// Vascular Dementia

Vascular dementia is the second most common cause of dementia after Alzheimer’s disease. Vascular dementia may be characterized by its stepwise decline, with each infarct (or stroke) producing changes and deterioration in daily functioning. Vascular Dementia may be partially responsible for up to 30 percent of cases. The prevalence (or how common it is) ranges from 1.5 percent in people 70-75 years, to about 15 percent in those above 80 years. Vascular dementia is more common in men. Vascular lesions may complicate or worsen the course of Alzheimer’s disease in up to 20% of cases (in some studies).

There are commonly used research criteria for vascular dementia, which were developed in 1993 and require three basic elements for diagnosis: cognitive loss, evidence of cerebrovascular lesions (strokes) on neuroimaging (CAT scan or MRI of the brain), and the exclusion of other causes of dementia such as Alzheimer’s disease.

Vascular dementia may result from a stroke where the blood supply to a part of the brain is cut off (similar to what happens in the heart with a heart attack), anoxia (lack of oxygen to the brain), or hemorrhage (bleeding in the brain). Risk factors include hypertension (high blood pressure), diabetes, a history of transient ischemic attacks (TIAs or pre-strokes), and heart disease.

The Diagnosis of Vascular dementia is usually made in the context of clinical strokes, vascular risk factors (such as high cholesterol, high blood pressure, smoking) and brain imaging (like a CAT scan or MRI).

There is another way that vascular disease can cause dementia – this is called small vessel disease, in which there are tiny “strokes” which can disrupt the communication between different parts of the brain and can effect a variety of systems. This is called Binswanger’s disease. Binswanger’s disease produces a type of dementia with executive dysfunction (problems with organizing, planning, sequencing), inattention, memory loss, slowed motor function, problems with gait, urinary incontinence, and loss of verbal fluency. Apathy and depression are also common findings.

Treatment

The treatment of vascular dementia revolves around reducing risk factors such as high blood pressure and high cholesterol or other lipids, to prevent additional strokes. Medications to “thin the blood” such as aspirin, antiplatelet medications (such as clopidogerl (plavix) and anticoagulants (e.g. warfarin (counamdin)) may be recommended, depending on other medical concerns.