Vascular dementia is an acute or chronic cognitive deterioration by diffuse or focal cerebral infarction, which usually occur as part of a cerebrovascular Erankung.

Dementia is a chronic, global, usually irreversible deterioration of cognition. Vascular dementia is the second most common cause of dementia in the elderly. It is more common in males and usually begins after the age of 70. It is more common in people with vascular risk factors (eg. As hypertension, diabetes mellitus, hyperlipidemia, smoking) and in patients with multiple insults in prehistory. Many people have both vascular dementia and Alzheimer’s disease.

Vascular dementia is an acute or chronic cognitive deterioration by diffuse or focal cerebral infarction, which usually occur as part of a cerebrovascular Erankung. Dementia is a chronic, global, usually irreversible deterioration of cognition. Vascular dementia is the second most common cause of dementia in the elderly. It is more common in males and usually begins after the age of 70. It is more common in people with vascular risk factors (eg. As hypertension, diabetes mellitus, hyperlipidemia, smoking) and in patients with multiple insults in prehistory. Many people have both vascular dementia and Alzheimer’s disease. Dementia should not be confused mitDelirium although the perception is impaired in both. The following helps to distinguish these: Dementia mainly affects memory, is usually caused by anatomical changes in the brain shows a slow start and is usually irreversible. A Dellir mainly concerns the attention is usually caused by an acute illness or drug or drug toxicity (sometimes fatal) and is often reversible. Other characteristics contribute to distinguish the two disorders (see Table: Differences Between Delirium and Dementia *). Etiology The vascular dementia typically occurs when multiple small cerebral infarcts (or sometimes bleeding) have caused plenty of neuronal or axonal damage to impede brain function. For vascular dementia include multiple lacunar infarction: Small blood vessels are affected. There appear many small infarcts deep in the white and gray matter of the hemispheres. Multi-infarct dementia: Medium blood vessels are affected. Strategic single infarct dementia: A single infarction occurs in a critical area of ??the brain (e.g., angular gyrus, thalamus.). Dementia in M. Binswanger (subcortical arteriosclerotic encephalopathy): This unusual variant of a disease of small vessels with dementia associated with severe, barely controllable hypertension and systemic vascular disease. caused diffuse and irregular loss of axons and myelin with extensive gliosis, the destruction of tissue due to infarction or loss of blood supply to the white matter of the brain. Symptoms and discomfort symptoms and signs of vascular dementia are similar to those of other dementias (z. B. to start memory loss, impaired executive function, difficulty actions or tasks, slowed thinking, personality and mood swings, language deficits). However, vascular dementia tends compared with Alzheimer’s disease to later to cause memory loss and to influence the executive function earlier. The symptoms can vary, depending on where the infarct occurs. Unlike other dementias multi-infarct dementia progresses more progress in definable steps. Each episode is accompanied by intellectual degradation, sometimes followed by a moderate recovery. Subcortical vascular dementia due to ischemic damage of small vessels (incl. Multiple lacunar infarction and dementia in M. Binswanger) gives rather small, incremental deficits; Thus, the deterioration seems to gradually erfoglen. With the progression of the disease often develop focal neurological deficits: Exaggerated deep tendon reflexes Plantarextensionsreaktion gait disturbances weakness of an extremity hemiplegia pseudobulbar with pathological laughing and crying Other signs of extrapyramidal dysfunction aphasia A cognitive function loss can be focal. Short-term memory such can. For example, be less affected than other dementias. Because of the loss can be focal, patients can retain more aspects of mental function. Therefore, they must take their deficits conscious and depression may be more common here than in other dementias. Diagnosis generally similar diagnosis as with other dementias Neuroimaging The diagnosis of vascular dementia is similar to using other forms of dementia (Dementia: Diagnosis). A general diagnosis of dementia requires each of the following: cognitive or behavioral (neuropsychiatric) symptoms that interfere with the ability to function at work and perform usual daily activities. These symptoms represent a decline of previous functional levels. These symptoms can be explained not by delirium or major mental disorder. To Abkl√§rungder cognitive function includes the recording of the patient’s medical history and by a person who knows the patient, plus an examination of the mental state at the bedside or if the investigation at the bedside remains inconclusive, formal neuropsychological examination (dementia: assessment of cognitive function). Differentiation between vascular dementia and other dementia based on clinical judgment. Among the factors that suggest a vascular dementia (Alzheimer’s disease, or cerebrovascular disease), include the following: Detection of cerebral infarcts High Hachinski Ischemia score Clinical features, characteristic (for vascular dementia, for example, prominent executive dysfunction, less than or. lack of memory loss) the confirmation of vascular dementia requires a history of stroke or evidence of detected by neuroradiological imaging vascular dementia cause. If focal neurological signs or evidence be cerebrovascular disorder, a thorough investigation into cerebral insult should be performed. CT and MRI can show bilateral multiple infarctions in the dominant hemisphere and limbic structures, multiple lacunar insults or periventricular white matter lesions that extend far into the white matter. In dementia in M. Binswanger imaging shows a leukoencephalopathy of the brain, semi oval adjacent to the cortex, often with multiple lacunar infarctions, the deep structures of the gray matter of concern (eg. As the basal ganglia, thalamic nuclei). The Hachinski ischemia scale is sometimes used in the differentiation of vascular dementia from Alzheimer’s disease (see Table: Modified Hachinski ischemic score). relatively obtain modified Hachinski ischemia score feature points * Sudden onset of symptoms 2 Gradual deterioration (eg. as decrease stability decline) 1 2 Fluctuating course Nocturnal confusion 1 Personality 1 Depression 1 Somatic complaints (eg. B. limb pain, chest pain) 1 1 emotional lability history or presence of hypertension history of stroke 1 2 detection of concurrent arteriosclerosis (z. B. PAD, myocardial infarction) 1 focal neurological symptoms (z. B. hemiparesis, homonymous hemianopia, aphasia ) 2 Focal neurological signs (eg. B. sided weakness, sensory disturbances, asymmetric reflexes, Babinski sign) 2 * Determination of Total score: <4: Indicates a primary dementia (eg Alzheimer's disease).. 4-7: undetermined. > 7: Suspected. vascular dementia. PAD = peripheral arterial disease Prognosis The 5-year mortality rate is 61%, higher than the mortality rate for most forms of dementia, probably due to the concurrent further atherosclerotic disorders. Treatment safety and supportive care treatment of vascular risk factors, including smoking cessation safety and support measures similar to those in other forms of dementia. For example, the environment should be bright, friendly and familiar, and it should be designed so that an orientation is reinforced (eg. As placement of large clocks and calendars in the room). Measures to ensure the safety of the patient (eg., Signal monitoring systems for patients who walk) should be initiated. Disturbing symptoms can be treated. The treatment of vascular risk factors (eg. As hypertension, diabetes, hyperlipidemia) can slow the progression of vascular dementia and help to prevent future strokes, which could cause more cognitive impairment. Treatment includes the following steps: blood pressure control cholesterol-lowering therapy regulation of plasma glucose (90 to 150 mg / dl) smoking cessation drugs such as cholinesterase inhibitors and memantine may be helpful in some dementias. Cholinesterase inhibitors may improve cognitive function. Memantine, an NMDA (N-methyl-D-aspartate) antagonist, can help to slow the loss of cognitive function and act synergistically when combined administration with a cholinesterase inhibitor in patients with moderate to severe dementia. The effectiveness of cholinesterase inhibitors and memantine is not secured in vascular dementia. Nevertheless, an attempt of these drugs makes sense, because older patients with vascular dementia may also have Alzheimer’s disease. Adjuvant drugs for depression, psychosis, and sleep are helpful. Conclusion A vascular dementia can as a series of separate episodes (which may look like a gradual deterioration), or occur as a single episode. Focal neurological symptoms may help to differentiate vascular dementia from other dementias. Make sure motivated by a history of stroke or findings because neuroradiological imaging, suggesting a vascular cause, ensure that the dementia is vascular conditions. Check the vascular risk factors, and when Alzheimer’s disease could be additionally be treated with cholinesterase inhibitors and memantine.

Health Life Media Team

Leave a Reply