Neurological Manifestations of Vascular Dementia Clinical Presentation

  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA   more...
 
Updated: Apr 10, 2012
 

History

Criteria for the diagnosis of dementia require impairment in memory and at least 1 other cognitive domain (eg, orientation, language, praxis, executive functions, visuospatial abilities). These should be serious enough to affect activities of daily living and be consistently present to distinguish dementia from episodic impairments of consciousness such as delirium.

  • Currently, several sets of diagnostic criteria for vascular dementia exist. This list summarizes the main common criteria.
    • Vascular risk factors such as hypertension, coronary disease, and diabetes mellitus[8]
    • Specific evidence of cerebrovascular disease, eg, strokes and transient ischemic attacks: The cerebrovascular insult should precede (by no more than 3 mo) or coincide with the onset or worsening of cognitive abnormalities.
    • Neuroimaging evidence of strokes
    • Lateralizing neurologic signs
    • Psychiatric disturbances (eg, emotional lability, depression, apathy)
  • Depression is a common comorbidity in patients with cerebrovascular disease and vascular dementia.
  • Medications should be reviewed because of the potential of drugs to interfere with alertness and cognition.
  • Differences between the cognitive disturbances in vascular dementia and Alzheimer disease are of limited value in discriminating vascular dementia from Alzheimer disease in a clinical setting.
    • Vascular dementia is thought to be associated with less significant memory dysfunction than Alzheimer disease.[9]
    • Frontal dysfunction due to widespread involvement of subcortical structures in vascular dementia is thought to lead to a dysexecutive syndrome with abulia and apathy.
  • A cognitively impaired patient with vascular risks factors but no history of cerebrovascular disease is most likely to have Alzheimer disease. Patients with dementia and vascular disease frequently have mixed pathology (ie, both Alzheimer disease and vascular dementia).
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Physical

The physical examination should be focused on the cardiovascular system and neurologic localizing signs.

  • The temporal arteries may show decreased pulsatility, local tenderness, and thickening associated with giant cell arteritis.[10]
  • Funduscopic examination provides important information regarding end-organ effects of hypertension and diabetes mellitus.
  • Cardiac auscultation may detect rhythmic and valvular abnormalities.
  • Low scores on a standardized instrument (eg, Mini Mental Status Examination, Short Blessed questionnaire) can provide corroborating evidence of a cognitive disturbance.
  • Spasticity, hemiparesis, visual field defects, pseudobulbar palsy, and extrapyramidal signs confirm focal pathology.
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Causes

Vascular dementia and cerebrovascular disease share risk factors, including age, male sex, diabetes mellitus, hypertension, cardiomyopathy, and possibly homocysteine levels.

  • So far, no relationship between cholesterol, serum lipoproteins, and the risk of vascular dementia is clearly indicated.
  • Evidence for tobacco consumption as a risk factor for vascular dementia is conflicting. However, a multiethnic, population-based study published in 2010 suggested that the brain is not immune to long-term consequences of heavy smoking. In fact, 21,123 heavy midlife smokers were followed for a mean of 23 years and were found more than 2 decades later to have a greater than 100% increased risk of dementia, Alzheimer disease, and vascular dementia.[11]
  • Limited alcohol consumption may be protective.[12]
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Contributor Information and Disclosures
Author

Jasvinder Chawla, MD, MBA  Chief of Neurology, Hines Veterans Affairs Hospital; Associate Professor and Director, Neurology Residency Training Program, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jaime Grutzendler, MD  Assistant Professor, Department of Neurology and Physiology, Northwestern University School of Medicine

Jaime Grutzendler, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience

Disclosure: Nothing to disclose.

Giovanni d'Avossa  MD, Lecturer, School of Psychology, Bangor University; NHS Honorary Consultant in Neurology

Disclosure: Nothing to disclose.

Fredy J Revilla, MD  Assistant Professor of Neurology, Head of Division of Movement Disorders, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati Veterans Affairs Medical Center

Fredy J Revilla, MD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Christopher Luzzio, MD  Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA  Professor of Neurology, University of Central Florida College of Medicine; Director of Cognitive Neurology, Director of Stroke Program, James A Haley Veterans Affairs Hospital

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Heart Association, and American Society of Neuroimaging

Disclosure: Nothing to disclose.

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