Vascular dementia
Epidemiology
- Second most common type of dementia (15–20% of cases)
- Prevalence increases with age (∼ 1–4% in patients ≥ 65 years).
Etiology
- VD may occur as a result of a prolonged and severe cerebral ischemia of any etiology, primarily:
- Large artery occlusion (usually cortical ischemia)
- Lacunar stroke (small vessel occlusion resulting in subcortical ischemia)
- Chronic subcortical ischemia
Pathophysiology
- Large-vessel atherosclerosis
- Small-vessel disease (eg, arteriolosclerosis)
- Cerebral amyloid angiopathy
Clinical features
- Multi-infarct: often with stepwise decline
- Strategic infarct: associated with localizing cortical deficits
- These infarcts are termed "strategic" because they affect regions that play a crucial role in certain brain functions.
- Subcortical vascular encephalopathy: associated with subcortical signs (eg, urinary incontinence, gait disturbances)
The most significant symptoms of vascular dementia tend to involve speed of thinking and problem-solving rather than memory loss.
Diagnostics
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Treatment
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