Vascular

• Vascular dementia:

  • Second most common type of dementia
  • More common in males
  • Thought to be due to their increased risk of vascular disease - increased prevalence in those who have had a stroke
  • Progresses in a stepwise fashion - a period of stability at one level of functioning before an acute decline, followed by another period of stability
• Aetiology:

  • Several subtypes of vascular dementia - most common is multiple (commonly small) cerebrovascular infarcts
  • Most affected areas of the brain are the white matter of both cerebral hemispheres, grey nuclei, thalamus and the striatum
  • Hypertension is a major risk factor for diffuse vascular dementia
  • Other vascular risk factors - smoking, diabetes, hyperlipidaemia, obesity and hypercholesterolaemia
• Clinical features:

  • Single infarct vascular disease classically presents with cognitive impairment (acutely or subacutely) following the event
  • Mood disturbances and mood disorders are common
  • Psychosis, delusions, hallucinations and paranoia - especially in the later stages
  • Patients should be screened for depression and for signs of psychomotor retardation