| Revision as of 12:26, 10 April 2024 editOzzie10aaaa (talk | contribs)Autopatrolled, Extended confirmed users, New page reviewers214,159 edits →Epidemiology← Previous edit | Latest revision as of 20:01, 1 November 2024 edit undoSlothwizard (talk | contribs)Extended confirmed users1,398 editsNo edit summaryTags: Visual edit Mobile edit Mobile web edit | ||
| (41 intermediate revisions by 9 users not shown) | |||
| Line 1: | Line 1: | ||
| {{Short description|Dementia |
{{Short description|Dementia resulting from stroke}} | ||
| {{cs1 config|name-list-style=vanc|display-authors=6}} | |||
| {{Infobox medical condition (new) | {{Infobox medical condition (new) | ||
| | name |
| name = Vascular dementia | ||
| |image=BrainAtrophy(exvacuo).png | | image = BrainAtrophy(exvacuo).png | ||
| |caption=Brain atrophy from |
| caption = Brain atrophy from vascular dementia | ||
| |image_size=300px | | image_size = 300px | ||
| | synonyms |
| synonyms = Dementia due to cerebrovascular disease;<ref name="ICD11" /><br /> Vascular cognitive impairment<ref name="iadecola">{{cite journal |vauthors=Iadecola C, Duering M, Hachinski V, Joutel A, Pendlebury ST, Schneider JA, Dichgans M |title = Vascular Cognitive Impairment and Dementia|journal=Journal of the American College of Cardiology |volume=73 |issue=25 |pages=3326–3344 |date=July 2019 |pmid=31248555 |pmc=6719789 |doi=10.1016/j.jacc.2019.04.034}}</ref> | ||
| | symptoms |
| symptoms = ], short-term ]<ref name=nhlb/> | ||
| | complications = ], loss of ability to care for self and ], ]<ref name="mlp">{{cite web |title=Vascular dementia |url=https://medlineplus.gov/ency/article/000746.htm |publisher=MedlinePlus, US National Library of Medicine |language=en}}</ref> | |||
| | complications = | |||
| | onset |
| onset = | ||
| | duration |
| duration = | ||
| | types |
| types = | ||
| | causes = Conditions that impair blood vessels in the brain and therefore interfere with oxygen delivery to the brain<ref name=nhlb/> | |||
| | causes = | |||
| | risks = ], ], ], ]<ref name="nhlb">{{cite web |title=Vascular dementia |url=https://www.nhlbi.nih.gov/health/vascular-dementia |publisher=National Heart, Lung, and Blood Institute, US National Institutes of Health |language=en |date=28 September 2022|accessdate=10 April 2024}}</ref> | |||
| | risks = | |||
| | diagnosis = Lab test, neuroimaging test, neuropsychological testing<ref name="sanders">{{cite web |vauthors=Sanders AE, Schoo C, Kalish VB|title=Vascular dementia |url=https://www.ncbi.nlm.nih.gov/books/NBK430817/ |publisher=StatPearls, US National Library of Medicine |access-date=9 April 2024 |date=22 October 2023|pmid=28613567 }}</ref> | |||
| | diagnosis = | |||
| | differential = | | differential = ]<ref name=sanders/> | ||
| | prevention |
| prevention = | ||
| | treatment = | | treatment = ]<ref name=nhlb/><ref name=mlp/> | ||
| | medication |
| medication = | ||
| | prognosis |
| prognosis = | ||
| | frequency = 15-30% of dementia cases in the United States, Europe, and Asia<ref name=sanders/><ref name=wong/> | |||
| | frequency = | |||
| | deaths |
| deaths = | ||
| }} | }} | ||
| '''Vascular dementia''' is ] caused by a series of ]s.<ref name=iadecola/><ref name=mlp/> Restricted blood flow due to strokes reduces oxygen and glucose delivery to the brain, causing cell injury and neurological deficits in the affected region.<ref name="wong">{{cite journal |vauthors=Wong CE, Chui CH |title=Vascular cognitive impairment and dementia |journal=Continuum|volume=28 |issue=3 |pages=750–780 |date=June 2022 |pmid=35678401 |pmc=9833847 |doi=10.1212/CON.0000000000001124}}</ref> Subtypes of vascular dementia include subcortical vascular dementia, multi-infarct dementia, stroke-related dementia, and mixed dementia.<ref name=iadecola/><ref name=sanders/> | |||
| '''Vascular dementia''' is ] caused by problems in the ], resulting from a ]. Restricted blood supply (]) leads to cell and tissue death in the affected region, known as an ]. The three types of vascular dementia are subcortical vascular dementia, multi-infarct dementia, and stroke related dementia.{{cn}} Subcortical vascular dementia is brought about by ] in the brain. Multi-infarct dementia is brought about by a series of ]s where many regions have been affected. The third type is ] related where more serious damage may result.{{cn}} Such damage leads to varying levels of cognitive decline. When caused by mini-strokes, the decline in ] is gradual.<ref>{{MedlinePlusEncyclopedia|000746|Multi-infarct dementia}}</ref> When due to a stroke, the cognitive decline can be traced back to the event.<ref name="dementia cunningham">{{cite journal | vauthors = Cunningham EL, McGuinness B, Herron B, Passmore AP | title = Dementia | journal = The Ulster Medical Journal | volume = 84 | issue = 2 | pages = 79–87 | date = May 2015 | pmid = 26170481 | pmc = 4488926 }}</ref> | |||
| Subcortical vascular dementia occurs from ] in the brain. Multi-infarct dementia results from a series of small strokes affecting several brain regions. Stroke-related dementia involving successive small strokes causes a more gradual decline in ].<ref name=mlp/> Dementia may occur when neurodegenerative and cerebrovascular pathologies are mixed, as in susceptible elderly people (75 years and older).<ref name=iadecola/><ref name=sanders/> Cognitive decline can be traced back to occurrence of successive strokes.<ref name=mlp/> | |||
| ⚫ | ] lists vascular dementia as |
||
| ⚫ | ] lists vascular dementia as ''dementia due to cerebrovascular disease''.<ref name="ICD11">{{cite web |title=ICD-11: Dementia due to cerebrovascular disease |url=https://icd.who.int/browse/2024-01/mms/en#1365258270 |publisher=World Health Organization |access-date=10 April 2024|date=2024}}</ref> ] lists vascular dementia as either ''major or mild vascular neurocognitive disorder''.<ref name="DSM5">{{cite book | author = American Psychiatric Association |url=https://archive.org/details/diagnosticstatis0005unse/page/621|title=Diagnostic and statistical manual of mental disorders : DSM-5|date=2013|publisher=American Psychiatric Association|isbn=978-0-89042-554-1|edition=5th|location=Washington, DC|pages=}}</ref> | ||
| ==Signs and symptoms== | ==Signs and symptoms== | ||
| People with vascular dementia present with progressive ], acutely or sub-acutely as in ], frequently step-wise, after multiple strokes.<ref name=sanders/> | |||
| ⚫ | Differentiating dementia syndromes can be challenging, due to the frequently overlapping clinical features and related underlying pathology. ], involving two types of dementia, can occur. In particular, ] often co-occurs with vascular dementia. |
||
| The disease is described as both a ] and ] within the ].<ref name="ICD11A">{{cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/334423054 |website=icd.who.int |access-date=2022-12-09}}</ref> Signs and symptoms are cognitive, motor, behavioral, and for a significant proportion of people, also ]. These changes typically occur over a period of 5–10 years. Signs are typically the same as in other dementias, but mainly include cognitive decline and memory impairment of sufficient severity as to interfere with activities of daily living, sometimes with presence of focal neurological signs, and evidence of features consistent with cerebrovascular disease on brain imaging (CT or MRI).<ref name=mlp/><ref name=sanders/> | |||
| People with vascular dementia present with progressive ], acutely or sub-acutely as in ], frequently step-wise, after multiple cerebrovascular events (strokes). Some people may appear to improve between events and decline after further ]s. A rapidly deteriorating condition may lead to death from a stroke, heart disease, or infection.<ref>{{cite web| author = Office of Communications and Public Liaison|title=NINDS Multi-Infarct Dementia Information Page|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Multi-Infarct-Dementia-Information-Page |website=www.ninds.nih.gov |access-date=2017-09-19}}</ref> | |||
| The |
The neurological signs localizing to certain areas of the brain that can be observed are ], ], ], extensor ]es, ], ], as well as ] problems and ]. People have patchy deficits in terms of cognitive testing. They tend to have better ] and fewer ] when compared with people having ].<ref>{{cite web |last1=Alagiakrishnan |first1=Kannayiram |title=Vascular Dementia Clinical Presentation: History, Physical, Causes |url=https://emedicine.medscape.com/article/292105-clinical#b4 |website=emedicine.medscape.com |access-date=2021-03-19}}</ref> In the more severely affected people, or those affected by infarcts in ] or ] areas, specific problems with speaking called ] and ]s may be present.<ref name=iadecola/><ref name=sanders/> | ||
| In ], the frontal lobes are often affected. Consequently, people with vascular dementia tend to perform worse than their Alzheimer's disease counterparts in ] tasks, such as verbal fluency, and may present with frontal lobe problems: ], ] (lack of will or initiative), problems with attention, orientation, and urinary incontinence. They tend to exhibit more ] behavior. People with vascular dementia may also present with general slowing of processing ability, difficulty ], and impairment in abstract thinking. Apathy early in the disease is more suggestive of vascular dementia.<ref name= |
In ], the frontal lobes are often affected. Consequently, people with vascular dementia tend to perform worse than their Alzheimer's disease counterparts in ] tasks, such as verbal fluency, and may present with frontal lobe problems: ], ] (lack of will or initiative), problems with attention, orientation, and urinary incontinence. They tend to exhibit more ] behavior. People with vascular dementia may also present with general slowing of processing ability, difficulty ], and impairment in abstract thinking. Apathy early in the disease is more suggestive of vascular dementia.<ref name=iadecola/><ref name=sanders/> | ||
| Rare genetic disorders that cause vascular lesions in the brain have other presentation patterns. As a rule, they tend to occur earlier in life and have a more aggressive course. In addition, infectious disorders, such as ], can cause arterial damage, strokes, and bacterial inflammation of the brain.<ref>{{Cite journal |last1=Cannistraro |first1=Rocco J. |last2=Badi |first2=Mohammed |last3=Eidelman |first3=Benjamin H. |last4=Dickson |first4=Dennis W. |last5=Middlebrooks |first5=Erik H. |last6=Meschia |first6=James F. |date=2019-06-11 |title=CNS small vessel disease: A clinical review |journal=Neurology |volume=92 |issue=24 |pages=1146–1156 |doi=10.1212/WNL.0000000000007654 |issn=1526-632X |pmc=6598791 |pmid=31142635}}</ref> | Rare genetic disorders that cause vascular lesions in the brain have other presentation patterns. As a rule, they tend to occur earlier in life and have a more aggressive course. In addition, infectious disorders, such as ], can cause arterial damage, strokes, and bacterial inflammation of the brain.<ref>{{Cite journal |last1=Cannistraro |first1=Rocco J. |last2=Badi |first2=Mohammed |last3=Eidelman |first3=Benjamin H. |last4=Dickson |first4=Dennis W. |last5=Middlebrooks |first5=Erik H. |last6=Meschia |first6=James F. |date=2019-06-11 |title=CNS small vessel disease: A clinical review |journal=Neurology |volume=92 |issue=24 |pages=1146–1156 |doi=10.1212/WNL.0000000000007654 |issn=1526-632X |pmc=6598791 |pmid=31142635}}</ref> | ||
| ==Causes== | ==Causes== | ||
| ] | |||
| Vascular dementia can be caused by ischemic or hemorrhagic ]s affecting multiple brain areas, including the ] territory, the ]s, or the ].<ref name= |
Vascular dementia can be caused by ischemic or hemorrhagic ]s affecting multiple brain areas, including the ] territory, the ]s, or the ].<ref name=sanders/> On rare occasion, infarcts in the ] or ] are the cause of dementia.<ref>{{cite journal |last1=Kaur |first1=Mandeep |last2=Sharma |first2=Saurabh |title=Molecular mechanisms of cognitive impairment associated with stroke |journal=Metabolic Brain Disease |date=1 February 2022 |volume=37 |issue=2 |pages=279–287 |doi=10.1007/s11011-022-00901-0 |pmid=35029798 |url=https://link.springer.com/article/10.1007/s11011-022-00901-0 |language=en |issn=1573-7365}}</ref> A history of stroke increases the risk of developing dementia by around 70%, and recent stroke increases the risk by around 120%.<ref name = "Kuźma_2018">{{cite journal | vauthors = Kuźma E, Lourida I, Moore SF, Levine DA, Ukoumunne OC, Llewellyn DJ | title = Stroke and dementia risk: A systematic review and meta-analysis | language = English | journal = Alzheimer's & Dementia | volume = 14 | issue = 11 | pages = 1416–1426 | date = November 2018 | pmid = 30177276 | pmc = 6231970 | doi = 10.1016/j.jalz.2018.06.3061 }}</ref> Brain vascular lesions can also be the result of diffuse ], such as ].<ref name=sanders/> | ||
| ===Risk factors=== | |||
| ⚫ | ]s for vascular dementia include increasing age, ], smoking, ], ], ], and ].<ref name= |
||
| {{seealso|Brain health and pollution#Cognitive decline and dementia}} | |||
| ⚫ | ]s for vascular dementia include increasing age, ], smoking, ], ], ], and ].<ref name=iadecola/><ref name=sanders/> Other risk factors include lifestyle, geographic origin, and ] ].<ref name=iadecola/><ref name=sanders/> | ||
| Vascular dementia can sometimes be triggered by ], which involves accumulation of ] plaques in the walls of the cerebral arteries, leading to breakdown and rupture of the vessels.<ref name= |
Vascular dementia can sometimes be triggered by ], which involves accumulation of ] plaques in the walls of the cerebral arteries, leading to breakdown and rupture of the vessels.<ref name=iadecola/><ref name=sanders/> Since amyloid plaques are a characteristic feature of ], vascular dementia may occur as a consequence.<ref name=iadecola/><ref name=wong/> | ||
| ==Diagnosis== | ==Diagnosis== | ||
| Several specific diagnostic criteria can be used to diagnose vascular dementia, including the ], Fourth Edition (DSM-IV) criteria, the ], Tenth Edition (ICD-10) criteria, the ] criteria, Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria, the Alzheimer's Disease Diagnostic and Treatment Center criteria, and the Hachinski Ischemic Score (after ]).<ref>{{cite journal |last1=Robinson |first1=Louise |last2=Tang |first2=Eugene |last3=Taylor |first3=John-Paul |title=Dementia: timely diagnosis and early intervention |journal=BMJ |date=16 June 2015 |volume=350 |pages=h3029 |doi=10.1136/bmj.h3029 |url=https://www.bmj.com/content/350/bmj.h3029.abstract |language=en |issn=1756-1833}}</ref> |
Several specific diagnostic criteria can be used to diagnose vascular dementia, including the ], Fourth Edition (DSM-IV) criteria, the ], Tenth Edition (ICD-10) criteria, the ] criteria, Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria, the Alzheimer's Disease Diagnostic and Treatment Center criteria, and the Hachinski Ischemic Score (after ]).<ref name=iadecola/><ref name=wong/><ref>{{cite journal |last1=Robinson |first1=Louise |last2=Tang |first2=Eugene |last3=Taylor |first3=John-Paul |title=Dementia: timely diagnosis and early intervention |journal=BMJ |date=16 June 2015 |volume=350 |pages=h3029 |doi=10.1136/bmj.h3029 |pmid=26079686 |pmc=4468575 |url=https://www.bmj.com/content/350/bmj.h3029.abstract |language=en |issn=1756-1833}}</ref> | ||
| The recommended investigations for cognitive impairment include: blood tests (for anemia, vitamin deficiency, thyrotoxicosis, infection, |
The recommended investigations for cognitive impairment include: blood tests (for anemia, vitamin deficiency, thyrotoxicosis, infection, among others), chest xray, ], and neuroimaging, preferably a scan with a functional or metabolic sensitivity beyond a simple CT or MRI.<ref name=iadecola/><ref name=mlp/> When available as a diagnostic tool, ] (SPECT) and ] (PET) neuroimaging may be used to confirm a diagnosis of multi-infarct dementia in conjunction with evaluations involving ].<ref name=iadecola/><ref name=mlp/><ref name=wong/> | ||
| In a person already having dementia, SPECT appears to be superior in differentiating multi-infarct dementia from Alzheimer's disease, compared to the usual mental testing and ] analysis.<ref>{{cite journal |last1=Engelhardt |first1=E |last2=Tocquer |first2=C |last3=André |first3=C |last4=Moreira |first4=DM |last5=Okamoto |first5=IH |last6=Cavalcanti |first6=JLS |last7=Working Group on Alzheimer's Disease and Vascular Dementia of the Brazilian Academy of |first7=Neurology |title=Vascular dementia: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I. |journal=Dementia & Neuropsychologia |date=October 2011 |volume=5 |issue=4 |pages=251–263 |doi=10.1590/S1980-57642011DN05040003 |pmid=29213752 |pmc=5619038}}</ref>{{additional citation needed|date=April 2024}} | |||
| ⚫ | The screening blood tests typically include ], ], ], lipid profile, ], ], ] serology, calcium serum level, fasting glucose, ], ], ], and ]. |
||
| ⚫ | The screening blood tests typically include ], ], ], lipid profile, ], ], ] serology, calcium serum level, fasting glucose, ], ], ], and ].<ref name=mlp/><ref name=wong/> | ||
| ===Differential diagnosis=== | |||
| ⚫ | Differentiating dementia syndromes can be challenging, due to the frequently overlapping clinical features and related underlying pathology. ], involving two types of dementia, can occur. In particular, ] often co-occurs with vascular dementia.<ref name=iadecola/><ref name=sanders/> | ||
| Mixed dementia is diagnosed when people have evidence of ] and cerebrovascular disease, either clinically or based on neuro-imaging evidence of ischemic lesions.<ref>{{Cite journal|last1=Custodio|first1=Nilton|last2=Montesinos|first2=Rosa|last3=Lira|first3=David|last4=Herrera-Pérez|first4=Eder|last5=Bardales|first5=Yadira|last6=Valeriano-Lorenzo|first6=Lucía|date=2017|title=Mixed dementia: A review of the evidence|journal=Dementia & Neuropsychologia|volume=11|issue=4|pages=364–370|doi=10.1590/1980-57642016dn11-040005|issn=1980-5764|pmc=5769994|pmid=29354216}}</ref> | Mixed dementia is diagnosed when people have evidence of ] and cerebrovascular disease, either clinically or based on neuro-imaging evidence of ischemic lesions.<ref>{{Cite journal|last1=Custodio|first1=Nilton|last2=Montesinos|first2=Rosa|last3=Lira|first3=David|last4=Herrera-Pérez|first4=Eder|last5=Bardales|first5=Yadira|last6=Valeriano-Lorenzo|first6=Lucía|date=2017|title=Mixed dementia: A review of the evidence|journal=Dementia & Neuropsychologia|volume=11|issue=4|pages=364–370|doi=10.1590/1980-57642016dn11-040005|issn=1980-5764|pmc=5769994|pmid=29354216}}</ref> | ||
| ===Pathology=== | ===Pathology=== | ||
| Gross examination of the brain may reveal noticeable lesions and damage to blood vessels. Accumulation of various substances such as lipid deposits and clotted blood appear on microscopic views. The ] is |
Gross examination of the brain may reveal noticeable lesions and damage to blood vessels.<ref name=iadecola/><ref name=wong/> Accumulation of various substances such as lipid deposits and clotted blood appear on microscopic views. The ] is substantially affected, with noticeable atrophy (tissue loss), in addition to calcification of the arteries.<ref name=iadecola/><ref name=wong/><ref>{{cite journal |last1=Hase |first1=Yoshiki |last2=Horsburgh |first2=Karen |last3=Ihara |first3=Masafumi |last4=Kalaria |first4=Raj N. |title=White matter degeneration in vascular and other ageing-related dementias |journal=Journal of Neurochemistry |year=2018 |volume=144 |issue=5 |pages=617–633 |doi=10.1111/jnc.14271 |pmid=29210074 |s2cid=33778577 |doi-access=free |hdl=20.500.11820/780992bd-e933-4715-8099-c4d463070a58 |hdl-access=free }}</ref> Microinfarcts may also be present in the gray matter (cerebral cortex), sometimes in large numbers.<ref name=iadecola/> | ||
| Although ] of the major cerebral arteries is typical in vascular dementia, smaller vessels and arterioles are mainly affected. |
Although ] of the major cerebral arteries is typical in vascular dementia, smaller vessels and arterioles are mainly affected.<ref name=iadecola/><ref name=wong/> | ||
| ==Prevention== | ==Prevention== | ||
| Early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable. ] are irreversible, but the person with vascular dementia can demonstrate periods of stability or even mild improvement.<ref name="VaD textbook">{{cite book|last1=Erkinjuntti|first1=Timo|editor4-first=John|editor4-last=Geddes|editor3-first=Juan|editor3-last=Lopez-Ibor|editor2-first=Nancy|editor2-last=Andreasen|editor1-first=Michael|editor1-last=Gelder|title=New Oxford Textbook of Psychiatry|date=February 2012|publisher=Oxford University Press|location=Oxford|isbn= |
Early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable. ] are irreversible, but the person with vascular dementia can demonstrate periods of stability or even mild improvement.<ref name="VaD textbook">{{cite book|last1=Erkinjuntti|first1=Timo|editor4-first=John|editor4-last=Geddes|editor3-first=Juan|editor3-last=Lopez-Ibor|editor2-first=Nancy|editor2-last=Andreasen|editor1-first=Michael|editor1-last=Gelder|title=New Oxford Textbook of Psychiatry|date=February 2012|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-969675-8|edition=2|url=http://oxfordmedicine.com/view/10.1093/med/9780199696758.001.0001/med-9780199696758-chapter-48|access-date=2015-09-07|doi=10.1093/med/9780199696758.001.0001}}</ref> Since stroke is an essential part of vascular dementia,<ref name = "Kuźma_2018" /> the goal is to prevent new strokes. This is attempted through reduction of stroke risk factors, such as ], ], ], or ].<ref name=iadecola/><ref name=sanders/> | ||
| Medications for high blood pressure are used to prevent pre-stroke dementia.<ref name="sant">{{cite journal |vauthors=Santisteban MM, Iadecola C, Carnevale D |title=Hypertension, neurovascular dysfunction, and cognitive impairment |journal=Hypertension |volume=80 |issue=1 |pages=22–34 |date=January 2023 |pmid=36129176 |pmc=9742151 |doi=10.1161/HYPERTENSIONAHA.122.18085}}</ref> These medications include ]s, ]s, ]s, sympathetic nerve inhibitors, ]s or ]s.{{medcn|date=April 2024}} | |||
| A 2023 review found that therapy with ] drugs was ineffective in treating or preventing stroke or dementia in people without a history of cerebrovascular disease.<ref name="goldstein">{{cite journal |vauthors=Goldstein LB, Toth PP, Dearborn-Tomazos JL, Giugliano RP, Hirsh BJ, Peña JM, Selim MH, Woo D|title=Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association |journal=Arteriosclerosis, Thrombosis, and Vascular Biology |volume=43 |issue=10 |pages=e404–e442 |date=October 2023 |pmid=37706297 |doi=10.1161/ATV.0000000000000164|url=https://www.ahajournals.org/doi/full/10.1161/ATV.0000000000000164}}</ref> | |||
| ==Treatment== | ==Treatment== | ||
| As of |
As of 2024, there are no medications used specifically for prevention or treatment of vascular dementia.<ref name=mlp/><ref name=nhlb/> | ||
| ==Prognosis== | ==Prognosis== | ||
| Many studies have been conducted to determine average survival of people with dementia. The studies were frequently small and limited, which caused contradictory results in the connection of mortality to the type of dementia and the person's gender. One 2015 study found that the one-year mortality was three to four times higher in people after their first referral to a day clinic for dementia, when compared to the general population.<ref name="van de vorst prognosis">{{cite journal | vauthors = van de Vorst IE, Vaartjes I, Geerlings MI, Bots ML, Koek HL | title = Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands | journal = BMJ Open | volume = 5 | issue = 10 | pages = e008897 | date = October 2015 | pmid = 26510729 | pmc = 4636675 | doi = 10.1136/bmjopen-2015-008897 }} {{open access}}</ref> If the person was hospitalized for dementia, the mortality was even higher than in people hospitalized for ].<ref name="van de vorst prognosis" /> Vascular dementia was found to have either comparable or worse survival rates when compared to Alzheimer's disease;<ref>{{cite journal | vauthors = Villarejo A, Benito-León J, Trincado R, Posada IJ, Puertas-Martín V, Boix R, Medrano MR, Bermejo-Pareja F | title = Dementia-associated mortality at thirteen years in the NEDICES Cohort Study | journal = Journal of Alzheimer's Disease | volume = 26 | issue = 3 | pages = 543–51 | date = 2011 | pmid = 21694455 | doi = 10.3233/JAD-2011-110443 }}</ref> another |
Many studies have been conducted to determine average survival of people with dementia. The studies were frequently small and limited, which caused contradictory results in the connection of mortality to the type of dementia and the person's gender. One 2015 study found that the one-year mortality was three to four times higher in people after their first referral to a day clinic for dementia, when compared to the general population.<ref name="van de vorst prognosis">{{cite journal | vauthors = van de Vorst IE, Vaartjes I, Geerlings MI, Bots ML, Koek HL | title = Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands | journal = BMJ Open | volume = 5 | issue = 10 | pages = e008897 | date = October 2015 | pmid = 26510729 | pmc = 4636675 | doi = 10.1136/bmjopen-2015-008897 }} {{open access}}</ref> If the person was hospitalized for dementia, the mortality was even higher than in people hospitalized for ].<ref name="van de vorst prognosis" /> Vascular dementia was found to have either comparable or worse survival rates when compared to Alzheimer's disease;<ref>{{cite journal | vauthors = Villarejo A, Benito-León J, Trincado R, Posada IJ, Puertas-Martín V, Boix R, Medrano MR, Bermejo-Pareja F | title = Dementia-associated mortality at thirteen years in the NEDICES Cohort Study | journal = Journal of Alzheimer's Disease | volume = 26 | issue = 3 | pages = 543–51 | date = 2011 | pmid = 21694455 | doi = 10.3233/JAD-2011-110443 }}</ref> another 2014 study found that the prognosis for people with vascular dementia was worse for male and older people.<ref>{{cite journal | vauthors = Garcia-Ptacek S, Farahmand B, Kåreholt I, Religa D, Cuadrado ML, Eriksdotter M | title = Mortality risk after dementia diagnosis by dementia type and underlying factors: a cohort of 15,209 patients based on the Swedish Dementia Registry | journal = Journal of Alzheimer's Disease | volume = 41 | issue = 2 | pages = 467–77 | date = 2014 | pmid = 24625796 | doi = 10.3233/JAD-131856 | doi-access = free }}</ref> | ||
| Vascular dementia may be a direct cause of death due to the possibility of a fatal interruption in the brain's blood supply.<ref name="RCP">{{cite web |url=https://www.rcpath.org/profession/medical-examiners/good-practice-series.html |title=Good Practice Series No 11- MEs and Dementia |page = 8|vauthors = Fletcher, A|date= June 2023 |website= The Royal College of Pathologists|publisher= |access-date=March 19, 2024 }}</ref> | Vascular dementia may be a direct cause of death due to the possibility of a fatal interruption in the brain's blood supply.<ref name="RCP">{{cite web |url=https://www.rcpath.org/profession/medical-examiners/good-practice-series.html |title=Good Practice Series No 11- MEs and Dementia |page = 8|vauthors = Fletcher, A|date= June 2023 |website= The Royal College of Pathologists|publisher= |access-date=March 19, 2024 }}</ref> | ||
| ==Epidemiology== | ==Epidemiology== | ||
| Vascular dementia is the second-most-common form of dementia after ] |
Vascular dementia is the second-most-common form of dementia after ] in older adults.<ref name=mlp/> The ] of the illness is 1.5% in Western countries and approximately 2.2% in Japan. It accounts for 50% of all dementias in Japan, 20% to 40% in Europe and 15% in Latin America. 25% of people with stroke develop new-onset dementia within one year of their stroke. One study found that in the United States, the prevalence of vascular dementia in all people over the age of 71 is 2.43%, and another found that the prevalence of the dementias doubles with every 5.1 years of age.{{citation needed|date=April 2024}} | ||
| The incidence peaks between the fourth and the seventh decades of life and 80% of people have a history of ].<ref>{{cite journal |last1=Wolters |first1=Frank J. |last2=Ikram |first2=M Arfan |title=Epidemiology of Vascular Dementia |journal=Arteriosclerosis, Thrombosis, and Vascular Biology |year=2019 |volume=39 |issue=8 |pages=1542–1549 |publisher=Arterioscler Thromb Vasc Biol |doi=10.1161/ATVBAHA.119.311908 |pmid=31294622 |doi-access=free }}</ref>{{additional citation needed|date=April 2024}} | |||
| A 2018 ] identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants).<ref name = "Kuźma_2018" /> For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69; for incident stroke, the pooled risk ratio was 2.18.<ref name= "Kuźma_2018" /> Study characteristics did not modify these associations, with the exception of sex, which explained 50.2% of between-study heterogeneity for prevalent stroke. These results confirm that stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.<ref name= "Kuźma_2018" /> | A 2018 ] identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants).<ref name = "Kuźma_2018" /> For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69; for incident stroke, the pooled risk ratio was 2.18.<ref name= "Kuźma_2018" /> Study characteristics did not modify these associations, with the exception of sex, which explained 50.2% of between-study heterogeneity for prevalent stroke. These results confirm that stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.<ref name= "Kuźma_2018" /> | ||
Latest revision as of 20:01, 1 November 2024
Dementia resulting from strokeMedical condition
| Vascular dementia | |
|---|---|
| Other names | Dementia due to cerebrovascular disease; Vascular cognitive impairment |
.png) | |
| Brain atrophy from vascular dementia | |
| Specialty | Psychiatry, neurology  |
| Symptoms | Cognitive impairment, short-term memory loss |
| Complications | Heart disease, loss of ability to care for self and interact, pneumonia |
| Causes | Conditions that impair blood vessels in the brain and therefore interfere with oxygen delivery to the brain |
| Risk factors | High blood pressure, high cholesterol, atrial fibrillation, diabetes |
| Diagnostic method | Lab test, neuroimaging test, neuropsychological testing |
| Differential diagnosis | Alzheimer’s disease |
| Treatment | Symptomatic |
| Frequency | 15-30% of dementia cases in the United States, Europe, and Asia |
Vascular dementia is dementia caused by a series of strokes. Restricted blood flow due to strokes reduces oxygen and glucose delivery to the brain, causing cell injury and neurological deficits in the affected region. Subtypes of vascular dementia include subcortical vascular dementia, multi-infarct dementia, stroke-related dementia, and mixed dementia.
Subcortical vascular dementia occurs from damage to small blood vessels in the brain. Multi-infarct dementia results from a series of small strokes affecting several brain regions. Stroke-related dementia involving successive small strokes causes a more gradual decline in cognition. Dementia may occur when neurodegenerative and cerebrovascular pathologies are mixed, as in susceptible elderly people (75 years and older). Cognitive decline can be traced back to occurrence of successive strokes.
ICD-11 lists vascular dementia as dementia due to cerebrovascular disease. DSM-5 lists vascular dementia as either major or mild vascular neurocognitive disorder.
Signs and symptoms
People with vascular dementia present with progressive cognitive impairment, acutely or sub-acutely as in mild cognitive impairment, frequently step-wise, after multiple strokes.
The disease is described as both a mental and behavioral disorder within the ICD-11. Signs and symptoms are cognitive, motor, behavioral, and for a significant proportion of people, also affective. These changes typically occur over a period of 5–10 years. Signs are typically the same as in other dementias, but mainly include cognitive decline and memory impairment of sufficient severity as to interfere with activities of daily living, sometimes with presence of focal neurological signs, and evidence of features consistent with cerebrovascular disease on brain imaging (CT or MRI).
The neurological signs localizing to certain areas of the brain that can be observed are hemiparesis, bradykinesia, hyperreflexia, extensor plantar reflexes, ataxia, pseudobulbar palsy, as well as gait problems and swallowing difficulties. People have patchy deficits in terms of cognitive testing. They tend to have better free recall and fewer recall intrusions when compared with people having Alzheimer's disease. In the more severely affected people, or those affected by infarcts in Wernicke's or Broca's areas, specific problems with speaking called dysarthria and aphasias may be present.
In small vessel disease, the frontal lobes are often affected. Consequently, people with vascular dementia tend to perform worse than their Alzheimer's disease counterparts in frontal lobe tasks, such as verbal fluency, and may present with frontal lobe problems: apathy, abulia (lack of will or initiative), problems with attention, orientation, and urinary incontinence. They tend to exhibit more perseverative behavior. People with vascular dementia may also present with general slowing of processing ability, difficulty shifting sets, and impairment in abstract thinking. Apathy early in the disease is more suggestive of vascular dementia.
Rare genetic disorders that cause vascular lesions in the brain have other presentation patterns. As a rule, they tend to occur earlier in life and have a more aggressive course. In addition, infectious disorders, such as syphilis, can cause arterial damage, strokes, and bacterial inflammation of the brain.
Causes
Vascular dementia can be caused by ischemic or hemorrhagic infarcts affecting multiple brain areas, including the anterior cerebral artery territory, the parietal lobes, or the cingulate gyrus. On rare occasion, infarcts in the hippocampus or thalamus are the cause of dementia. A history of stroke increases the risk of developing dementia by around 70%, and recent stroke increases the risk by around 120%. Brain vascular lesions can also be the result of diffuse cerebrovascular disease, such as small vessel disease.
Risk factors
See also: Brain health and pollution § Cognitive decline and dementiaRisk factors for vascular dementia include increasing age, hypertension, smoking, hypercholesterolemia, diabetes mellitus, cardiovascular disease, and cerebrovascular disease. Other risk factors include lifestyle, geographic origin, and APOE-ε4 genotype.
Vascular dementia can sometimes be triggered by cerebral amyloid angiopathy, which involves accumulation of amyloid beta plaques in the walls of the cerebral arteries, leading to breakdown and rupture of the vessels. Since amyloid plaques are a characteristic feature of Alzheimer's disease, vascular dementia may occur as a consequence.
Diagnosis
Several specific diagnostic criteria can be used to diagnose vascular dementia, including the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, the International Classification of Diseases, Tenth Edition (ICD-10) criteria, the National Institute of Neurological Disorders and Stroke criteria, Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria, the Alzheimer's Disease Diagnostic and Treatment Center criteria, and the Hachinski Ischemic Score (after Vladimir Hachinski).
The recommended investigations for cognitive impairment include: blood tests (for anemia, vitamin deficiency, thyrotoxicosis, infection, among others), chest xray, ECG, and neuroimaging, preferably a scan with a functional or metabolic sensitivity beyond a simple CT or MRI. When available as a diagnostic tool, single photon emission computed tomography (SPECT) and positron emission tomography (PET) neuroimaging may be used to confirm a diagnosis of multi-infarct dementia in conjunction with evaluations involving mental status examination.
In a person already having dementia, SPECT appears to be superior in differentiating multi-infarct dementia from Alzheimer's disease, compared to the usual mental testing and medical history analysis.
The screening blood tests typically include full blood count, liver function tests, thyroid function tests, lipid profile, erythrocyte sedimentation rate, C reactive protein, syphilis serology, calcium serum level, fasting glucose, urea, electrolytes, vitamin B-12, and folate.
Differential diagnosis
Differentiating dementia syndromes can be challenging, due to the frequently overlapping clinical features and related underlying pathology. Mixed dementia, involving two types of dementia, can occur. In particular, Alzheimer's disease often co-occurs with vascular dementia.
Mixed dementia is diagnosed when people have evidence of Alzheimer's disease and cerebrovascular disease, either clinically or based on neuro-imaging evidence of ischemic lesions.
Pathology
Gross examination of the brain may reveal noticeable lesions and damage to blood vessels. Accumulation of various substances such as lipid deposits and clotted blood appear on microscopic views. The white matter is substantially affected, with noticeable atrophy (tissue loss), in addition to calcification of the arteries. Microinfarcts may also be present in the gray matter (cerebral cortex), sometimes in large numbers.
Although atheroma of the major cerebral arteries is typical in vascular dementia, smaller vessels and arterioles are mainly affected.
Prevention
Early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable. Ischemic changes in the brain are irreversible, but the person with vascular dementia can demonstrate periods of stability or even mild improvement. Since stroke is an essential part of vascular dementia, the goal is to prevent new strokes. This is attempted through reduction of stroke risk factors, such as high blood pressure, high blood lipid levels, atrial fibrillation, or diabetes mellitus.
Medications for high blood pressure are used to prevent pre-stroke dementia. These medications include angiotensin converting enzyme inhibitors, diuretics, calcium channel blockers, sympathetic nerve inhibitors, angiotensin II receptor antagonists or adrenergic antagonists.
A 2023 review found that therapy with statin drugs was ineffective in treating or preventing stroke or dementia in people without a history of cerebrovascular disease.
Treatment
As of 2024, there are no medications used specifically for prevention or treatment of vascular dementia.
Prognosis
Many studies have been conducted to determine average survival of people with dementia. The studies were frequently small and limited, which caused contradictory results in the connection of mortality to the type of dementia and the person's gender. One 2015 study found that the one-year mortality was three to four times higher in people after their first referral to a day clinic for dementia, when compared to the general population. If the person was hospitalized for dementia, the mortality was even higher than in people hospitalized for cardiovascular disease. Vascular dementia was found to have either comparable or worse survival rates when compared to Alzheimer's disease; another 2014 study found that the prognosis for people with vascular dementia was worse for male and older people.
Vascular dementia may be a direct cause of death due to the possibility of a fatal interruption in the brain's blood supply.
Epidemiology
Vascular dementia is the second-most-common form of dementia after Alzheimer's disease in older adults. The prevalence of the illness is 1.5% in Western countries and approximately 2.2% in Japan. It accounts for 50% of all dementias in Japan, 20% to 40% in Europe and 15% in Latin America. 25% of people with stroke develop new-onset dementia within one year of their stroke. One study found that in the United States, the prevalence of vascular dementia in all people over the age of 71 is 2.43%, and another found that the prevalence of the dementias doubles with every 5.1 years of age.
The incidence peaks between the fourth and the seventh decades of life and 80% of people have a history of hypertension.
A 2018 meta-analysis identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants). For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69; for incident stroke, the pooled risk ratio was 2.18. Study characteristics did not modify these associations, with the exception of sex, which explained 50.2% of between-study heterogeneity for prevalent stroke. These results confirm that stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.
See also
References
- ^ "ICD-11: Dementia due to cerebrovascular disease". World Health Organization. 2024. Retrieved 10 April 2024.
- ^ Iadecola C, Duering M, Hachinski V, Joutel A, Pendlebury ST, Schneider JA, et al. (July 2019). "Vascular Cognitive Impairment and Dementia". Journal of the American College of Cardiology. 73 (25): 3326–3344. doi:10.1016/j.jacc.2019.04.034. PMC 6719789. PMID 31248555.
- ^ "Vascular dementia". National Heart, Lung, and Blood Institute, US National Institutes of Health. 28 September 2022. Retrieved 10 April 2024.
- ^ "Vascular dementia". MedlinePlus, US National Library of Medicine.
- ^ Sanders AE, Schoo C, Kalish VB (22 October 2023). "Vascular dementia". StatPearls, US National Library of Medicine. PMID 28613567. Retrieved 9 April 2024.
- ^ Wong CE, Chui CH (June 2022). "Vascular cognitive impairment and dementia". Continuum. 28 (3): 750–780. doi:10.1212/CON.0000000000001124. PMC 9833847. PMID 35678401.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Washington, DC: American Psychiatric Association. pp. 591–603. ISBN 978-0-89042-554-1.
- "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 2022-12-09.
- Alagiakrishnan K. "Vascular Dementia Clinical Presentation: History, Physical, Causes". emedicine.medscape.com. Retrieved 2021-03-19.
- Cannistraro RJ, Badi M, Eidelman BH, Dickson DW, Middlebrooks EH, Meschia JF (2019-06-11). "CNS small vessel disease: A clinical review". Neurology. 92 (24): 1146–1156. doi:10.1212/WNL.0000000000007654. ISSN 1526-632X. PMC 6598791. PMID 31142635.
- Mossanen Parsi M, Duval C, Ariëns R (2021). "Vascular dementia and crosstalk between the complement and coagulation systems". Frontiers in Cardiovascular Medicine. 8: 803169. doi:10.3389/fcvm.2021.803169. PMC 8733168. PMID 35004913.
- Kaur M, Sharma S (1 February 2022). "Molecular mechanisms of cognitive impairment associated with stroke". Metabolic Brain Disease. 37 (2): 279–287. doi:10.1007/s11011-022-00901-0. ISSN 1573-7365. PMID 35029798.
- ^ Kuźma E, Lourida I, Moore SF, Levine DA, Ukoumunne OC, Llewellyn DJ (November 2018). "Stroke and dementia risk: A systematic review and meta-analysis". Alzheimer's & Dementia. 14 (11): 1416–1426. doi:10.1016/j.jalz.2018.06.3061. PMC 6231970. PMID 30177276.
- Robinson L, Tang E, Taylor JP (16 June 2015). "Dementia: timely diagnosis and early intervention". BMJ. 350: h3029. doi:10.1136/bmj.h3029. ISSN 1756-1833. PMC 4468575. PMID 26079686.
- Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti J, et al. (October 2011). "Vascular dementia: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I." Dementia & Neuropsychologia. 5 (4): 251–263. doi:10.1590/S1980-57642011DN05040003. PMC 5619038. PMID 29213752.
- Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L (2017). "Mixed dementia: A review of the evidence". Dementia & Neuropsychologia. 11 (4): 364–370. doi:10.1590/1980-57642016dn11-040005. ISSN 1980-5764. PMC 5769994. PMID 29354216.
- Hase Y, Horsburgh K, Ihara M, Kalaria RN (2018). "White matter degeneration in vascular and other ageing-related dementias". Journal of Neurochemistry. 144 (5): 617–633. doi:10.1111/jnc.14271. hdl:20.500.11820/780992bd-e933-4715-8099-c4d463070a58. PMID 29210074. S2CID 33778577.
- Erkinjuntti T (February 2012). Gelder M, Andreasen N, Lopez-Ibor J, Geddes J (eds.). New Oxford Textbook of Psychiatry (2 ed.). Oxford: Oxford University Press. doi:10.1093/med/9780199696758.001.0001. ISBN 978-0-19-969675-8. Retrieved 2015-09-07.
- Santisteban MM, Iadecola C, Carnevale D (January 2023). "Hypertension, neurovascular dysfunction, and cognitive impairment". Hypertension. 80 (1): 22–34. doi:10.1161/HYPERTENSIONAHA.122.18085. PMC 9742151. PMID 36129176.
- Goldstein LB, Toth PP, Dearborn-Tomazos JL, Giugliano RP, Hirsh BJ, Peña JM, et al. (October 2023). "Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association". Arteriosclerosis, Thrombosis, and Vascular Biology. 43 (10): e404 – e442. doi:10.1161/ATV.0000000000000164. PMID 37706297.
- ^ van de Vorst IE, Vaartjes I, Geerlings MI, Bots ML, Koek HL (October 2015). "Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands". BMJ Open. 5 (10): e008897. doi:10.1136/bmjopen-2015-008897. PMC 4636675. PMID 26510729.
- Villarejo A, Benito-León J, Trincado R, Posada IJ, Puertas-Martín V, Boix R, et al. (2011). "Dementia-associated mortality at thirteen years in the NEDICES Cohort Study". Journal of Alzheimer's Disease. 26 (3): 543–51. doi:10.3233/JAD-2011-110443. PMID 21694455.
- Garcia-Ptacek S, Farahmand B, Kåreholt I, Religa D, Cuadrado ML, Eriksdotter M (2014). "Mortality risk after dementia diagnosis by dementia type and underlying factors: a cohort of 15,209 patients based on the Swedish Dementia Registry". Journal of Alzheimer's Disease. 41 (2): 467–77. doi:10.3233/JAD-131856. PMID 24625796.
- Fletcher, A (June 2023). "Good Practice Series No 11- MEs and Dementia". The Royal College of Pathologists. p. 8. Retrieved March 19, 2024.
- Wolters FJ, Ikram MA (2019). "Epidemiology of Vascular Dementia". Arteriosclerosis, Thrombosis, and Vascular Biology. 39 (8). Arterioscler Thromb Vasc Biol: 1542–1549. doi:10.1161/ATVBAHA.119.311908. PMID 31294622.
| Mental disorders (Classification) | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| |||||||||||||||||
| Diseases of the nervous system, primarily CNS | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Inflammation |
| ||||||||||||||||||||||||
| Brain/ encephalopathy |
| ||||||||||||||||||||||||
| Both/either |
| ||||||||||||||||||||||||
| Classification | D |
|---|---|
| External resources |