(Binswanger’s Disease; Senile Dementia; Binswanger’s Type; Vascular Cognitive Impairment)
Vascular dementia is the third most common cause of dementia]]> . It is caused by disease of the small blood vessels in the brain. Parts of the brain called white matter (as well as subcortical grey matter) are injured, often by multiple small ]]>strokes]]> .
Healthy and Injured Brain Blood Vessels
Vascular dementia occurs when cells below the surface of the brain (the cortex) receive an inadequate supply of oxygen and nutrients and, in turn, die. This process is due to hardening of the blood vessels within the white matter of the brain, which affects the blood supply. As a result, the oxygen and nutrient supply to the neurons and their supporting cells are also affected.
The exact cause is unknown. However, factors that play a role in causing the disease include:
Vascular dementia usually affects older individuals. Vascular dementia and Alzheimer’s dementia]]> can occur together, making the diagnosis of one over the other difficult. Other factors that increase the risk of the disease include:
- High blood pressure (the most closely associated risk factor)
- Cardiovascular disease
- Hardening of blood vessels (atherosclerosis and lipohyalinosis)
- Conditions that cause the blood to clot
- Genetic disorders
In some patients, symptoms appear suddenly with neurologic changes like those caused by a stroke. Sometimes, the small strokes that lead to vascular dementia can happen without other symptoms. This makes the condition difficult to detect.
In some cases, symptoms may stabilize or even improve. However, in most patients, the disease continues to progress.
The main symptoms of vascular dementia include:
- Abrupt onset
Progressive deterioration of:
- Intellectual abilities
- Processing speed
- Cognitive and motor abilities
- Progressive memory loss
- Slow, unsteady gait
- Focal neurologic symptoms
Other symptoms that may be present in people with this disease include:
- Laughing, crying, or smiling during inappropriate times
- Difficulty speaking
- Swallowing difficulties
- ]]>Paralysis]]> of one side of the body
- Apathy (loss of interest in activities)
-like symptoms, including:
- Loss of coordination
- Loss of trunk mobility
- Nighttime confusion
The symptoms of vascular dementia can resemble other causes of dementia, such as Alzheimer’s disease]]> .
Your doctor will ask about your symptoms and medical history and perform a physical exam. Tests may include:
- ]]>MRI scan]]> —a test that uses magnetic waves to make pictures of your brain
- ]]>CT scan]]> —a type of x-ray that uses a computer to take pictures of your brain
- Single photon-emission computed tomography (SPECT)—a test to look for functional degeneration of the white matter in the brain
- Neuropsychological testing
- Ultrasound of the carotid arteries
- ]]>Echocardiogram]]> —a test that uses high-frequency sound waves to exam the size, shape, and motion of the heart; to test for causes of strokes
- ]]>Electrocardiogram]]> (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle; to test for causes of strokes
- Blood work to test for problems with blood clotting
- ]]>Electroencephalogram]]> (EEG)—a test for abnormalities in the patterns of brain waves
There is no known cure for vascular dementia. Most patients die within 5-10 years after onset of the disease. Minimizing risk factors and alleviating symptoms are important in trying to slow disease progression and improve quality of life.
Medications can be given to help limit or control symptoms and possibly slow progression of the disease. These include:
- Medications to control:
- Antidepressant medications
- Nimodipine—may help improve cognitive function in the short-term
- Medications used to treat Alzheimer's disease, such as ]]>donepezil]]> (eg, Aricept) and ]]>memantine]]> (eg, Namenda)
There are no definitive guidelines for the prevention of vascular dementia. However, the following may help reduce your risk:
- Don’t smoke. If you smoke, quit.]]>
- Eat a diet that is ]]>low in fat]]> and ]]>low in salt]]> .
- If you drink alcohol, do so only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.
- Have your blood pressure and blood cholesterol levels checked regularly (at least once per year).
- Avoid low blood pressure. If you get dizzy when you stand up or have a history of ]]>fainting]]> , talk to your doctor.
National Institute of Neurological Disorders and Stroke
National Organization for Rare Diseases
Alzheimer Society of Canada
Heart and Stroke Foundation of Canada
Aminoff MJ, Greenberg DA, Simon RP. Disorders of cognitive function. Clinical Neurology, Access Medicine website. Available at: http://www.accessmedicine.com/content.aspx?aID=2079000 . Accessed February 4, 2009.
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
Binswanger’s disease—revisited. Neurology . 1995;45: 626-633.
Bowler JV, Hachinski V. Vascular Dementia. In: Gilman S, ed. MedLink Neurology website. Available at http://www.medlink.com . Accessed February 4, 2009.
National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov .
Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res . 2004;26:454-458.
Roman GC, Erkinjuntti T, Wallin A, et al. Subcortical ischaemic vascular dementia. Lancet Neurology . 2002;1:426-436.
Ropper AH, Brown RH. Degenerative diseases of the nervous system. Adams and Victor's Principles of Neurology, Access Medicine website. Available at: http://www.accessmedicine.com/content.aspx?aID=976498 . Accessed February 4, 2009.
Vascular dementia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php Updated January 24, 2009. Accessed February 4, 2009.
Last reviewed January 2009 by ]]>J. Thomas Megerian, MD, PhD, FAAP]]>
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