# vascular dementia | Symptoms, Causes, Tests and Treatment | OSANG > Vascular dementia refers to a condition in which cognitive function is reduced due to cerebrovascular damage such as cerebral infarction, cerebral hemorrhage, and chroni… - Official page: https://osns.co.kr/en/encyclopedia/vascular-dementia - Organization: OSANG Neurosurgery ## Page content Dementia/Cognition ## vascular dementia Vascular Dementia · F01.5, I67.9 Vascular dementia is a type of dementia in which cognitive function declines due to damage to brain tissue due to stroke or chronic cerebrovascular disease, and is the second most common cause after Alzheimer's disease. ## At a glance Vascular dementia refers to a condition in which cognitive function is reduced due to cerebrovascular damage such as cerebral infarction, cerebral hemorrhage, and chronic small vessel disease. It is the second most common dementia after Alzheimer's disease, accounting for approximately 15-20% of all cases. It is characterized by progressive progressive deterioration, focal neurological signs, and a predominance of executive function decline. Diagnosis is made by confirming the relationship between cognitive decline and vascular lesions on brain MRI, and management of correctable vascular risk factors such as high blood pressure, diabetes, and atrial fibrillation is the key to prevention and treatment. - 01Definition and Overview - 02Causes and Pathophysiology - 03symptoms - 04diagnosis - 05treatment ## Definition and Overview Vascular dementia is a type of dementia in which brain tissue is damaged due to cerebrovascular damage such as cerebral infarction, cerebral hemorrhage, and chronic cerebrovascular disease, leading to a decline in cognitive function. It is the second most common form of dementia after Alzheimer's disease, accounting for approximately 15-20% of all cases. Recently, it is treated as a broad concept called vascular cognitive impairment, encompassing a continuum from mild cognitive decline to dementia. In elderly patients, a mixed type in which both Alzheimer's pathology and vascular pathology exist together is common. In ICD-10, it is classified into the F01 series and I67.9, which indicates cerebrovascular disease. ## Causes and Pathophysiology Vascular dementia is divided into several types depending on the size of damaged blood vessels and lesion pattern. - Multiple infarction dementia: Cognitive function gradually deteriorates due to the accumulation of multiple large vessel cerebral infarctions. - Strategic infarction dementia: Dementia can occur even if a single infarction occurs in areas key to cognition, such as the thalamus and hippocampus. - Subcortical ischemic vascular dementia: The small blood vessels (small blood vessels) in the brain are chronically damaged, causing white matter degeneration and multiple lacunar infarcts to accumulate and progress slowly. Subcortical damage caused by small vessel disease breaks the circuit connecting the frontal lobe and the subcortex, reducing executive function and processing speed. Among the risk factors, high blood pressure is the most important, followed by diabetes, dyslipidemia, smoking, atrial fibrillation, and old age. ## symptoms The clinical manifestations of vascular dementia vary depending on the area and extent of damage, but the following characteristics are common. - Gradual deterioration: In many cases, the condition worsens suddenly or progresses in steps in line with the timing of the stroke. - Predominant decline in executive function: Decrease in planning, judgment, and processing speed appears first and more clearly than memory. - Focal neurological signs: Hemiplegia, paresthesia, dysarthria, gait disturbance, and dysphagia. - Others: Depression, apathy, and difficulty controlling emotions (pathological crying and laughing) are common. However, the form caused by small vessel disease progresses slowly without a clear stroke, so it may be difficult to distinguish it from Alzheimer's disease. ## diagnosis Diagnosis aims to confirm cognitive decline and demonstrate that the decline is temporally and anatomically related to cerebrovascular lesions. - History taking: history of stroke, progressive deterioration pattern, vascular risk factors identified - Neurological examination: check for local neurological signs such as hemiplegia and gait disturbance - Neuropsychological testing: Assessment of cognitive domains including executive function and processing speed - Brain MRI: Evaluation of location and burden of vascular lesions such as infarction, hemorrhage, white matter high-signal lesion, and lacunar - Blood tests and cardiac evaluation: Check for vascular risk factors and embolic sources (such as atrial fibrillation) Vascular dementia is diagnosed when vascular lesions are sufficient compared to the degree of cognitive decline and a correlation between the two is recognized. ## treatment ### Vascular risk factor management The key to treating vascular dementia is preventing additional cerebrovascular damage. Control high blood pressure, diabetes, and dyslipidemia to target levels, and quit smoking, abstain from drinking, and exercise regularly. If atrial fibrillation is present, embolic cerebral infarction can be prevented with anticoagulant treatment, and recurrence can be reduced with antiplatelet medication when necessary. ### Drugs and Rehabilitation Treatment There is no established drug specifically for stopping vascular dementia itself. In the mixed type with Alzheimer's pathology, cholinesterase inhibitors or memantine are used to relieve cognitive symptoms. Motor, language, and cognitive rehabilitation after stroke contributes to recovery and maintenance of function. ### Non-pharmacological management Regular exercise, cognitive stimulation, social activity, and depression management help maintain cognitive function. Managing vascular risk factors is beneficial not only for cerebrovascular disease but also for preventing dementia overall. ## Frequently asked questions ### Q01How is vascular dementia different from Alzheimer's disease? While Alzheimer's disease begins slowly with recent memory decline and progresses gradually, vascular dementia often worsens suddenly or in a stepwise manner, coinciding with the time of a stroke. Another difference is that a decline in executive function and processing speed predominates over memory, and is accompanied by local neurological signs such as hemiplegia or gait disturbance. ### Q02Does everyone who suffers a stroke develop vascular dementia? Not all of them lead to dementia. Results vary depending on the location and extent of the damaged brain and existing cognitive status. However, because the risk of cognitive decline after stroke increases, recurrence prevention, risk factor management, and rehabilitation are important to maintain cognitive function. ### Q03Can vascular dementia be treated with medication? There is no established drug specifically for stopping vascular dementia itself. The key to treatment is to prevent further damage by managing vascular risk factors such as high blood pressure, diabetes, dyslipidemia, and atrial fibrillation. In mixed cases with Alzheimer's pathology, cholinesterase inhibitors may be used. ### Q04Can vascular dementia be prevented? Management of correctable vascular risk factors is the key to prevention. Controlling blood pressure, blood sugar, and cholesterol, quitting smoking, abstaining from drinking, regular exercise, and anticoagulant treatment for atrial fibrillation lower the risk of cerebrovascular damage and subsequent cognitive decline. ### Q05What does dementia caused by small vessel disease look like? When small blood vessels in the brain are chronically damaged, white matter degeneration and small lacunar infarcts accumulate, leading to slowly progressive cognitive decline. Decreased processing speed and executive function, gait instability, and depression are common, and white matter hyperintense lesions and lacunae are observed on brain MRI. ### Q06Can the progression of vascular dementia be stopped? Although brain tissue that has already been damaged cannot be reversed, thorough management of risk factors can slow the progression by reducing additional blood vessel damage. Regular blood pressure and blood sugar measurements, medication use, lifestyle management, and prevention of recurrent stroke should be done together. ## Related articles - Dementia Overview - Alzheimer's disease - Lewy body dementia - frontotemporal dementia This article provides general medical information and does not replace an individual diagnosis or treatment plan. 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