Psychiatry for Physicians – Dementia – Vascular Dementia

Vascular dementia (VaD) is caused by inadequate functioning of the supplying vessels in the brain. Vascular inadequacy is the second most common cause. Men are more vulnerable and usual age of onset is after 60 years. Risk factors for VaD are hypertension, heart disease, cigarette smoking, diabetes mellitus, excessive consumption of alcohol, and hyperlipidemia.

Strokes cause Vascular dementia in many ways. Both intra and extracranial vessels can be involved. According to the prevalence rates the most common causes are subcortical lacunar infarction, extracranial atherosclerosis, multiple cerebral emboli etc. Mixture of more than one stroke is also common in cases of VaD. Volume, number and location of infarction are the factors that modulate the dementic outcome of after a stroke. But among these location of infarction is the most important factor.

Clinical features of Vascular dementia are abrupt onset, stepwise progression, fluctuating course, depression, pseudobulbar palsy, history of hypertension, history of strokes, evidence of associated atherosclerosis, and focal neurological signs and symptoms. Ischemia score can help differentiate in between VaD and DAT. If the Hachinski ischemia score is 4 or less then the diagnosis should be DAT. But if it is 7 or more then it should be VaD.

VaD is diagnosed with the help of different neuroimaging techniques in presence of the following clinical features present in a patient –

1. Memory impairment

2. Cognitive disturbances like aphasia, apraxia, agnosia etc

3. Impairments cause significant practical disturbances

4. Presence of neurological or laboratory findings in support of causative cerebrovascular disease

MRI is the most useful and important neuroimaging technique for the diagnosis of VaD.

VaD is treated with the target to halt the progression of cognitive deterioration and for optimization of the intact cognitive capacity. So the following steps are taken for the above purposes –

1. Management of risk factors

2. Intervention for medical illnesses

3. Treatment of psychiatric illnesses

But as long the risk factors can also be the causative factors, preventive measures are very important so that situations or diseases risking us for VaD do not occurs.