Vascular Dementia

Also known as Multi-Infarct Dementia

When most people think of dementia they immediately think of Alzheimer's disease. While Alzheimer's disease is the most common cause of dementia among adults over the age of 65 there are other conditions that can produce dementia. Dementia is actually a group of symptoms that point to an underlying cause. Serious forgetfulness, mood swings, and other behavioral changes are not a normal part of aging. These symptoms may be short term and reversible if a result of poor diet, medications or lack of sleep. Untreated depression may also produce some of these symptoms.

The second most common cause of dementia is vascular dementia caused by damage to brain cells. The most common culprit in the damage is a series of small strokes that block blood flow to a part of the brain damaging brain cells. When this occurs it is referred to as "multi-infarct dementia". Strokes can be caused when a blood clot or fatty deposit (called plaque) blocks the vessels that supply blood to the brain. A stroke also can happen when a blood vessel in the brain bursts. Strokes can be caused by:

• uncontrolled high blood pressure
• diabetes
• heart disease
• high cholesterol

Multi-infarct dementia is caused by a series of small strokes that cause brain damage. The stoke may produce little or no symptoms at the time but a series of them can lead to cognitive changes that include:

• confusion and problems with recent memory
• wandering or getting lost in familiar places
• moving with rapid, shuffling steps
• loss of bladder or bowel control
• laughing or crying inappropriately
• difficulty following instructions
• problems handling money

Diagnosis and Treatment
When these types of cognitive and behavior changes are identified a thorough medical examination is important. The physical and history should look at diet, medications and social issues. Blood pressure should be checked and lab tests such as blood tests for diabetes and cholesterol carried out. A CAT Scan or MRI can help identify areas of the brain that may have sustained damage from small strokes. It is important to determine the cause of the dementia as the treatments for Alzheimer's disease and multi-infarct dementia are different. It is also important to identify the underlying cause of the strokes. Treatment may include medications to control high blood pressure, heart disease or diabetes. Surgery may be called for to open blood vessels and prevent blockage.

Care
Long term care plans will vary depending on the progression of the dementia. The patient may just require supervision and monitoring or may need complete care. Care should be provided on an individual basis based on amount of impairment. While damage to brain cells cannot be repaired further damage may not occur if the cause is treated successfully.

SOURCES National Institute on Aging;National Institute of Neurological Disorders and Stroke April, 2006