Vascular Dementia
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Vascular Dementia

(Binswanger’s Disease; Senile Dementia; Binswanger’s Type)

En Español (Spanish Version)

Definition

Vascular dementia is one of the most common causes of dementia . It is caused by disease of the small blood vessels in the brain. Parts of the brain called white matter (as well as subcortical grey matter) are injured, often by multiple small strokes (called lacunes).

Healthy and Injured Brain Blood Vessels

Blood Flow and Lack of Blood Flow to the Brain

© 2008 Nucleus Medical Art, Inc.

Causes

Vascular dementia occurs when cells below the surface of the brain (the cortex) receive an inadequate supply of oxygen and nutrients and in turn die. This process is due to hardening of the blood vessels within the white matter of the brain, which affects the blood supply. As a result, the oxygen and nutrient supply to the neurons and their supporting cells are also affected.

The exact cause of vascular dementia is unknown. However, factors that play a role in causing the disease include:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Vascular dementia usually affects older individuals. Other factors that increase the risk of the disease include:

  • High blood pressure (the most closely associated risk factor)
  • Cardiovascular disease
  • Hardening of blood vessels (atherosclerosis and lipohyalinosis)
  • Diabetes
  • Smoking
  • Hypercoagulable states (ie, hyperhomocysteinemia, hyperfibrinogenemia)
  • Genetic disorders, such as CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

Symptoms

In some patients, symptoms appear suddenly in a step-wise fashion with neurologic changes like those caused by a stroke. Usually, however, symptoms begin slowly and grow progressively worse. Sometimes, symptoms may stabilize or even improve after they appear. However, in most patients, the disease continues to progress.

The main symptoms of vascular dementia include:

  • Progressive deterioration of:
    • Intellectual abilities
    • Processing speed
    • Cognitive and motor abilities
  • Progressive memory loss
  • Slow, unsteady gait

Other symptoms that may be present in people with this disease include:

  • Incontinence
  • Difficulty speaking
  • Swallowing difficulties
  • Paralysis of one side of the body
  • Apathy (loss of interest in activities)
  • Inactivity
  • Depression
  • Parkinson -like symptoms, including:
    • Tremors
    • Loss of coordination
    • Loss of trunk mobility
  • Seizures
  • Strokes
  • Confusion
  • Paranoia
  • Disorientation

Diagnosis

The symptoms of vascular dementia can resemble other causes of dementia such as Alzheimer’s disease .

Your doctor will ask about your symptoms and medical history and perform a physical exam. Tests may include:

  • MRI scan —a test that uses magnetic waves to take pictures of your brain
  • CT scan —a type of x-ray that uses a computer to take pictures of your brain
  • SPECT (single photon-emission computed tomography)—a test to look for functional degeneration of the white matter in the brain

Treatment

There is no known cure for vascular dementia. Most patients die within 5 to 10 years after onset of the disease. Minimizing risk factors and alleviating symptoms are important in trying to slow disease progression and improve quality of life.

Medications can be given to help limit or control symptoms and possibly slow progression of the disease. These include:

  • Medications to control:
  • Antidepressant medications
  • Medications such as Aricept and Namenda (used for Alzheimer’s disease)

Prevention

There are no definitive guidelines for the prevention of vascular dementia. However, the following may help reduce your risk:

  • Don’t smoke. If you smoke, quit.
  • Eat a diet that is low in fat and low in salt .
  • If you drink alcohol, do so only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.
  • Have your blood pressure and blood cholesterol levels checked regularly (at least once per year), and if treatment is recommended follow your doctor’s guidelines.
  • Avoid low blood pressure. If you get dizzy when you stand up or have a history of fainting, be sure to talk with your doctor about ways to ensure a safe amount of blood circulation for your brain at all times.

RESOURCES:

Alzheimer’s Association
http://www.alz.org

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

National Organization for Rare Diseases
http://www.rarediseases.org

CANADIAN RESOURCES:

Alzheimer Society of Canada
http://www.alzheimer.ca

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .

Binswanger’s disease—revisited. Neurology . 1995;45: 626-633.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov .

Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res . 2004 Jul;26(5):454-8.

Roman GC, Erkinjuntti T, Wallin A, et al. Subcortical ischaemic vascular dementia. Lancet Neurology . 2002;1:426-436.



Last reviewed October 2007 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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