Fast Five Quiz: Dementia

Helmi L. Lutsep, MD


October 17, 2018

Major depression is a widely observed mood disorder in vascular dementia. Severe depression is more common in persons with vascular dementia than in those with Alzheimer disease. Elderly demented patients may not endorse depressed mood and may be socially withdrawn with decreased psychomotor activity. Suicidal thoughts or intent, passive wishes to die, and feeling that life is not worthwhile is seen in these patients, and they should be closely followed.

Cognitive impairment, acutely or subacutely, after an acute neurologic event with a stepwise progression is a typical history suggestive of vascular dementia. However, this classic history is usually observed with multi-infarct dementia and may not be observed with a lacunar state.

The average age of onset for Binswanger dementia is between the fourth and seventh decades of life, and 80% of patients have a history of hypertension. Patients also show progressive motor, cognitive, mood, and behavioral changes over a period of 5-10 years. Mood and behavioral changes are observed early and, in some patients, may be the presenting feature. Patients may be apathetic or abulic. Intellectual deficits are also observed early in the disease, and patients are frequently described as disoriented, having memory deficits, being inattentive, and speaking vaguely. Patients with Binswanger dementia often have early-onset urinary incontinence and gait disturbances.

The onset of vascular dementia associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy occurs between the third and fourth decades of life. The clinical picture is similar to that of Binswanger disease but lacks a history of hypertension and risk factors for cerebrovascular disease.

For more on the presentation of vascular dementia, read here.


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