Clinical description and diagnostic guidelines
Vascular (formerly arteriosclerotic) dementia, which includes multi-infarct dementia, is distinguished from dementia in Alzheimer's disease by its history of onset, clinical features, and subsequent course. Typically, there is a history of transient ischemic attacks with brief impairment of consciousness, or visual loss. The dementia may also follow a succession of acute cerebrovascular accidents or, less commonly, a single major stroke. Some impairment of memory and thinking then becomes apparent. Onset, which is usually in later life, can be abrupt, following one particular ischemic episode, or there may be more gradual emergence. The dementia is usually the result of infarction of the brain due to vascular diseases, including hypertensive cerebrovascular disease. The infarcts are usually small but cumulative in their effect.
The diagnosis presupposes the presence of a dementia as described above. Impairment of cognitive function is commonly uneven, so that there may be memory loss, intellectual impairment, and neurological signs. Insight and judgement may be relatively well preserved. An abrupt onset of deterioration, as well as the presence of neurological signs and symptoms, increases the probability of the diagnosis; in some cases, confirmation can be provided only by a CT Scan or, ultimately, neuropathological examination.
Associated features are: hypertension, emotional lability with depressive mood, weeping or explosive laughter, and episodes of clouded consciousness or delirium, often caused by further infarctions. Personality is believed to be relatively well preserved, but personality changes may be evident in some cases with apathy, egocentricity, paranoid attitudes, or irritability.
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