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

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

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

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

OBJECTIVE: This study was designed to evaluate the cause of mortality in patients with dementia, including Alzheimer's disease and multi-infarct dementia, and those without dementia. METHOD: Hospital records of geriatric patients (> or =65) in nursing home having dementia were reviewed retrospectively for 6 years. The total number of patients was 351 (the number of demented patients was 146 and those without dementia was 68). Of the ones with dementia, 146 had dementia of Alzheimer's type, 101 patients had vascular dementia, and 36 patients had non-specific dementia. This study focused on the different complications associated with Alzheimer's disease and cerebrovascular dementia. RESULT: 1) The average age at death of demented patient is higher than the non-demented population;however, there is no difference in age between Alzheimer's disease and vascular dementia. 2) There is no difference in time spent in the nursing home among the non-demented group, Alzheimer's disease and vascular dementia group from admission to death. The life expectancy of male patients with Alzheimer's disease after admission to the nursing home is significant shorter than their female counterpart. 3) Patients with vascular dementia have a higher incidence of hypertension, atherosclerotic disease, and diabetes than the Alzheimer's patients. 4) The main overall causes of the death (in nursing home patients) are infection and sepsis. In Alzheimer's disease's, sepsis is the major cause of death, while in vascular dementia, atherosclerotic disease is the number one cause. CONCLUSION: Knowledge of the causes of the death in demented patients may help the management of the possible complications associated with the different types of dementia. However, long-term research is then needed to analyze the survival rates of demented nursing home patients.
Alzheimer Disease ; Cause of Death ; Dementia* ; Dementia, Multi-Infarct ; Dementia, Vascular ; Female ; Hospital Records ; Humans ; Hypertension ; Incidence ; Life Expectancy ; Male ; Mortality* ; Nursing Homes* ; Nursing* ; Retrospective Studies ; Sepsis ; Survival Rate

The Mini Mental State Examination (MMSE; Folstein et al., 1975) is a quick and easy measure of cognitive functioning that has been widely used in clinical evaluation and research involving patients with dementia. The present study was conducted to examine the validity of the newly constructed Korean version of the MMSE (K-MMSE) in dementia patients. The K-MMSE was administered to 84 patients with Alzheimer's a disease, 64 patients with vascular dementia, and 23 patients with a diagnosis of pseudo-dementia. The result showed that of the cognitive components of the K-MMSE, Orientation, Attention and Calculaton, Recall, and Visual Construction are impaired in dementia patients. The sensitivities of the K-MMSE in detecting dementia were .70-83. Factor analysis indicated that the multiple cognitive components of the K-MMSE can he explained by one or two factors. The K-MMSE was also highly correlated with another brief measure of cognitive functioning, the Blessed Orientation Memory-Information(r=.78). The result, however, further suggested that the K-MMSE is relatively insensitive to detect the early stage of dementia, causing an increase in false negatives.
Dementia* ; Dementia, Vascular ; Diagnosis ; Humans

BACKGROUND: Dementia has emerged as a major healthy challenge, not only for clinicians but for society as a whole. So, there is a growing need for study of dementia. Evaulating the patients with dementia, examination of the sense of smell is not routinely performed. However, one of several neurologic changes include alterations in olfaction. OBJECTIVES: The aim of this study was to evaluate the value of olfactory function test in demented patients as diagnostic tool. MATERIALS AND METHOD: We studied the olfactory functions in 35 patients with dementia of the Alzheimer's type(DAT) and 20 patients with vascular dementia(VD) and compared with normal controls(n=30). These subjects were divided according to the Mini-Mental State Examination(MMSE). We used the T & T olfactometer for the olfactory function test. RESULTS: In the group of questionable DAT, the detection and recognition threshold were 0.25+/-0.95, 2.38+/-1.87, in the group of definitive DAT, 1.51+/-1.52, 3.91+/-1.55 and in the group of definitive vascular dementia, 2.03+/-1.48, 4.53+/-1.45. But, in the normal controls, the detection and recognition threshold was 0.66+/-0.90, 1.55+/-0.81 respectively. CONCLUSION: These findings suggest that olfactory function test are valuable in demented patients as diagnostic tool, but not specific in DAT group and that early detection of DAT is possible by olfactory function test.
Dementia* ; Dementia, Vascular ; Humans ; Smell