Causes and symptoms of vascular dementia

Risk factors for stroke also serve as risk factors and vascular dementia. These include hypertension, diabetes, atrial fibrillation, smoking, ischemic heart disease, heart failure, noise heard over the carotid artery, alcohol abuse, old age, male sex. Additional risk factors for vascular dementia include low educational level, unskilled labor, the presence of the APOE-e4 allele, the absence of estrogen replacement therapy in menopause, the presence of epileptic seizures, cardiac arrhythmias, pneumonia. The presence of these factors supports the diagnosis of vascular dementia, but is not mandatory for its establishment. Nevertheless, measures to reduce these risk factors are one of the most important areas in the prevention and treatment of vascular dementia.

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Risk Factors for Vascular Dementia

• Arterial hypertension
• Diabetes
• Smoking
• Ischemic heart disease risk
• Heart rhythm disturbances,
• Heart failure
• Noise above the carotid arteries
• Elderly age
• Male
• Low educational level
• Profession
• APOE-e4
• Epileptic seizures
• Uncorrected osteogenic insufficiency

It is accepted to distinguish several subtypes of vascular dementia.

So, in the recently published review of Koppo, eight of them have been singled out. The first subtype of vascular dementia is multi-infarct dementia. It is characterized by the presence of multiple major cerebral infarcts, often resulting from cardiogenic embolism. According to some reports, 27% of cases of vascular dementia belong to this type. The second type of vascular dementia is associated with single or multiple heart attacks localized in strategic zones (the thalamus, the white matter of the frontal lobe, the basal ganglia, the angular gyrus). This subtype accounts for 14% of cases of vascular dementia.

The third subtype of vascular dementia is characterized by the presence of multiple subcortical lacunar infarctions that result from arteriosclerotic or degenerative changes in the walls of deep penetrating arterioles, often associated with hypertension or diabetes. Clinically, in this case, the development of dementia may be preceded by episodes of transient ischemic attacks or strokes with good recovery of functions, but often the brain damage remains subclinical up to a certain time, and subsequently manifests itself gradually increasing cognitive defect, simulating the symptoms   of Alzheimer's disease. In neuroimaging, subcortical lacunar infarcts are identified. Lacunar infarctions lead to the development of separation syndromes with a decrease in blood flow and metabolic activity in distant cortical and subcortical structures. This is the most frequent subtype of vascular dementia, which accounts for about 30% of its cases.

Subtypes of vascular dementia

• Multi-infarct dementia
• A single heart attack or several heart attacks located in the "strategic" zones
• Multiple subcortical lacunar infarcts
• Arteriosclerotic subcortical leukoencephalopathy
• Combination of large and small infarcts, affecting cortical and subcortical structures
• Hemorrhagic foci, infarct dementia.
• Subcortical lacunar infarctions due to genetically determined arteriolopathies
• Mixed (vascular and Alzheimer's) dementia

A fourth subtype of vascular dementia - this disease Binswanger, or subcortical arteriosclerotic leukoencephalopathy. Pathomorphologically, Binswanger's disease is characterized by a decrease in white matter density, resulting from the partial loss of myelin sheaths, oligodendrocytes and axons. Small vessels, blood supplying white matter, are occluded by fibrogialin tissue. Clinically, the disease manifests itself as dementia, rigidity of limbs, abulia, incontinence. Differential diagnosis must be made with AIDS, multiple sclerosis or the effects of radiation. Progression of Binswanger's disease occurs gradually or stupenoobrazno, and neurological symptoms are increasing for several years. In neuroimaging, multiple lacunar infarcts, changes in periventricular white matter, and hydrocephalus are identified.

The fifth subtype of vascular dementia is characterized by a combination of large and small infarcts involving both cortical and subcortical structures.

The sixth subtype of vascular dementia occurs as a result of hemorrhagic brain damage in intracranial hemorrhages. Risk factors in this case are uncontrolled arterial hypertension, arteriovenous malformations, intracranial aneurysms.

The seventh subtype of vascular dementia is caused by genetically determined arteriopathies, which cause subcortical lacunar infarcts. Pathomorphologically, in this case, lesions of small penetrating arteries, blood supplying the basal ganglia and subcortical white matter, are revealed. Examples are familial amyloid angiopathy, coagulopathy, or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy - TsADASIL.

The eighth subtype of vascular dementia is a combination of vascular dementia and Alzheimer's disease (mixed dementia). Usually these are patients with an indication of Alzheimer's disease in a family history, also having risk factors for stroke. In neuroimaging, cortical atrophy and cerebral infarcts or hemorrhagic foci are detected. This subtype of vascular dementia also includes patients with Alzheimer's disease who developed intracerebral hemorrhage as a complication of concomitant amyloid angiopathy.