Vascular dementia
Dementia caused by cerebrovascular disease, presenting with a stepwise or abrupt decline in executive function and processing speed rather than the gradual memory loss of Alzheimer disease. Diagnosis requires evidence of cerebrovascular disease on imaging plus a temporally related or stepwise cognitive course; management is aggressive vascular risk factor control, since no drug reverses established vascular injury.
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What this article covers
- Overview
Dementia from cerebrovascular disease: vascular dementia (vascular cognitive impairment) is a syndrome of cognitive decline in which cerebrovascular disease, either large-vessel infarcts, strategic…
- Epidemiology
Prevalence rises steeply with age, paralleling the burden of cerebrovascular disease, and is highest among patients older than 85 years.
- Risk factors
Hypertension: the single most modifiable driver of both large-vessel and small-vessel ischemic brain injury.
- Pathophysiology
Multiple vascular mechanisms converge on cognitive networks: vascular dementia is not one lesion type but a final common pathway from several patterns of vascular brain injury, including multiple…
- Clinical features
Stepwise or abrupt decline is the classic pattern: cognitive function typically worsens in discrete steps temporally associated with clinically apparent strokes, in contrast to the smooth, gradually…
- Differential diagnosis
Alzheimer disease: presents with early, prominent amnesia and progressive smooth decline rather than stepwise decline; MRI shows disproportionate hippocampal atrophy rather than confluent white matter change.
- Diagnosis
Diagnosis requires dementia or cognitive impairment plus evidence linking it to cerebrovascular disease: the diagnostic formulation requires cognitive impairment, imaging or clinical evidence of…
- Management
First step: aggressive control of vascular risk factors, since this is both treatment and secondary prevention and follows the same protocols used for secondary stroke prevention.
- Complications
Progressive functional decline: loss of independence in activities of daily living tracks with cumulative infarct burden and white matter disease severity.
- Prognosis
Course depends on the pattern of vascular injury and ongoing risk factor control: patients with well-controlled vascular risk factors and no further strokes may have a relatively stable plateau…
- Prevention
Blood pressure control below 130/80 mm Hg is the single highest-yield preventive measure, starting in midlife, to reduce both stroke and subsequent vascular dementia risk.
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Related articles
- Alzheimer disease
Alzheimer disease is the most common cause of dementia, presenting as insidious memory, language, and visuospatial decline with minimal motor involvement until late stages. Diagnosis is clinical, supported by hippocampal atrophy on MRI; first-line treatment is an acetylcholinesterase inhibitor such as donepezil, with memantine added for moderate to severe disease.
- Dementia with Lewy bodies
Dementia with Lewy bodies is a synuclein-related neurodegenerative dementia defined by dementia plus parkinsonism, fluctuating attention, visual hallucinations, and REM sleep behavior disorder arising within about two years of each other. Diagnosis is clinical; acetylcholinesterase inhibitors treat cognitive symptoms and first-generation antipsychotics must be avoided because of severe neuroleptic sensitivity.
- Frontotemporal dementia
Frontotemporal dementia (FTD) is the second most common neurodegenerative dementia in patients under 65, comprising a behavioral variant marked by early personality and disinhibition change and language variants (primary progressive aphasia) marked by isolated progressive language decline. Diagnosis rests on clinical criteria supported by MRI or FDG-PET showing frontotemporal atrophy; there is no approved disease-modifying or symptomatic drug therapy.
- Mild cognitive impairment
Mild cognitive impairment (MCI) is a clinical diagnosis of measurable cognitive decline with preserved daily function, requiring a reversible-cause workup (TSH, vitamin B12, structural imaging) before counseling. No medication is approved to treat MCI or prevent progression; management is exercise, risk-factor control, and monitoring, since annual dementia conversion risk is 5-15%.
- Lacunar stroke
Small subcortical infarct, under 1.5 cm, from occlusion of a single penetrating artery, most often caused by hypertensive lipohyalinosis, producing one of five classic pure motor, pure sensory, ataxic hemiparesis, dysarthria-clumsy hand, or mixed sensorimotor syndromes without cortical signs, diagnosed by MRI and managed with the standard acute stroke pathway plus aggressive antiplatelet, statin, and blood pressure secondary prevention.
- Ischemic stroke
Ischemic stroke is sudden focal neurologic deficit from arterial occlusion confirmed by infarction on neuroimaging. Diagnosis relies on urgent noncontrast head CT to exclude hemorrhage; treatment is IV alteplase within 4.5 hours and mechanical thrombectomy for large-vessel occlusion within an extended window, followed by antiplatelet therapy and risk-factor control.