- Stroke-related VD – multi-infarct or single-infarct dementia
- Subcortical VD – caused by small vessel disease
- Mixed dementia – the presence of both VD and Alzheimer’s disease
- History of stroke or transient ischaemic attack (TIA)
- Atrial fibrillation
- Diabetes mellitus
- Coronary heart disease
- A family history of stroke or cardiovascular
Rarely, VD can be inherited as in the case of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
- Several months or several years of a history of a sudden or stepwise deterioration of cognitive function.
Symptoms and the speed of progression vary but may include:
- Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
- The difficulty with attention and concentration
- Memory disturbance
- Gait disturbance
- Speech disturbance
- Emotional disturbance
- A comprehensive history and physical examination
- Formal screen for cognitive impairment
- Medical review to exclude medication cause of cognitive decline
- MRI scan – may show infarcts and extensive white matter changes
National Institute for health and care excellence (NICE) recommends that diagnosis be made using the NINDS-AIREN criteria for probable vascular dementia
|Presence of cognitive decline that interferes with activities of daily living, not due to secondary effects of the cerebrovascular event|
|A relationship between the above two disorders inferred by:|
- Treatment is mainly symptomatic with the aim to address individual problems and provide support to the patient and carers
- Important to detect and address cardiovascular risk factors – for slowing down the progression
- Tailored to the individual
- Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy
- Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication
- There is no specific pharmacological treatment approved for cognitive symptoms
- Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
- There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia.
- No randomized trials found evaluating statins for vascular dementia