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Vascular dementia 

Vascular dementia
Chapter:
Vascular dementia
Author(s):

Timo Erkinjuntti

DOI:
10.1093/med/9780199696758.003.0048
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date: 18 October 2018

Vascular dementia is the second most frequent cause of dementia. Because vascular causes of cognitive impairment are common, may be preventable, and the patients could benefit from therapy, early detection, and accurate diagnosis of vascular dementia is desirable. Vascular dementia is not only multi-infarct dementia, but is related to other vascular mechanisms and pathological changes in the brain, and has other causes and clinical manifestations. Vascular dementia is not a disease, but a syndrome. The origin of this syndrome reflects complex interactions between vascular aetiologies (cerebrovascular disorders and vascular risk factors), changes in the brain (infarcts, white-matter lesions, atrophy), host factors (age, education), and cognition. Conceptual issues related to of vascular dementia include the definition of the cognitive syndrome (type, extent, and combination of impairments in different cognitive domains), and the vascular causes (vascular aetiologies and changes in the brain). Variations in these definitions has led to different estimates of point prevalence, to different groups of patients, and to reports of different types and distribution of brain lesions. The cognitive syndrome of vascular dementia is characterized by predominate executive dysfunction rather than deficits in memory and language function. Although the course of cognitive decline may be stepwise, it is often slowly progressive, and may include periods of stability or even some improvement. The relationship between vascular lesions in the brain and cognitive impairment is important, but which type, extent, side, site, and tempo of vascular lesions in the brain relates to different types of vascular dementia is not established in detail. Current criteria for vascular dementia are based on the concept of cerebral infarcts. For example the widely used NINDS-AIREN criteria include dementia, cerebrovascular disease, and a relationship between these two disorders. The main tools for the diagnosis include detailed history, neurological examination, mental state examination, relevant laboratory examinations, and preferably magnetic resonance imaging of the brain. Vascular dementia research, until recently overshadowed by that into Alzheimer's disease, is now developing rapidly. There is great promise for intervention. Developments in classification, diagnosis, and treatment are likely.

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