Signs and Symptoms
MID and AD, despite the fact that the two organic disorders have different causes, can be almost impossible to tell apart clinically and are often misdiagnosed. Patients suffering from vascular dementia present with cognitive impairment, acutely or subacutely, after an acute cerebrovascular event. After the onset a stepwise progression is typical.
In small vessel disease the incidence peaks between the 4th and the 7th decades of life and 80% will have a history of hypertension. Patients develop progressive cognitive, motor and behavioral signs and symptoms. A significant proportion of them also develop affective symptoms. These changes occur over a period of 5–10 years. If the frontal lobes are affected, which is often the case, patients may present as apathetic or abulic. This is often accompanied by problems with attention, orientation and urinary incontinence.
As already stated, small vessel disease and focal lesions often overlap, so these two patterns may be evident in the same individual concurrently. Although atheroma of the major cerebral arteries is typical in MID, the condition mainly affects smaller vessels and arterioles.
Rare genetic disorders which result in vascular lesions in the brain have other patterns of presentation. As a rule of thumb they tend to present earlier in life and have a more aggressive course. In addition, infectious disorders such as syphilis lead to artery damage and strokes along with bacterial inflammation of the brain.
Read more about this topic: Multi-infarct Dementia
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