HC8: Vascular Dementia
Vascular dementia (VAD) – dementia caused by cerebrovascular disease
Cerebrovascular disease (CVD) – disease of blood vessels in brain affects blood
supply
Cerebrovascular pathology associated with reduction in blood flow
Until 1960s cerebrovascular disease regarded main cause of dementia in older
adults
Prevalence
VAD second most common form of dementia, after AD
o Netherlands: 16% of dementia cases are VAD (Alzheimer Nederland)
o UK: 17% vascular (Alzheimer Society)
Cerebral vascular pathology and AD – majority cases dementia and MCI in older
adults
o Pure VAD
o Pure AD
o Mixed dementia: combination of both pathologies
Vascular cognitive impairment (VCI): all forms of cognitive impairment caused by
cerebrovascular disease (Gorelick et al., 2011)
- Very mild – severe
- Milder forms: VCI no dementia (VCIND) or vascular MCI (VaMCI)
- More severe forms: consequences for daily functioning, vascular dementia (VAD)
VAD is a result of 2 main forms of cerebrovascular disease:
1. White matter lesions, lacunar infarcts, small vessel stroke
2. Cerebral arteries stroke/large vessel stroke
Combination of 1 and 2.
White matter lesions, lacunar infarcts, small vessel stroke
o Vessel disease – hypoperfusion brain tissue (less/insufficient perfusion to the
brain) – degeneration white matter (white matter lesions)
o Vessel disease – microbleeds in brain tissue – tissue death
o Diffuse
White matter lesions are visible as
hyperintensities on MRI scans: minor (L)
and extensive (R)
, Underlying causes: atherosclerosis
- Build up plaque inside arteries
- Hardens and narrows the arteries
- Limits blood flow to tissues
- Risk rupture
Narrowed arteries or high blood pressure
increase risk lacunar infarct/lacunar stroke.
This is the most common type of stroke
Cerebral arteries stroke/large vessel stroke
o Ischemic or hemorrhagic, occlusion or rupture
o More localized
o Strategic location or volume
VAD: small vessel disease seems to be more common in people diagnosed with dementia
than large vessel disease.
Staekenborg et al. 2008: 522 patients had small vessel disease, 126 had large vessel
disease, 58 patients were mixed. Roughly, 4/5 times as many patients had small vessel
disease than large vessel disease.
Clinical features
Clinical presentation VAD is diverse heterogeneity is the rule
Variety cerebrovascular events can lead to symptoms, and it depends on the location
Damage can occur in variety of locations
Criteria for diagnosis has also been revised several times
Earlier criteria (e.g., DSM 4)
Memory prominent impairment
o Memory critical impairment (from AD)
o Not always most prominent impairment in VAD
o Pathology may not include medial temporal areas (as AD).
Stepwise deterioration (abrupt deterioration and stable intervals)
o Cognitive decline in steps: rapid decline and stable periods
Further stroke: rapid decline
Unlike gradual decline in AD
Vascular dementia (VAD) – dementia caused by cerebrovascular disease
Cerebrovascular disease (CVD) – disease of blood vessels in brain affects blood
supply
Cerebrovascular pathology associated with reduction in blood flow
Until 1960s cerebrovascular disease regarded main cause of dementia in older
adults
Prevalence
VAD second most common form of dementia, after AD
o Netherlands: 16% of dementia cases are VAD (Alzheimer Nederland)
o UK: 17% vascular (Alzheimer Society)
Cerebral vascular pathology and AD – majority cases dementia and MCI in older
adults
o Pure VAD
o Pure AD
o Mixed dementia: combination of both pathologies
Vascular cognitive impairment (VCI): all forms of cognitive impairment caused by
cerebrovascular disease (Gorelick et al., 2011)
- Very mild – severe
- Milder forms: VCI no dementia (VCIND) or vascular MCI (VaMCI)
- More severe forms: consequences for daily functioning, vascular dementia (VAD)
VAD is a result of 2 main forms of cerebrovascular disease:
1. White matter lesions, lacunar infarcts, small vessel stroke
2. Cerebral arteries stroke/large vessel stroke
Combination of 1 and 2.
White matter lesions, lacunar infarcts, small vessel stroke
o Vessel disease – hypoperfusion brain tissue (less/insufficient perfusion to the
brain) – degeneration white matter (white matter lesions)
o Vessel disease – microbleeds in brain tissue – tissue death
o Diffuse
White matter lesions are visible as
hyperintensities on MRI scans: minor (L)
and extensive (R)
, Underlying causes: atherosclerosis
- Build up plaque inside arteries
- Hardens and narrows the arteries
- Limits blood flow to tissues
- Risk rupture
Narrowed arteries or high blood pressure
increase risk lacunar infarct/lacunar stroke.
This is the most common type of stroke
Cerebral arteries stroke/large vessel stroke
o Ischemic or hemorrhagic, occlusion or rupture
o More localized
o Strategic location or volume
VAD: small vessel disease seems to be more common in people diagnosed with dementia
than large vessel disease.
Staekenborg et al. 2008: 522 patients had small vessel disease, 126 had large vessel
disease, 58 patients were mixed. Roughly, 4/5 times as many patients had small vessel
disease than large vessel disease.
Clinical features
Clinical presentation VAD is diverse heterogeneity is the rule
Variety cerebrovascular events can lead to symptoms, and it depends on the location
Damage can occur in variety of locations
Criteria for diagnosis has also been revised several times
Earlier criteria (e.g., DSM 4)
Memory prominent impairment
o Memory critical impairment (from AD)
o Not always most prominent impairment in VAD
o Pathology may not include medial temporal areas (as AD).
Stepwise deterioration (abrupt deterioration and stable intervals)
o Cognitive decline in steps: rapid decline and stable periods
Further stroke: rapid decline
Unlike gradual decline in AD
