Vasculaire dementie Flashcards
(9 cards)
Vascular dementia
VaD; form of dementia caused by cerebrovascular disease
Not a neurodegenerative disease; not a diseas
CVD is a disease of blood vessels in the brain, meaning it affects blood supply
Reduced blood flow is associated w cerebrovascular pathology
Until 60s, regarded as main cause of dementia (also senile dementia)
Vascular cognitive impairment
VCI; all forms of cognitive impairment that are caused by cerebrovascular disease;
Mild;
- VCI no dementia (VCIND)
- Vascular MCI (VaMCI)
- Both of these are when there’s cognitive impairment but no effect on daily functioning
Severe;
- Vascular dementia (VaD, aka VCID)
- Multi infarct dementia (MID)
Small vessel strokes
More common than large vessel disease;
White matter lesions
Lacunar infarcts
- Narrow arteries in deep brain tissue get blocked, no blood flow
- often subcortical areas, in particular subcortical frontal lobe
Small vessel stroke
- Small arterie strokes, ischemic. Typically lacunar infarcts (silent strokes)
Large vessel stroke
Can be ischemic or hemorrhagic
Effect depends on the location or volume
- ACA
- MCA
- PCA
Impairment onset is acute (not silent)
Clinical features of large vessel strokes
Large variety in cerebrovascular events, locations and volumes meaning large variety in symptoms
Subtypes are identified to ease diagnosing
MCA; hemi-neglect and anasognosia
ACA; Naming impairment, personality changes
PCA: Memory, language comprehension, recognition
Diagnosis criteria
Presence of cognitive impairment (dementia/MCI) on neuropsychological tests (eg the NINDS)
- DSM; in at least one domain
- NINDS: in memory and at least 2 other domains
Deficit should interfere with independence
- NINDS: functional, not due to physical effect CVD
Presence of cerebrovascular disorder (CVD) on neuroimaging, regardless of cause.
Established relationship between CI and CVD
- Spatial; location of lesion in line w cognitive impairments
- Temporal; Cognitive impairments appear shortly after CVD
NINDS: also abrupt or stepwise deterioration of cog functions
VCI: deficit start within 6 m of CV event
Stepwise deterioration
The cognitive decline is in steps; rapid decline followed by stable periods.
Decline rapid due to further stroke
This patter is more likely in large vessel stroke
- In small vessel lesions insidious onset is more likely
Prevalence
Second most common form of dementia after AD
NL; 16% of dementia cases
In asia; 30%
Comorbidity makes it difficult to measure exactly, but with AD (pure form and mixed with VaD) it makes up most of dementia cases in older adults
Progression and life expectancy
After large vessel stroke’; approx 30% meet criteria VaD within 12 months
Almost half of those in early stage VCI progress to VaD within 5 years
Life expectancy after diagnosis is about 5 years.
- more likely to die from stroke or heart attack than AD
