(1)
Department of Cardiovascular Medicine and Electrophysiology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
Abbreviations
AD
Alzheimer dementia
DM
Diabetes mellitus
HL
Hyperlipidemia
HTN
Hypertension
MRI
Magnetic resonance imaging
NINDS-AIREN
National Institute of Neurological Disorders and Stroke Association Internationale pour la Recherché et l’Enseignement en Neurosciences
NMDA
N-methyl-D-aspartate
PSD
Post-stroke dementia
VAD
Vascular dementia
Introduction
Cognitive decline is an all-too frequent downstream consequence of stroke. Dementia associated with vascular disease has variable presentations and limited treatment options. Identifying these patients early, however, may enable the patient and family to adapt and develop techniques to work around the deficits. Here, we highlight the variable presentations of dementia associated with vascular disease, proper evaluation methods, and treatment options.
Definitions
Post-stroke dementia (PSD):
Includes any dementia occurring after stroke
About 25 % of stroke patients develop new onset dementia 1 year after stroke
Lacunar and left hemispheric strokes are of higher risk for developing PSD
Age, race (nonwhite), low education, concomitant DM are also risks
Smoking not associated with PSD
Associated with decreased survival rates (40 % survival at 5 years vs. 75 % for non-PSD stroke patients)
Largely due to arteriosclerosis of small cerebral arteries, with recurrent and multiple lacunar infarcts
25–50 % of patients with vascular dementia pathology lack a history of clinical stroke
Vascular dementia (VAD)
Definition (NINDS-AIREN): the definition of vascular dementia is evolving, but the most commonly used definition requires three components for probable vascular dementia
1) Presence of dementia:
The presence of memory and at least one other cognitive domain as determined by neuropsychological testing or clinical assessment
Rule out of confounders such as delirium, psychosis, severe aphasia, or motor problems precluding neuropsychological testing
Interference with activities of daily living for vascular dementia. If minor or no disturbance of activities of daily living, then it is called vascular cognitive impairment
2) Presence of cerebrovascular disease: determined by clinical and imaging examination
3) A relationship between the former two points: stepwise or abrupt deterioration of cognition or dementia within 3 months of stroke
Second most common cause of dementia following AD
Risk Factors
Age: the main risk factor is age; the risk doubles every 5 years
Clinical stroke: 15–30 % of patients develop vascular dementia within 3 months of strokeRelated posts:
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