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Vascular dementia
Last reviewed: 23.04.2024
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Vascular dementia is an acute or chronic decline in cognitive function, resulting from a diffuse decrease in the blood supply to the brain or local infarctions, which in most cases are associated with cerebrovascular disease.
In the US, vascular dementia ranks second in prevalence after Alzheimer's disease. In some other regions of the world, where the incidence of stroke is very high, vascular dementia is ahead of the prevalence of Alzheimer's disease. Various criteria have been proposed for the diagnosis of vascular dementia, including the criteria NINDS-AIREN, ADDTC, DSM-IV (American Psychiatric Association, 1994), ICD-10. The DSM-IV and ICD-10 criteria are intended for clinical practice and are more sensitive than the criteria developed for scientific research (NINDS-AIREN).
These criteria of vascular dementia have significant differences, which predetermines the wide variability in its diagnosis. Several studies compared criteria across the same patient groups. As a result, it turned out that only a small part of the patients met all the criteria at the same time. Diagnostic criteria differ in sensitivity and specificity and are not interchangeable. In some studies, the diagnosis was made taking into account neuroimaging criteria in addition to clinical ones. Only a few criteria are validated pathomorphologically. The lack of common criteria makes it difficult to study the issues of differential diagnosis, epidemiology, prognosis and treatment.
Causes of Vascular Dementia
Vascular dementia is the second leading cause of dementia in the elderly. In most cases, it occurs in men, usually at the age of 70 years. Most often it occurs in people with vascular risk factors (including hypertension, diabetes, hyperlipidemia, smoking), and in those who have suffered several strokes. Many patients have a combination of vascular dementia and Alzheimer's disease.
Vascular dementia occurs in situations where cerebral infarcts (or sometimes hemorrhages) result in the loss of as many neurons or axons that disrupt the functioning of the brain. Vascular dementia is the result of small vascular disease (lacunar disease) or medium-sized vessels (multi-infarct dementia).
Binswanger's dementia (subcortical atherosclerotic encephalopathy) is a rare occurrence of dementia that occurs against the background of the lesion of small vessels in the brain, is associated with severe poorly controlled hypertension. In the development of the disease there are multiple lacunar infarctions in the white and gray matter of the deep hemispheres of the brain.
The symptoms of the dementia vascular are similar to other types of dementia. However, since cerebral infarctions are at the basis of vascular dementia, the disease tends to develop discretely; each episode is accompanied by a further intellectual decline, sometimes following a moderately strong recovery. In the case of disease progression, deficit neurological symptoms often appear, which is represented by an increase in deep tendon reflexes, extensor plantar phenomena, gait disorders, limb muscle weakness, hemiplegia, pseudobulbar paralysis with violent laugh and crying syndrome, extrapyramidal disorders. However, in the case of ischemic brain damage against the background of the defeat of small vessels, this deterioration is gradual in nature. Cognitive functions may suffer selectively. Patients with incomplete aphasia can be largely aware of their deficiency, so with this type of dementia, depression can develop more often than with the rest.
[Diagnosis of vascular dementia
Diagnosis of vascular dementia is similar to the diagnosis of other types of dementia. If there is focal neurological symptomatology or evidence of cerebrovascular disease, a compulsory thorough examination for a stroke is necessary.
CT and MRI can reveal bilateral multiple infarcts in the hemispheres and limbic system, multiple lacunar cysts, or periventricular white matter damage spreading into the hemispheres. With dementia of Binswanger, neuroimaging reveals leukoencephalopathy in the zone of the semiovalicular center adjacent to the cortex, often with the presence of lacunae that affect the structure of the gray matter deep in the hemispheres of the brain (including the basal ganglia, the thalamus).
In the differential diagnosis of vascular dementia and Alzheimer's disease, it may be useful to use the ischemic Khachinsky scale.
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Treatment of vascular dementia
The level of 5-year mortality is 61%, and it is higher than for most other types of dementia, which, apparently, is associated with concomitant disorders caused by atherosclerosis.
In general, the treatment is the same as with other dementias. However, vascular dementia is preventable and its progression can be slowed down by reducing blood pressure and its control, cholesterol-lowering therapy, regulation of blood glucose (from 90 to 150 mg / dL), and non-smoking.
The efficacy of drugs that improve cognitive function, including cholinesterase inhibitors, has not been established. Despite this, due to the fact that many patients also have Alzheimer's disease, the use of these drugs can bring certain benefits. The use of additional drugs to correct depression, psychosis and sleep disorders is useful.
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