Vascular Multi

8/18/2019 Vascular Multi

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What Is Multi-Infarct Dementia?

Multi-infarct dementia (MID) is loss of brain function caused by a series of small strokes. A

stroke (also called a brain infarct) occurs when the blood flow to any part of the brain is

interrupted or blocked. Blood carries oxyen to the brain! and without oxyen! brain tissue

"uickly dies.

#he location of the stroke damae determines the type of symptoms that occur. $troke increases

the risk of dementia as much as four to twel%e times. #he mechanism of this is not fully

understood.

MID can cause the loss of memory and coniti%e function and can initiate psycholoical

problems. #reatment focuses on controllin the symptoms and reducin the risk for future

strokes.

Signs and symptoms of vascular dementia

&ascular dementia affects different people in different ways and the speed of the proression

%aries from person to person. $ome symptoms may be similar to those of other types of dementia

and usually reflect increasin difficulty to perform e%eryday acti%ities like eatin! dressin! or

shoppin.

Beha%ioral and physical symptoms can come on dramatically or %ery radually! althouh it

appears that a proloned period of #IAs'the mini-strokes discussed abo%e'leads to a radualdecline in memory! whereas a bier stroke can produce profound symptoms immediately.

eardless of the rate of appearance! %ascular dementia typically proresses in a stepwise

fashion! where lapses in memory and reasonin abilities are followed by periods of stability! only

to i%e way to further decline.



Common Signs and Symptoms of Vascular Dementia

Mental and Emotional Signs and Symptoms

$lowed thinkin

Memory problems eneral

foretfulness

*nusual mood chanes (e..

depression! irritability)

+allucinations and delusions

,onfusion! which may et worse at niht

ersonality chanes and loss of social skills

Physical Signs and Symptoms

Diiness

/e or arm weakness

#remors

Mo%in with rapid! shufflin steps

Balance problems

/oss of bladder or bowel control

ehavioral Signs and Symptoms

$lurred speech

/anuae problems! such as difficulty

findin the riht words for thins

0ettin lost in familiar surroundins

/auhin or cryin inappropriately

Difficulty plannin! oraniin! or followin

instructions

Difficulty doin thins that used to come easily (e..

handlin money! payin bills! or playin a fa%orite card

ame)

educed ability to function in daily life

Causes of Vascular Multi-infarct Dementia

&ascular dementia results from conditions that damae your brain1s blood %essels! reducin their

ability to supply your brain with the amounts of nutrition and oxyen it needs to perform thouht

processes effecti%ely.

,ommon conditions that may lead to %ascular dementia include2



• $troke (infarction) blockin a brain artery- $trokes that block a brain artery usually cause

a rane of symptoms that may include %ascular dementia. But some strokes don1t cause

any noticeable symptoms. #hese 3silent brain infarctions3 still increase dementia risk.

4ith both silent and apparent strokes! the risk of %ascular dementia increases with the

number of infarctions that occur o%er time. 5ne type of %ascular dementia in%ol%inmany strokes is called multi-infarct dementia.

• 6arrowed or chronically damaed brain blood %essels- ,onditions that narrow or inflict

lon-term damae on your brain blood %essels also can lead to %ascular dementia. #hese

conditions include the wear and tear associated with ain hih blood pressure

hardenin of the arteries diabetes lupus erythematosus brain hemorrhae and temporal

arteritis.

Multi-infarct dementia! "he most common type of vascular dementia

Multi-infarct dementia (MID) is caused by a series of small strokes (sometimes called 3mini-

strokes3 or 3silent strokes3) that often o unnoticed. #hese mini-strokes! also referred to as

transient ischemic attacks (#IAs)! result in only temporary! partial blockaes of blood supply and

brief impairments in consciousness or siht. 5%er time! howe%er! as more areas of the brain

become damaed! the symptoms of %ascular dementia bein to appear. MID usually affects

people between the aes of 78 to 9:! and is more common in men than women.

#is$ factors of Vascular Multi- infarct Dementia

#he risk factors for %ascular dementia are similar to those for stroke or heart disease! andinclude2

• Increasing age% &ascular dementia is most common in those o%er the ae of 7:. isk

increases the older you et.

• &igh 'lood pressure (hypertension)% Doctors estimate that about :8 percent of cases of

%ascular dementia result from hypertension. +ih blood pressure places extra stress on

blood flow throuhout the body! includin the brain.

• * history of heart attac$ or stro$es may increase the risk of de%elopin blood flow

problems in the brain.

•

&igh cholesterol% +ih /D/ or 3bad3 cholesterol le%els are linked with an increased riskof %ascular dementia.

• *therosclerosis occurs when deposits of cholesterol or pla"ues build up in the arteries

and narrow blood %essels! reducin blood flow to the brain.

• Dia'etes% +ih lucose le%els can damae blood %essels throuhout the body! includin

the brain.

• Smo$ing directly damaes the blood %essels that feed blood to the brain.



• *trial fi'rillation% Abnormal heart rhythm can reduce blood flow to the brain and

increase the risk of blood clots formin.

Medical Management

Doctors dianose MID with radioloical imain and biochemical and coniti%e tests. ;ach case

of MID is different. Memory may suffer serious impairment in one case and only mild

impairment in another. #o ain an understandin of the damae done! doctors will use multiple

tests.

Imaging "ests

adioloical imain tests can include2

• brain computed tomoraphy (,#)2 a detailed! cross-sectional <-ray of the brain

• manetic resonance imain (MI) of the brain2 a detailed imae of the brain obtained

usin a manetic field and pulses of radio wa%e enery

• electroencephaloram (;;0)2 measures the electrical acti%ity of the brain

• transcranial Doppler (#,D)2 measures the %elocity of blood flow throuh the brain=s

blood %essels

iochemical "estsBiochemical tests look for chanes in2

• superoxidase dismutatse ($5D)2 an enyme that repairs cells and reduces damae from

free radicals

• malondialdehyde (MDA)2 a marker for oxidati%e stress

• homocysteine (+,>)2 an amino acid produced as a by-product of eatin meat. +ih

le%els may be associated with increased risk for atherosclerosis! heart attack! blood clots!

Alheimer=s disease! and stroke.

• testosterone (#)2 a steroid hormone

• ?9 beta-estradiol (;@)2 an estroenic hormone

Mental +unction "ests



#ests of mental ability include2

• Barthel Index2 assesses functional status

• luid 5bect Memory ;%aluation2 looks at short-term memory

• clock test2 assesses your ability to reconie and set time

• coniti%e ($$-IC,5D;) test2 the Informant Cuestionnaire on ,oniti%e Decline in the

;lderly!E which uses a close relati%e to obtain information on a patient=s coniti%e status

Medicine used in treating *l,heimers disease!

+ow Is MID #reatedF

#reatment is tailored to the indi%idual. Both medicinal and nonpharmacoloical treatments

are used.

Medication#here are two main types of medication used for MID2

Cholinesterase inhi'itors treat memory loss! confusion! and problems thinkin and

reasonin. #hese include

• donepeil

• ri%astimine

• alantamine

.oncholinesterase inhi'iting medications include2

• memantine

• nimodipine

• hydrerine

• folic acid

• ,D-choline

5ther medication options include2

• selective serotonin reupta$e inhi'itors ($$Is)2 antidepressants that may also help

neurons row and reestablish connections in the brain

• calcium channel 'loc$ers for short-term coniti%e function

• *CE inhi'itor anti-hypertensi%e therapy to lower blood pressure



*lternative "herapies

+erbal supplements ha%e rown in popularity as treatments for MID. +owe%er! not

enouh studies ha%e been done to pro%e a sinificant amount of success throuh their

use. ;xamples of herbal supplements that are currently bein studies for use in treatinMID include

• Artemisia absinthium (wormwood)2 used to impro%e coniti%e function

• Melissa officinalis (lemon balm)2 used to restore memory

• Bacopa monnieri (water hyssop)2 used to impro%e memory and intellectual function

Be sure to discuss these supplements with your doctor before takin them! as they can

interfere with other medications.

6onpharmacoloical options for treatment include2

• reular exercise to build muscle strenth

• coniti%e trainin to reain mental function

• rehabilitation for mobility issues

What Is the /ong-"erm 0utloo$ for MID?

MID has no cure. 4hile medications and coniti%e trainin may help preser%e mental

function! the patient will continue to decline. #he speed and ad%ance of dementia %aries.

$ome patients die soon after an MID dianosis! and others sur%i%e for years.

Prevention of Vascular Multi-infarct Dementia

+ow ,an MID Be re%entedF

#here is no e%idence of any completely effecti%e measure to a%oid MID. As with many

conditions! the best pre%ention is to take care of your body2

•%isit the doctor reularly

• eat a balanced diet

• bein or maintain a reular exercise proram

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