Diagnosis:

Vascular dementia VaD, NINDS AIREN criteria for probable disease:

Dementia +evidence of cerebrovascular disease +a relationship between them
Evidence of cerebrovascular disease:

• Clinical features:
  • Exam showing evidence of previous
  • Also, a triad of: short shuffling gait “marche au petit pas”, pseudobulbar palsy, pseudobulbar affect can occur.
• MRI (1st choice) or CT:
  • Large vessel disease:
    • Bilateral anterior cerebral artery
    • Dominant lobe: inferior medial temporal lobe, parieto-temporal association, tempero-occipital association, paramedian thalamic, angular gyrus, frontal parietal watershed areas,
  • Small vessel disease (subcortical vascular dementia):
    • White matter hyperintensity WMH
    • >25% of white matter, frontal lacunes, multiple basal ganglia or bilateral thalamus
• Relationship:
  • Dementia <3 months of a stroke
  • Abrupt deterioration or stepwise progression

Vascular cognitive disorder is the umbrella heading that includes vascular dementia, vascular cognitive impairment VCI i.e. without dementia, cerebrovacular disease with Alzheimers disease

Treatment:

General measures for dementia
Vascular risk modification:

• Control blood pressure e.g. by ACE inhibitor
• Aspirin
• Consider: statin

Dementia:

• Galantamine does not work

Related articles:

• Approach to cognitive impairment,
• Ischemic stroke, hemorrhagic stroke, cerebral amyloid angiopathy,