Vascular dementia

Last updated: June 29, 2023

Summarytoggle arrow icon

Epidemiologytoggle arrow icon

  • Second most common type of dementia (15–20% of cases) [1]
  • Prevalence increases with age (∼ 1–4% in patients ≥ 65 years).

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Lesions of the smaller (microangiopathy) and larger (macroangiopathy) cerebral arteries share common risk factors and pathological features but produce distinct clinical entities. [3]

Small vessel disease [3][4]

Large vessel disease

Clinical featurestoggle arrow icon

Symptoms depend on the location of ischemic events and therefore vary widely between individuals, but a progressive impairment of daily life is common. Because of the diverse clinical picture, the term “vascular cognitive impairment” is gaining popularity over VD. [5]

Dementia due to small vessel disease [6]

  • Symptoms tend to progress gradually or stepwise and comparatively slower than in multi-infarct dementia.
  • Generally associated with signs of subcortical pathology:
    • Early symptoms
      • Reduced executive functioning
      • Loss of visuospatial abilities
      • Confusion
      • Apathy
      • Motor disorders (e.g., gait disturbance, urinary incontinence)
    • Later symptoms
      • Impaired memory
      • Further cognitive decline: loss of judgment, disorientation
      • Mood disorders (e.g., euphoria, depression)
      • Behavioral changes (e.g., aggressiveness)
    • Advanced stages: further motor deterioration: dysphagia, dysarthria

Dementia due to large vessel disease [6]

  • Usually sudden onset
  • Multi-infarct dementia: typically, stepwise deterioration
  • Generally associated with signs of cortical pathology:
    • Cognitive impairment in combination with asymmetric or focal deficits (e.g., unilateral visual field defects, hemiparesis, Babinski reflex present)
    • Symptoms depend on the affected cerebral region(s): See “Clinical features” in “Stroke”.

Subtypes and variantstoggle arrow icon

Diagnosticstoggle arrow icon

VD is a clinical diagnosis (as with all dementias; see “Mini-Mental State Examination”) based on medical history and clinical features, which is supported by imaging findings.

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

VD results in an irreversible loss of cognitive skills. Management is therefore aimed at symptomatic treatment of dementia (e.g., memory therapy) and prevention of additional ischemic events.

Referencestoggle arrow icon

  1. Wolters FJ, Ikram MA. Epidemiology of Vascular Dementia. Arterioscler Thromb Vasc Biol. 2019; 39 (8): p.1542-1549.doi: 10.1161/atvbaha.119.311908 . | Open in Read by QxMD
  2. CADASIL. . Accessed: January 4, 2021.
  3. Iemolo F, Duro G, Rizzo C, Castiglia L, Hachinski V, Caruso C. Pathophysiology of vascular dementia.. Immun Ageing. 2009; 6: p.13.doi: 10.1186/1742-4933-6-13 . | Open in Read by QxMD
  4. Caplan LR, Siesjo BK, Weir B et al.. Primer on Cerebrovascular Diseases. ACADEMIC PRESS ; 1997
  5. Jellinger KA. Pathology and pathogenesis of vascular cognitive impairment-a critical update. Frontiers in Aging Neuroscience. 2013; 5.doi: 10.3389/fnagi.2013.00017 . | Open in Read by QxMD
  6. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42 (9): p.2672-713.doi: 10.1161/STR.0b013e3182299496 . | Open in Read by QxMD
  7. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  8. Heiss WD, Rosenberg GA, Thiel A, Berlot R, de Reuck J. Neuroimaging in vascular cognitive impairment: a state-of-the-art review.. BMC Med. 2016; 14 (1): p.174.doi: 10.1186/s12916-016-0725-0 . | Open in Read by QxMD

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