Vascular dementia (VaD) is the second most common cause of dementia and its prevalence increases after the sixth decade of life [1] [2]. It is defined as a condition characterized by features of stroke or subclinical vascular brain injury which involves malfunction of at least two cognitive domains leading to a decrease in the ability to perform activities of daily living [3]. The cognitive features of VaD depend on the anatomical location of the vascular injury and this has led to the classification of VaD into different subtypes: small, large, or mixed vessel disease [4] [5]. Patients with small vessel disease present with a higher incidence of executive dysfunction whereas dysfunctional language and visuospatial perception are noticed more often in patients with large vessel VaD [6]. Clinical presentation of VaD in cortical injury includes speech abnormalities and neglect while a subcortical injury is associated with cognitive, emotional and behavioral difficulties, psychomotor retardation, pseudobulbar palsy, and gait dysfunction [1] [3]. Other features of VaD are restlessness, agitation, aggressive behavior, hallucinations, delusions, paranoia, circadian mood disturbances (sundowning), disorientation, and depression. As the brain injury is variable in VaD, memory disturbances may also be variable or may be completely absent [1]. The intellectual decline in VaD is classically described as "step-wise" (multi-infarct dementia) but can be continuous (lacunar infarcts) too.

Clinical presentation of VaD may resemble that of Alzheimer's disease (AD) although the following features help to differentiate between the two conditions:

• major depression is more commonly seen in patients with VaD
• apathy is seen in the early stages of VaD while it occurs in the late stages of AD
• VaD patients have diminished language fluency compared to AD patients
• Long-term memory deficits are more prevalent in AD patients

• Vertical Gaze Palsy

  On examination, the patient had a supranuclear vertical gaze palsy. A CT scan of the brain performed ten days after admission showed enhancing bilateral medial thalamic infarctions. [web.archive.org]

• Stroke

  Stroke can be broadly classified in two major clinical types: ischemic stroke (IS) and hemorrhagic stroke. [ncbi.nlm.nih.gov]

  (eMedicine.com) Living With Stroke—Memory and Problem Solving – Tips on how to improve attention span and problem solving abilities following a stroke, along with how to distinguish between types of memory deficits. [web.archive.org]

  Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989;20:1407–1431. [oadoi.org]

• Mild Cognitive Impairment

  KEYWORDS: dementia; mild cognitive impairment; stroke; vascular dementia [ncbi.nlm.nih.gov]

• Memory Impairment

  impairment and other deficits to meet operationalized criteria for dementia, and (3) the use of limited test batteries whose psychometric properties are incompletely understood. [ncbi.nlm.nih.gov]

  Moreover, contrary to the early memory impairment that characterizes AD, the memory deficit in pure LBD usually appears later in the disease course. [doi.org]

  The development of multiple cognitive deficits manifested by both: Memory impairment (impaired ability to learn new information or to recall previously learned information) One or more of the following cognitive disturbances: (a) aphasia (language disturbance [strokecenter.org]

  impaired in episodic memory, and more severely impaired on tests of attentional/executive function, semantic memory, and visuospatial skills. [jnnp.bmj.com]

• Aphasia

  Transcortical sensory and motor aphasia was observed in four patients with thalamic hemorrhages and infarcts. In these patients SPECT detected hypoperfusion in adjacent cortical areas. [ncbi.nlm.nih.gov]

  Exclusion criteria : cases with disturbance of consciousness, delirium, psychosis, severe aphasia, or major sensorimotor impairment precluding neuropsychological testing. [strokecenter.org]

  […] neurologic deficits often develop: Exaggeration of deep tendon reflexes Extensor plantar response Gait abnormalities Weakness of an extremity Hemiplegias Pseudobulbar palsy with pathologic laughing and crying Other signs of extrapyramidal dysfunction Aphasias [merckmanuals.com]

  Those symptoms include confusion; memory loss; struggles with word recall, or aphasia; difficulty paying attention, or following a conversation; impaired motor skills, and vision loss. [lcbseniorliving.com]

• Apraxia

  Visual constructive apraxia is very common in dementia and impairment in these abilities can provide clinical information for differential diagnosis. [ncbi.nlm.nih.gov]

  […] of multiple cognitive deficits manifested by both: Memory impairment (impaired ability to learn new information or to recall previously learned information) One or more of the following cognitive disturbances: (a) aphasia (language disturbance) (b) apraxia [strokecenter.org]

  In addition, the person must have one or more of the following symptoms: Aphasia - A deterioration of language abilities Apraxia - Difficulty executing motor activities Agnosia - An impaired ability to recognize or identify objects Problems with executive [mentalhelp.net]

  […] dementia [ dĕ-men´shah ] a general loss of cognitive abilities, including impairment of memory as well as one or more of the following: aphasia, apraxia, agnosia, or disturbed planning, organizing, and abstract thinking abilities. [medical-dictionary.thefreedictionary.com]

A physician should suspect VaD in a patient with cognitive dysfunction which follows a neurologic episode/deficit. The workup should commence with a detailed history eliciting onset and progression of cognitive and neuropsychiatric symptoms as well as a history of atherosclerotic conditions like angina pectoris. A detailed neurological and psychiatric assessment is essential. The Mini-Mental Status Exam (MMSE) is likely to reveal patchy cognitive deficits in VaD compared to global deficits in AD [7]. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria provide the guidelines to help in the diagnosis of VaD [8].

Laboratory tests are performed to exclude other etiologies of dementia. They include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), blood glucose levels, thyroid, liver, and kidney function tests, vitamin B12 levels, and Venereal Disease Research Laboratory (VDRL) test for syphilis. In addition, other tests like human immunodeficiency virus (HIV) testing, and tests to rule out autoimmune diseases should be ordered.

Neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI) help to confirm the diagnosis with MRI being considered the gold standard. A vascular cause of dementia mainly can be excluded if CT and MRI do not demonstrate any cerebrovascular pathology. MRI findings in VaD include multiple white matter infarcts or lesions in the periventricular white matter, lacunar infarcts, and atrophy of the hippocampal or entorhinal cortical areas. Positron emission tomography (PET) helps in the identification of VaD and differentiates it from AD [9]. Cerebral angiography is only indicated prior to carotid endarterectomy and is likely to show beading of the cortical blood vessels. Other tests which may be performed include an electrocardiogram, echocardiography, Holter monitoring, and carotid Doppler studies.

• Cavitary Lesion

  Lacunar disease is due to small vessel occlusions and produces small cavitary lesions within the brain parenchyma secondary to occlusion of small penetrating arterial branches. [emedicine.com]

There are no pharmacological agents with a regulatory approval for its treatment or prevention. [ncbi.nlm.nih.gov]

Multi-Infarct Dementia Information Page (2009) This Web page provides an overview of multi-infarct dementia, including its symptoms, treatment, prognosis, and related research. [web.archive.org]

Prognosis The prognosis for individuals with MID is generally poor. The symptoms of the disorder may begin suddenly, often in a step-wise pattern after each small stroke. [ninds.nih.gov]

Similarly, no single prognosis can be given, being largely dependent on the underlying cause and the degree to which successful treatment can be initiated. Promoted articles (advertising) [radiopaedia.org]

Prognosis for People With Vascular Dementia If the conditions that cause vascular dementia go untreated, the prognosis is not good. [webmd.com]

There are a variety of etiologies that contribute to the development of vascular cognitive impairment and VaD, and these are often associated with other dementia-related pathologies such as Alzheimer disease. [ncbi.nlm.nih.gov]

SIDAM: a structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM III-R. Psychol Med. 1991 ; 21 :225-236. [dx.doi.org]

Author information 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands. [email protected] 2 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands. [email protected] 3 Department of Neurology, [ncbi.nlm.nih.gov]

Clinical presentations and epidemiology of vascular dementia. Clin Sci. 2017;131(11):1059-1068. doi:10.1042/CS20160607 Saito S, Yamamoto Y, Ihara M. Development of a Multicomponent Intervention to Prevent Alzheimer's Disease. [verywellhealth.com]

Keywords: Aging, cause of mortality, death, dementia, epidemiology, memory, mortality DOI: 10.3233/JAD-2011-110443 Journal: Journal of Alzheimer's Disease, vol. 26, no. 3, pp. 543-551, 2011 Accepted 28 April 2011 | Published: 19 September 2011 [doi.org]

CONCLUSIONS: An imbalance in pro-oxidant and anti-oxidant defenses is apparently involved in the pathophysiology of the AD and MD groups. [ncbi.nlm.nih.gov]

Similarly, the effects of lipids and lipid-lowering therapy on preventing or treating dementia remain unclear; the few trials that have assessed lipid-lowering therapy for preventing (two trials) or treating (four trials) dementia found no evidence to [ncbi.nlm.nih.gov]

It describes the difficulty of making a firm diagnosis and the importance of stroke prevention. [web.archive.org]

Prevention[edit] Early detection and accurate diagnosis are important[20], as vascular dementia is at least partially preventable. [en.wikipedia.org]

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3. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2011;42:2672–2713.
4. van Straaten ECW, Scheltens P, Knol DL, et al. Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke. 2003;34:1907–1912.
5. Jellinger KA. Morphologic diagnosis of “vascular dementia” – a critical update. J Neurol Sci. 2008;270:1–12
6. Ying H, Jianping C, Jianquing Y, et al. Cognitive variations among vascular dementia subtypes caused by small, large or mixed vessel disease. Arch Med Sci. 2016;12(4):747-753.
7. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders (5th ed.). Washington, DC. American Psychiatric Association; 2013.
9. Nagata K, Maruya H, Yuya H, et al. Can PET data differentiate Alzheimer's disease from vascular dementia?. Ann N Y Acad Sci. 2000;903:252-261.