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< Back to Differential Diagnosis

Differential Diagnosis of Vascular Dementia

Key features

  • Historically considered the second most common cause of dementia, accounting for about 20 to 30 percent of cases.
  • Traditionally, uniform diagnostic criteria for vascular dementia have been lacking. The clearest clinical picture may be impairment in one or more cognitive domains within a few months after a stroke, sometimes termed post-stroke dementia.
    • Specific cognitive domains affected depend on stroke location.
    • Deficits in attention and executive function are common.
    • Memory loss may or may not be prominent, depending on whether the stroke affected memory areas.
    • Specific cognitive domains affected depend on stroke location.
    • Decline may appear relatively suddenly and may or may not progress. Progression may be stepwise, occurring in discreet, sudden changes rather than gradually.
    • Daily activities may be impaired.
    • Focal neurological signs consistent with stroke may be present.
    • The patient may have a history of high blood pressure, elevated lipids, vascular disease, diabetes or past heart attacks or strokes
    • Vascular damage in the mid-brain regions may cause a gradual, progressive cognitive impairment that looks much like Alzheimer’s disease.

  • "Pure" vascular dementia may be relatively unusual; vascular changes may more commonly coexist with Alzheimer's plaques or other neuropathologies.
  • The Hachinski Ischemic Scale is a tool widely used to identify a likely vascular component once a dementia diagnosis has been established. A shortened 7-item version of the HIS has been validated. A score ≤2 suggests vascular involvement.

Reduced 7-item Hachinski Ischemic Score

Item description Yes No
Abrupt onset    
Stepwise deterioration    
Fluctuating course    
Emotional incontinence    
History of stroke    
Focal neurological symptoms    
Focal neurological signs    
Total “Yes” answers    

Hachinski V, Oveisgharan S, Romney AK, Shankle WR.
“Optimizing the Hachinski Ischemic Scale.” Arch Neuro
l. 2012;69(2):169-175.

Treatment

  • Because vascular dementia is closely tied to diseases of the heart and blood vessels, many experts consider it the most potentially treatable form. Monitoring of blood pressure, weight, blood sugar and cholesterol should begin early in life. Active management of these risk factors, avoidance of smoking and excess alcohol and treatment of underlying heart and blood vessel diseases could play major roles in preventing later cognitive decline for many individuals. For certain older adults who develop vascular dementia, active management of these factors could help avoid symptom progression.
  • Once vascular dementia develops, no drugs are approved by the FDA to treat it.
  • Most of the drugs used to treat cognitive symptoms of Alzheimer’s disease have also been shown to help individuals with vascular dementia to about the same modest extent they help those with Alzheimer’s. However, one clinical trial of donepezil (Aricept) for vascular dementia reported that a significantly greater number of deaths occurred in study participants receiving donepezil than in those taking a placebo.

Pathology

Vascular dementia occurs when impaired blood flow to parts of the brain deprives cells of food and oxygen. This impairment typically follows stroke-induced blockage of one or more blood vessels. Vascular damage often coexists with amyloid plaques and other neuropathologies associated with Alzheimer’s disease.

For your patients and families: Vascular Dementia and Mixed Dementia



 

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