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   Vascular dementia   
      
   Dementia is a gradual and permanent loss of brain function that 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.   
   Vascular dementia is also called multi-infarct dementia.   
      
   Causes   
   Vascular dementia is the second most common cause of dementia after Alzheimer   
   disease in people over age 65. MID usually affects people between ages 55 and   
   75. More men than women have vascular dementia.   
      
   Vascular dementia is caused by a series of small strokes.   
      
   A stroke is an interruption in or blockage of the blood supply to any part of   
   the brain. A stroke is also called an infarct. Multi-infarct means that more   
   than one area in the brain has been injured due to a lack of blood.   
   If blood flow is stopped for longer than a few seconds, the brain cannot get   
   oxygen. Brain cells can die, causing permanent damage.   
   When these strokes affect a small area, there may be no symptoms of a stroke.   
   These are called silent strokes. Over time, as more areas of the brain are   
   damaged, the symptoms of dementia appear.   
   Not all strokes are silent. Larger strokes that affect strength, sensation, or   
   other brain and nervous system (neurologic) function can also lead to dementia.   
   Risk factors for vascular dementia include:   
      
   Diabetes   
   Hardening of the arteries (atherosclerosis)   
   High blood pressure (hypertension)   
   Smoking   
   Stroke   
   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, and then decline after having more   
   silent strokes.   
      
   Early symptoms of dementia can include:   
      
   Difficulty performing tasks that used to come easily, such as balancing a   
   checkbook, playing games (such as bridge), and learning new information or   
   routines   
   Getting lost on familiar routes   
   Language problems, such as trouble finding the name of familiar objects   
   Losing interest in things you previously enjoyed, flat mood   
   Misplacing items   
   Personality changes and loss of social skills   
   As dementia worsens, symptoms are more obvious and the ability to take care of   
   oneself declines. Symptoms may include:   
      
   Change in sleep patterns, often waking up at night   
   Difficulty doing basic tasks, such as preparing meals, choosing proper   
   clothing, or driving   
   Forgetting details about current events   
   Forgetting events in your own life history, losing awareness of who you are   
   Having delusions, depression, or agitation   
   Having hallucinations, arguments, striking out, or violent behavior   
   Having more difficulty reading or writing   
   Having poor judgment and loss of ability to recognize danger   
   Using the wrong word, not pronouncing words correctly, or speaking in   
   confusing sentences   
   Withdrawing from social contact   
   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:   
      
   Anemia   
   Brain tumor   
   Chronic infection   
   Drug and medication intoxication (overdose)   
   Severe depression   
   Thyroid disease   
   Vitamin deficiency   
   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:   
      
   Head CT scan   
   MRI of the brain   
   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 risk factors such as high   
   blood pressure, smoking, and high cholesterol to prevent future strokes:   
      
   Avoid fatty foods. Follow a healthy, low-fat diet.   
   DO NOT drink more than 1 to 2 alcoholic drinks a day.   
   Keep blood pressure lower than 130/80 mm/Hg. Ask your doctor what your blood   
   pressure should be.   
   Keep LDL "bad" cholesterol lower than 70 mg/dL.   
   Quit smoking.   
   The doctor may suggest aspirin or other medicines (blood thinners) to help   
   prevent blood clots from forming in the arteries. DO NOT take or give aspirin   
   up without talking to the doctor first.   
   The goals of helping someone with dementia in the home are to:   
      
   Manage behavior problems, confusion, sleep problems, and agitation   
   Remove safety hazards in the home   
   Support family members and other caregivers   
   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.   
      
   Hearing aids, glasses, or cataract surgery may be needed if the person has   
   problems involving these senses.   
      
   Outlook (Prognosis)   
   Some improvement may occur for short periods, but the disorder will generally   
   get worse over time.   
      
   Possible Complications   
   Complications include the following:   
      
   Future strokes   
   Heart disease   
   Loss of ability to function or care for self   
   Loss of ability to interact   
   Pneumonia, urinary tract infections, skin infections   
   Pressure sores   
   When to Contact a Medical Professional   
   Call the health care provider 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. This is an emergency symptom of stroke.   
      
   Prevention   
   Control conditions that increase the risk of hardening of the arteries   
   (atherosclerosis) by:   
      
   Controlling high blood pressure   
   Controlling weight   
   Reducing saturated fats and salt in the diet   
   Treating related disorders   
   Alternative Names   
   MID; Dementia - multi-infarct; Dementia - post-stroke; Multi-infarct dementia   
      
   References   
   Apostolova LG, DeKosky ST, Cummings JL. Dementias. In: Daroff RB, Fenichel GM,   
   Jankovic J, Mazziotta JC. Bradley's Neurology in Clinical Practice. 6th ed.   
   Philadelphia, PA: Elsevier Saunders; 2012:chap 66.   
      
      
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