By : Lamiaa Moustafa Elbosaty
Vascular Dementia: It is slightly more common in men than in women. The prevalence increases with age, approximately doubling every 5 years. There appear to be geographical differences, with high rates reported in china, Japan, and the Russian Federation (O'Brien & Elias, 2004). Risk factors for vascular dementia include hypertension, cardiac abnormalities, diabetes mellitus, smoking, lipid abnormalities, autoimmune and infectious vasculitis. The age of onset is usually between 55 and 70 years (Gorelick, 2004).
v Clinical presentation:
The wide variation in symptomatology of vascular dementia depends on the areas of infarction. Patient may recover initially from the neurological and cognitive deficits associated with each infarct depending on the location and extent of damage (Esiri & Nagy, 2002). The presentation of vascular dementia is an abrupt onset of cognitive loss with onset of dementia within 3 months of asymptomatic cerebrovascular accident. The progression of dementia is stepwise, with paroxysmal deterioration of intellectual function (Román, 2002).
Emotional and personality changes may appear first, followed by impairments of memory and intellect that characteristically progress in steps. Depression is frequent and confusion is common, especially at night. Transient ischemic attacks or mild strokes may recur from time to time. Behavioral retardation and anxiety are more common than in Alzheimer's disease (Gold et al., 2002).
According to Román (2002), there is a history of frequent unexplained falls, urinary frequency, urgency or other urinary changes not explained by urological disease, emotional liability, and personality/mood changes. Cognitive changes of memory loss occur but are not always as prominent as with the presentation of Alzheimer's disease. Executive function as the ability to execute complex behavior, sequence information, and problem solve, changes are the more prominent cognitive changes of vascular dementia.
Other cognitive change of problems with concentration and comprehension and disturbances in abstract thinking, judgment, and impulse control (Gorelick, 2003).
The course of vascular dementia is usually a stepwise progression with periods of deterioration that are sometimes followed by partial recovery for a few months. About 50% of the patients die from ischemic heart disease and others die from cerebral infarction or renal complications. From the time of diagnosis, the life span varies widely; most studies showed somewhat shorter survival in than in Alzheimer's disease (Kuller et al., 2005).
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