At the INR we evaluate and and consider for treatment selected patients with vascular dementia. Vascular dementia often co-exists with other forms of dementia. The co-existence of two forms of dementia, such as Alzheimer’s disease and vascular dementia, is called mixed dementia. Some experts consider mixed dementia to be the most common form of dementia.
Vascular dementia is a common cause of memory loss in the elderly. Vascular dementia may be caused by multiple strokes or other disorders that disrupt the normal flow of blood to the brain, such as small vessel disease. Disruption of blood flow leads to damaged brain tissue. Strokes may occur without noticeable clinical symptoms. Doctors refer to these as “silent strokes.” An individual having a silent stroke may not even know it is happening, but over time, as more areas of the brain are damaged and more small blood vessels are blocked, the symptoms of vascular dementia begin to appear. Dementia caused by mutliple small strokes, even silent strokes, can be diagnosed by an MRI or CT of the brain, along with a neurological examination. Small vessel ischemic disease is a common finding on MRI or CT brain scans, and is often seen in patients in whom the primary diagnosis is Alzheimer’s disease, or mixed dementia. Symptoms include confusion or problems with short-term memory; wandering, or getting lost in familiar places; walking with rapid, shuffling steps; losing bladder or bowel control; laughing or crying inappropriately; having difficulty following instructions; and having problems counting money and making monetary transactions. Vascular dementia, which typically begins between the ages of 60 and 75, affects men more often than women. Because the symptoms of vascular dementia are so similar to Alzheimer’s disease, it can be difficult for a doctor to make a firm diagnosis. Since the diseases often occur together, making a single diagnosis of one or the other is even more problematic.
Inflammatory mechanisms are involved in vascular dementia. In particular, elevated levels of TNF have been found in the cerebrospinal fluid of patients with vascular dementia[1,2]. Therefore inflammatory mechanisms may constitute a therapeutic target for vascular, multi-infarct, or mixed dementia with a vascular component[3-6].
We encourage families of patients with vascular or mixed dementia to consult with an INR physician to explore the therapeutic options available.
1. Roman GC. Vascular dementia. Advances in nosology, diagnosis, treatment and prevention. Panminerva Med, 46(4), 207-215 (2004).
2. Tarkowski E, Tullberg M, Fredman P, Wikkelso C. Correlation between intrathecal sulfatide and TNF-alpha levels in patients with vascular dementia. Dement Geriatr Cogn Disord, 15(4), 207-211 (2003).
3. Tobinick E. Perispinal etanercept: a new therapeutic paradigm in neurology. Expert Rev Neurother, 10(6), 985-1002 (2010).
4. Angelopoulos P, Agouridaki H, Vaiopoulos H et al. Cytokines in Alzheimer’s disease and vascular dementia. Int J Neurosci, 118(12), 1659-1672 (2008).
5. Zuliani G, Cavalieri M, Galvani M et al. Markers of endothelial dysfunction in older subjects with late onset Alzheimer’s disease or vascular dementia. J Neurol Sci, 272(1-2), 164-170 (2008).
6. Zuliani G, Ranzini M, Guerra G et al. Plasma cytokines profile in older subjects with late onset Alzheimer’s disease or vascular dementia. J Psychiatr Res, 41(8), 686-693 (2007).