Vascular dementia

What it is

Vascular dementia is the second most common type of dementia, after Alzheimer's dementia. It accounts for 15 percent of patients with dementia, while Alzheimer's dementia accounts for around 60 percent of all cases and is the most common cause of dementia in patients older than 65 years; Alzheimer's is also slightly more common in women than men.

Causes and risk

What lies behind it is small infarctions that affect multiple areas of the brain. Two things sit with it in the table that names it: the presence of hypertension, and previous strokes or transient ischemic attacks. A second table adds diabetes, so the risk list reads post-stroke, HTN, diabetes and infarcts. It is also described in one line as a step-wise cognitive decline with significant vascular factors.

How it presents

The pattern that names it is stepwise cognitive deterioration: an abrupt onset of cognitive deficits, which plateau for a period of time, then a sudden onset of further cognitive deficits. Put the other way round, the symptoms may remain stable for a period of time, then suddenly deteriorate, then stabilize, then abruptly deteriorate again, which is why it is called a stepwise deterioration pattern.

Which deficits appear depends on the localization of the vascular lesions, so left hemisphere lesions tend to cause language problems. Because of that the presentation is diverse: it can include problems with executive function and cognition, aphasia, confusion, amnesia and motor disturbance. Focal neuro signs and gait disturbance belong with it.

The short form of the same is a stepwise decline with focal neuro signs and a history of stroke or HTN.