Drugs & Diseases > Psychiatry

Vascular Dementia
Updated: Nov 01, 2016
 Author: Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH; Chief Editor: Randon S
Welton, MD more...

Background
Vascular dementia is the second most common form of dementia after
Alzheimer Disease (AD). The condition is not a single disease; it is a group
of syndromes relating to different vascular mechanisms. As early as 1899,
arteriosclerosis and senile dementia were described as different
syndromes. In 1969, Mayer-Gross et al described this syndrome and
reported that hypertension is the cause in approximately 50% of
patients. Patients who have had a stroke are at increased risk for vascular
dementia. In 1974, Hachinski et al coined the term multi-infarct dementia.
In 1985, Loeb used the broader term vascular dementia. Recently, Bowler
and Hachinski introduced a new term, vascular cognitive impairment.
Vascular dementia is preventable; therefore, early detection and an
accurate diagnosis are important.
Case study

A 70-year-old woman came to the clinic with her son for assessment of her
cognitive decline. The son is concerned about her short-term memory
problems for the past 10 months. She had a fall 10 months ago; after that
fall, she started to ask the same questions over and over. There was
another fall 4 months ago and also an episode of dizziness 2 months ago.
With these incidents, her son noticed further decline in cognition. Recently,
her son noticed that she has become a bit more suspicious of her
daughter-in-law and has been hoarding things. She has lost interest in her
day-to-day activities and forgets to include the right ingredients when
cooking. Family has to remind her to take her medications, and her son is
helping with the management of her finances.
The patient has hypertension, diabetes, coronary artery
disease,osteoarthritis, and osteoporosis. On the Mini-Mental Status
Examination (MMSE), the patient scored 21/30 with abnormal clock
drawing. On the Geriatric Depression Scale (GDS), the patient scored 2/15.
CT scan of the head showed multiple lacunar infarcts in the right basal
ganglia and left cerebellar region.
Epidemiology

Frequency

Vascular dementia is the second most common cause of dementia in the United States and Europe,
but it is the most common form in some parts of Asia.

The prevalence rate of vascular dementia is 1.5% in Western countries and approximately 2.2% in
Japan. In Japan, vascular dementia accounts for 50% of all dementias that occur in individuals older
than 65 years.

In Europe, vascular dementia and mixed dementia account for approximately 20% and 40% of cases,
respectively.

In Latin America, 15% of all dementias are vascular.

In community-based studies in Australia, the prevalence rate for vascular and mixed dementia is 13%
and 28%, respectively.

The prevalence rate of dementia is 9 times higher in patients who have had a stroke than in controls.
One year after a stroke, 25% of patients develop new-onset dementia. Within 4 years following a
stroke, the relative risk of incident dementia is 5.5%.

The prevalence of vascular dementia is higher in men than in women.

Prognosis
Mortality/Morbidity

In patients with dementia who have had a stroke, the increase in mortality
is significant. The 5-year survival rate is 39% for patients with vascular
dementia compared with 75% for age-matched controls. [9]
Vascular dementia is associated with a higher mortality rate than AD,
presumably because of the coexistence of other atherosclerotic diseases.
Study on causes of death in patients with dementia showed that circulatory
system disorders (e.g., ischemic heart disease) is the most common
immediate cause of death in vascular dementia, followed by respiratory
system diseases (e.g., pneumonia). [10]
A study of hospitalization rates in patients with dementia showed that
persons who developed different types of incident dementia, including
vascular dementia, were found to have an increased risk of hospitalization,
including hospitalization for ambulatory care-sensitive conditions. [11]
DSM V (2013) memakai kata Neurocognitive Disorder (NCD) dengan dua derajat keparahan yaitu
Major NCD (Gangguan Neurokognisi Mayor) (lampiran 6) untuk demensia dan Mild NCD (Gangguan
Neurokognisi Ringan) (lampiran 7) untuk gangguan kognisi tidak demensia.
Tabel 3. Domain Contoh simptom dan Contoh pemeriksaan
Kognisi, Contoh observasi
Gejala dan
Pemeriksaan DSM V
Domain kognitif
Atensi kompleks Mayor: Kesulitan dalam Substained attention:
(sustained attention, lingkungan dengan Mempertahankan
divided attention, stimulus jamak (TV, atensi dalam kurun
processing speed) radio, percakapan); waktu tertentu (seperti
mudah terdistraksi oleh menekan tombol setiap
kejadian lain di mendengar nada
lingkunganm, tidak tertentu selama
dapat mengikuti kecuali periode tertentu).
masukan stimulus Selective attention:
dibatasi atau Mempertahankan
disederhanakan. atensi walaupun
Kesulitan terdapat stimulus lain
mempertahankan bersamaan dan/atau
informasi baru di otak distraktor lain;
seperti mengingat mendengar angka-
kembali nomor telefon angka dan huruf-huruf
atau alamat yang baru yang dibacakan dan
saja diberikan, atau diminta menghitung
melapor kembali apa hanya huruf saja.
yang baru saja Divided attention:
disebutkan. Tidak Mengikuti dua tugas
mampu melakukan dalam waktu yang
kalkulasi mental. sama; mengetuk jari
Semua proses berpikir segera saat
memerlukan waktu mempelajari suatu
yang lebih lama dari cerita yang dibacakan.
biasanya, dan Kecepatan proses dapat
komponen yang dihitung waktunya
diproses harus pada setiap tugas
disederhanakan (seperti waktu
menjadi satu atau menyusun balok, waktu
beberapa saja. mencocokkan simbol
Ringan: Membutuhkan dengan angka;
waktu yang lebih lama kecepatan merespons
untuk menyelesaikan seperti counting speed
tugas dibanding atau serial 3 speed)
sebelumnya. Lebih
sering menemukan
kesalahan dalam tugas
rutin; membutuhkan
double-check pada
pekerjaan. Berpikir
lebih mudah bila tidak
ada yang mengganggu
(radio, TV, percakapan
lain, telefon seluler,
atau saat menyetir)