Vascular dementia (VaD) is a dementia syndrome produced by vascular damage to the brain and increases in incidence with advancing age. Early Identification and diagnosis of VaD is particularly importent since its course may be modifiable through controlling vascular risk factors. VaD is heterogeneous and consists of several syndromes : multi-infarct dementia, strategic single infarcts dementia, and subcortical vascular dementia. The diagnosis of VaD is based on several features 1) dementia, 2) evidence of cerebrovascular disease, and 3) temporal relationship between dementia and cerebrovascular disease. Treatment of VaD includes control of vascular risk factors, prevention of further vascular injury and treatment of cognitive impairment. Cholinesterase inhibitors provide symptomatic benefits in treatment of VaD.
Brain ; Cholinesterase Inhibitors ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular ; Incidence ; Risk Factors ; Vascular System Injuries

Vascular dementia is defined as a clinical syndrome of acquired intellectual impairment resulting from a brain injury due to a cerebrovascular disorder. It incorporates various vascular pathophysiological mechanisms and changes in the brain, and has diverse cause and clinical manifestations. The main suptypes of vascular dementia include 1) multi-infarct dementia, 2) strategic infarct dementia, and 3) subcortical vascular dementia. Both multi-infarct dementia and strategic infarct dementia show heterogeneity in etiologies, changes of the brain, as well as clinical manifestations. On the contrary, subcortical vascular dementia is suggested to be a more homogenous group. To better understand the clinical features of vascular dementia, cases corresponding to each subtype of vascular dementia are briefly discussed this review.
Brain ; Brain Injuries ; Cerebrovascular Disorders ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Population Characteristics

Vascular dementia (VD) is a dementia syndrome associated with cerebrovascular disease. Among the several subtypes of VD, most common subtypes are multi-infarct dementia, single-infarct dementia, and subcortical vascular dementia. In patients with multi-infarct dementia, dementia occurs with a close temporal relationship to stroke episodes. Brain imaging usually shows multiple territory cortico-subcortical infarcts. Single-infarct dementia, in contrast, is caused by a single infarct in specific regions of the brain such as thalamus, caudate nucleus, capsular genu, angular gyrus, or hippocampus. In subcortical VD, primary lesion is lacunar infacts or ischemic white matter lesions that are located in subcortical regions, i.e., deep nuclei (basal ganglia and thalamus) or white matter (periventricular and deep white matter). The diagnosis of subcortical vascular dementia is challenging, since stroke episodes are often unrecognized, thus temporal relationship between onset of dementia and stroke is lacking. This article describes 1) subtypes of VD, 2) illustrative cases with vascular dementia, 3) research criteria for VD, 4) treatment of VD, and 5) a general guideline on caregiving for patients with VD, which will enable clinicians to provide better diagnosis and management of patients with VD.
Brain ; Caudate Nucleus ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Diagnosis ; Ganglia ; Hippocampus ; Humans ; Neuroimaging ; Stroke ; Thalamus

Vascular dementia (VaD) subtypes include multi-infarct dementia, subcortical ischemic vascular dementia, strategic-infarct dementia, etc. Poststroke dementia may be related to preexisting cognitive level, and the frequency increased with aging, lower educational level and accompanied vascular risk factors. Vascular cognitive impairment (VCI) forms a spectrum that includes VaD, mixed Alzheimer's disease (AD) with a vascular component, and VCI without dementia. The concept of VCI will improve the early diagnoses and secondary prevention and treatment of VaD, and promote the further research on vascular component in neurodegenrative disorders.
Cognition ; Cognition Disorders ; classification ; diagnosis ; etiology ; Dementia, Multi-Infarct ; classification ; diagnosis ; Dementia, Vascular ; classification ; diagnosis ; Humans

We report a 52-yr-old Korean woman with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) whose diagnosis was confirmed by skin biopsy and the presence of a novel mutation in the NOTCH3 gene. The patient's clinical features were rather unusual in that 1) clinical presentations were only two episodes of stroke and mild dementia unaccompanied by mood disturbances or migraine, and 2) there was no family history. Brain MRI showed T2 hyperintensities in both temporal pole areas in line with the recent suggestion by O'Sullivan et al. that the abnormality could be a radiologic marker of CADASIL. FDG-PET also showed a hypometabolism in the temporal pole areas with an abnormal finding on MRI in addition to the hypometabolism in cortical and subcortical regions. We could learn from this case that CADASIL may be included in the differential diagnoses in patients with vascular dementia associated with a small vessel disease, even in the absence of a family history, especially when there are no known stroke risk factors and when the MRI shows T2 hyperintensity in the temporal pole regions.
Amino Acid Substitution ; Biopsy ; Brain/pathology ; Codon/genetics ; Dementia, Multi-Infarct/diagnosis ; Dementia, Multi-Infarct/genetics* ; Dementia, Multi-Infarct/pathology ; Dementia, Multi-Infarct/radionuclide imaging ; Female ; Human ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Mutation, Missense* ; Neuropsychological Tests ; Point Mutation* ; Proto-Oncogene Proteins/genetics* ; Skin/pathology ; Tomography, Emission-Computed

OBJECTIVETo explore the mechanism of acupuncture in treatment of multi-infarct dementia (MID).

METHODSThe multi-infarct dementia model was made by injection of emboli into the internal carotid artery. The dementia rats were randomly divided into 3 groups: model group, acupuncture group and non-acupoint acupuncture group, and a normal group and a sham operation group were set up. The expression of CuZnSOD in the hippocampus of the rats were detected by in situ hybridization and immunohistochemical assay, and effects of acupuncture were analyzed.

RESULTSThe expressions of mRNA and protein of CuZnSOD in the hippocampus of the model group were significantly attenuated as compared with that in the normal control group. Both the parameters above were significantly increased in the acupuncture group as compared with the model control group, but with no significant difference between the acupuncture group and the normal control group.

CONCLUSIONAcupuncture can up-regulate the expressions of mRNA and protein of CuZnSOD in the rat with MID, so as to strengthen activity of antioxidase and effectively remove free radicals and improve intelligence of MID rats.

Acupuncture ; Acupuncture Therapy ; Animals ; Dementia, Multi-Infarct ; Hippocampus ; metabolism ; Humans ; RNA, Messenger ; genetics ; Rats ; Rats, Wistar

Differential diagnosis of Alzheimer's disease (AD) and vascular dementia(VaD) has an important bearing on the diagnosis and management of patients with dementia. This article provides a guideline for the differential diagnosis through 1) history taking, 2) neurological examination, 3) neuropsychological tests, and 4) neuroimaging studies. VaD consists of etiologically and clinically heterogeneous subtypes that include multi-infarct dementia (MID), single strategic infarct dementia, and subcortical vascular dementia. Patients with MID and single infarct dementia con be easily differentiated from patients with AD. However, clinical manifestations of subcortical vascular dementia can mimic those of AD, which may lead primary physicians to misdiagnose subcortical vascular dementia as AD. The issue of differential diagnosis is further complicated by the fact that many patients may have AD with concomitant VaD (mixed dementia).
Alzheimer Disease* ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Humans ; Neuroimaging ; Neurologic Examination ; Neuropsychological Tests

Underlying caustive diseases were observed on 108 patients with dementia diagnosed on DSM-III, who were admitted to Keimyung university Dongsan hospital during January 1985 to September 1988. The results were summarized as follows. 1. Male to female ratio was approximately 5 to 1. In all diseases causing dementia, male outnumbered female. In particular, alcoholic dementia, multi-infarct dementia, posttraumatic dementia, infection, hydrocephalus and subdural hematoma were almost limited to males. 2. The important causative diseases were alcoholic dementia (21.3%), multi-infarct dementia(18.5%), postanoxic encephalopathy (14.8%), dementia of Alzheimer type (12.1%), head trauma(8.3%), brain tumor (6.5%), pseudodementia(6.5%), infection(4.6%), hydrocephalus (4.6%), and subdural hematoma(2.8%) in the order of frequency. 3. Cerebral trauma was the most common cause of dementia in young adulthod, and alcoholic dementia, multiinfarct dementia and dementia of Alzheimer type were important in middle adulthood. In old age, multiinfarct dementia was noted to be the most common cause. 4. Thorough diagnostic evaluation has uncovered reversible disorders in 19.4% of the total patients and disorders which, though not reversible, nevertheless require active therapeutic intervention in an additional 60.2%.
Alcoholics ; Brain Neoplasms ; Dementia* ; Dementia, Multi-Infarct ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Head ; Hematoma, Subdural ; Humans ; Hydrocephalus ; Male

Atherothromboembolism and intracranial small vessel disease are considered to be the main causes of cerebrovascular injury, which may lead to cognitive impairment and vascular dementia (VaD). VaD appears to be the second most common type of dementia with prevalence estimates of 10-15%. Cortical or multi-infarct dementia and subcortical vascular dementia (SVD) are suggested to be the two main forms of VaD. The main clinical features of SVD comprise decreased motor performance, early impairment of attention and executive function with slowing of information processing. SVD results from lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter and are associated with more than 50% of the VaD cases. White matter changes including regions of incomplete infarction are usually widespread in VaD but their contribution to impairment of subcortical regions is unclear. While most of VaD occurs sporadically only a small proportion of cases bear clear familial traits. CADASIL is likely the most common form of hereditary VaD, which arises from subcortical arteriopathy. SVD needs unambiguous definition to impact on preventative and treatment strategies, and critical for selective recruitment to clinical trials.
Automatic Data Processing ; Basal Ganglia ; Brain Stem ; CADASIL ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Executive Function ; Infarction ; Prevalence ; Stroke ; Stroke, Lacunar ; Thalamus

Hachinski coined the term 'multi-infarct dementia', which now changed to 'vascular demntia', and used the Hachiski Ischemia Score (HIS) to differentiate multi-infarct dementia from Alzheimer's disease since 1974. The past two decades has seen a renewed interest in vascular dementia. New classification systems like DSM-IV, ICD-10, NINDS-AIREN and ADDTC have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke. Various aspects of clinical manefestation of vascular dementia were discussed and presented as tables.
Alzheimer Disease ; Classification ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; International Classification of Diseases ; Ischemia ; Neuroimaging ; Numismatics ; Stroke