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Vascular dementia

MID; Dementia - multi-infarct; Dementia - post-stroke; Multi-infarct dementia; Cortical vascular dementia; VaD; Chronic brain syndrome - vascular; Mild cognitive impairment - vascular; MCI - vascular; Binswanger disease

Dementia is a gradual and permanent loss of brain function. This occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.

Vascular dementia is caused by a series of small strokes over a long period.

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Causes

Vascular dementia is the second most common cause of dementia after Alzheimer disease in people over age 65.

Vascular dementia is caused by a series of small strokes.

Risk factors for vascular dementia include:

Symptoms of dementia may also be caused by other types of disorders of the brain. One such disorder is Alzheimer disease. Symptoms of Alzheimer disease can be similar to those of vascular dementia. Vascular dementia and Alzheimer disease are the most common causes of dementia, and may occur together.

Symptoms

Symptoms of vascular dementia may develop gradually or may progress after each small stroke.

Symptoms may begin suddenly after each stroke. Some people with vascular dementia may improve for short periods, but decline after having more silent strokes. Symptoms of vascular dementia will depend on the areas of the brain that are injured due to the stroke.

Early symptoms of dementia can include:

As dementia worsens, symptoms are more obvious and the ability to take care of oneself declines. Symptoms may include:

Nervous system (neurologic) problems that occur with a stroke may also be present.

Exams and Tests

Tests may be ordered to help determine whether other medical problems could be causing dementia or making it worse, such as:

Other tests may be done to find out what parts of thinking have been affected and to guide other tests.

Tests that can show evidence of previous strokes in the brain may include:

Treatment

There is no treatment to turn back damage to the brain caused by small strokes.

An important goal is to control symptoms and correct the risk factors. To prevent future strokes:

The goals of helping someone with dementia in the home are to:

Medicines may be needed to control aggressive, agitated, or dangerous behaviors.

Medicines used to treat Alzheimer disease have not been shown to work for vascular dementia.

Outlook (Prognosis)

Some improvement may occur for short periods, but the disorder will generally get worse over time.

Possible Complications

Complications include the following:

When to Contact a Medical Professional

Contact your doctor if symptoms of vascular dementia occur. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status, sensation, or movement. These are emergency symptoms of stroke.

Prevention

Control conditions that increase the risk of hardening of the arteries (atherosclerosis) by:

Related Information

Delirium
Depression
Stroke
High blood pressure - adults
Peripheral artery disease - legs
Diabetes
Dementia - what to ask your doctor

References

Budson AE, Solomon PR. Vascular dementia and vascular cognitive impairment. In: Budson AE, Solomon PR, eds. Memory Loss, Alzheimer's Disease, and Dementia. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 6.

Knopman DS. Cognitive impairment and dementia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 374.

Peterson R, Graff-Radford J. Alzheimer disease and other dementias. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 95.

Seshadri S, Economos A, Wright C. Vascular dementia and cognitive impairment. In: Grotta JC, Albers GW, Broderick JP et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 17.

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Review Date: 2/4/2020  

Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Stony Brook University School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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