What Is Vascular Cognitive Impairment?

Vascular dementia (VD) refers to severe cognitive dysfunction syndrome caused by ischemic stroke, hemorrhagic stroke, and cerebrovascular diseases that cause hypoperfusion of brain regions such as memory, cognition and behavior. The prevalence of VD in China is 1.1% to 3.0%, and the annual incidence is 5 to 9/1000 people.

Basic Information

English name

vasculardementia

Visiting department

Neurology

Multiple groups

Advanced age, smoking, family history of dementia, history of recurrent stroke, hypotension, etc.

Common causes

Ischemic stroke, hemorrhagic stroke, cerebral ischemia and hypoxia, etc.

Causes of vascular dementia

Ischemic stroke, hemorrhagic stroke, and cerebral ischemia and hypoxia can cause cerebrovascular dementia. The elderly, smoking, family history of dementia, history of recurrent stroke and hypotension are susceptible to vascular dementia.

Clinical manifestations of vascular dementia

VD can be divided into various types according to the etiology, the involved blood vessels, the location of the diseased brain tissue, the neuroimaging and pathological characteristics. The following briefly describes the main types according to the form of the onset:

Acute vascular dementia

(1) Multi-infarct dementia (MID) Dementia syndrome caused by multiple cerebral infarction involving the cerebral cortex or subcortical area is the most common type of VD. It is manifested by repeated strokes with sudden onset repeatedly, stepped aggravation, undetermined course of cognitive dysfunction, and diseased blood vessels involving cortical and subcortical areas with corresponding symptoms and signs.

(2) Critical site infarct dementia (SID) Dementia syndrome caused by a single cerebral infarct involving the cortex and subcortical functional sites that are closely related to cognitive function. The posterior cerebral artery infarction involves the inferior medial side of the temporal lobe, the occipital lobe, and the thalamus. It is manifested as amnesia and visual disturbances. The left lesion has percutaneous cortical sensory aphasia, and the right lesion is spatially disoriented. Presented as apathy and executive dysfunction; deep perforating branches of the anterior, middle, and posterior cerebral arteries can involve the thalamus and basal ganglia and cause dementia. It is manifested as impaired attention, initiation, executive function and memory, vertical gaze paralysis, medial rectus paralysis, inability to converge, dysarthria and hemiplegia. Inner capsule knee involvement is manifested by sudden changes in cognitive function, fluctuations in attention, confusion, loss of willpower, and executive dysfunction.

(3) Watershed infarct dementia belongs to hypoperfusion vascular dementia. Imaging examination plays an important role in the diagnosis of this disease, manifested as percortical aphasia, memory loss, apraxia, and visual spatial dysfunction.

(4) Hemorrhagic dementia Dementia caused by hemorrhage in the brain parenchyma and subarachnoid hemorrhage. Cognitive dysfunction and dementia are common in thalamic hemorrhage. Subdural hematomas can also cause dementia, which is common in the elderly, and cognitive impairment can slowly develop in some patients.

2. Subacute or chronic vascular dementia

(1) Subcortical arteriosclerotic encephalopathy presents a progressive and occult course, often with obvious pseudobulbar paralysis, gait instability, urinary incontinence, and signs of damaged pyramidal tracts. Some patients may not have a clear history of stroke.

(2) Autosomal dominant cerebral arterial disease with subcortical infarction and leukoencephalopathy is a hereditary vascular disease that progresses to vascular dementia at a later stage.

Vascular dementia test

Neuropsychological examination

The simple mental state scale, the Hasegawa dementia scale, the blessed dementia scale, the daily life function scale, and the clinical dementia rating scale are used to establish dementia and its degree; the Hachinski ischemia scale 7 points supports VD diagnosis.

2. Neuroimaging

Brain CT showed multiple low-density infarcts of varying sizes in the cerebral cortex and white matter of the brain, showing extensive low-density areas in the subcortical white matter or lateral ventricle white matter. Brain MRI showed multiple long T1 and long T2 lesions in bilateral basal ganglia, cerebral cortex and white matter. Brain atrophy was seen around the lesions.

Diagnosis of vascular dementia

There are many diagnostic criteria for VD. The main points of diagnosis are:

1. The cognitive function confirmed by neuropsychological examination is significantly reduced, and there is a significant decline in social function.

2. Through medical history, clinical manifestations, and various auxiliary examinations, it is confirmed that there is a basis for cerebrovascular disease related to the onset of dementia.

3. Dementia occurs within 3 to 6 months after cerebrovascular disease. Dementia symptoms can occur suddenly or slowly, and the course of the disease is fluctuating or exacerbated.

4. Exclude other causes of dementia.

Differential diagnosis of vascular dementia

1. Alzheimer's disease (AD)

AD onset is hidden, progress is slow, memory and other cognitive dysfunction are prominent, personality changes, neuroimaging manifestations of significant cerebral cortex atrophy, Hachacinski ischemic scale 4 points (modified Hachacinski ischemic scale 2 points ) Support AD diagnosis.

2.Pick disease

In progressive dementia, there are obvious personality changes and social behavior disorders, impaired language functions, and memory and other cognitive impairments relatively late. CT or MRI is mainly atrophy of the frontal and / or temporal lobe.

3. Lewy Body Dementia (DLB)

Volatile cognitive impairment, repetitive and vivid visual hallucinations, extrapyramidal symptoms. However, there were no infarcts on imaging, and no signs of localization were found on neurological examination.

4. Parkinson's disease dementia

In the early stage of Parkinson's disease dementia, symptoms of extrapyramidal involvement such as resting tremor and muscle rigidity are manifested. Impaired attention, computing power, visual space, and memory. There is generally no history of stroke.

Vascular dementia treatment

1. Treatment of primary cerebrovascular disease

For the treatment of hypertension, it is generally believed that controlling systolic blood pressure at 135 to 150 mmHg can improve cognitive function; antiplatelet aggregation therapy, aspirin, etc. can improve cerebral circulation; type 2 diabetes is an important risk factor for VD. VD has certain preventive significance; statins can reduce cholesterol and have positive significance for preventing cerebrovascular disease.

2. Treatment of cognitive symptoms

Vitamin E, vitamin C, and ginkgo biloba preparations may have some adjuvant therapeutic effects; the cholinesterase inhibitor donepezil may be effective for VD; brain activators such as piracetam and nigergoline help improve symptoms.

For patients with mental symptoms, various bad behaviors, sleep disorders, etc., corresponding medical treatment should be performed. The rehabilitation of patients is also very important, which is related to their quality of life.

Prognosis of vascular dementia

The prognosis of VD is related to the underlying disease causing vascular damage and the location of intracranial vascular lesions. By improving cerebral circulation and preventing the recurrence of cerebrovascular disease, symptoms can be reduced and the condition can be prevented from further worsening.