but include:

Routine tests for vascular dementia include clinical assessment, a detailed medical history, a neurological exam, ultrasound and CT (computed tomography scan). Other tests may include MRI and PET scans.

No cure or treatment is currently available for vascular dementia. However, symptomatic treatments can effectively control and delay progression of the disease.

Preventive measures to reduce the likelihood of further strokes include controlling both high blood pressure and high cholesterol levels, a balanced diet and exercise.

The main differences between the two types of dementia is that vascular dementia is characterized by:

In up to twenty percent of autopsies on dementia patients, vascular damage is discovered.

Multi-Infarct Dementia (MID): Multi-infarct dementia is a type of vascular dementia caused by multiple strokes that affect the brain. MID occurs when blood clots form in the brain, leading to the death of brain tissue.

No treatment exists for multi-infarct dementia, although many of the underlying diseases such as hypertension, high blood pressure and diabetes are treatable.

Risk factors for developing MID are similar to those for strokes and include old age, existing heart conditions, high blood pressure and diabetes. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADSIL), a hereditary type of multi-infarct dementia, is also a known risk factor.

The onset of multi-infarct dementia is most common between the ages of 60 and 75. Symptoms include cognitive and motor impairment, psychiatric problems, inappropriate social behavior, memory loss, migraines, depression, incontinence and hallucinations.

 

 

Binswanger's Dementia: Also called subcortical arteriosclerotic encephalopathy, Binswanger's dementia is an uncommon sub-type of multi-infarct dementia that affects the deep hemispheric white matter of the brain. Binswanger's is a neurological disease characterized by infarcts in the frontal lobes of the brain.

This rare type of vascular disease is linked with hypertension and severe atherosclerosis. Symptoms include intellectual impairment, memory loss, mood swings, personality changes and progressive dementia.

Resources

Hale, K.L. & Frank, J. (2005). Dementia overview. eMedicine Consumer Health.

Beers, M.H. & Berkow, R. (ed). Dementia. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

National Institute of Neurological Disorders and Stroke. (2005). NINDS Binswanger's disease information page.

National Institute of Neurological Disorders and Stroke. (2005). NINDS multi-infarct dementia information page.