Multi-infarct
dementia (MID), a common form of dementia in the elderly, occurs
when blood clots block small blood vessels in the brain and destroy
brain tissue. CADASIL (cerebral autosomal dominant arteriopathy
with subcortical infarcts and leukoencephalopathy) is an inherited
form of MID. This disease can cause stroke, dementia,
migraine-like headaches, and psychiatric disturbances. Symptoms
of MID, which often develop in a stepwise manner, include confusion,
problems with recent memory, wandering or getting lost in familiar
places, loss of bladder or bowel control, emotional problems such
as laughing or crying inappropriately, difficulty following instructions,
and problems handling money. Usually the damage is so slight that
the change is noticeable only as a series of small steps. However
over time, as more small vessels are blocked, there is a gradual
mental decline. The main characteristics of the disorder are:
Impairment in short- and long-term memory.
At least 1 of the following:
Impairment
in abstract thinking.
Impaired judgment.
Other disturbances of higher cortical function.
Personality change.
Memory impairment and intellectual impairment caused significant
social and occupational impairments.
Absence of occurrence exclusively during the course of Delirium.
Stepwise deteriorating course with "patchy" distribution
of deficits.
Focal neurologic signs and symptoms.
Evidence of repeated "strokes".
Associated
Features:
Learning
Problem
Dysarthria or Involuntary Movement
Hypoactivity
Psychosis
Depressed
Mood
Somatic
or Sexual Dysfunction
Hyperactivity
Sexually
Deviant Behavior
Odd/Eccentric
or Suspicious Personality
Anxious or Fearful or Dependent
Personality
Dramatic or Erratic or
Antisocial Personality
Differential
Diagnosis:
Some disorders have similar or even overlapping symptoms. The
clinician, therefore, in his diagnostic attempt, has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis.
Normal Process
of Aging;
Delirium
Schizophrenia.
Major Depressive Episode
Factitious Disorder with
Psychological Symptoms.
Cause:
Serious forgetfulness,
mood swings, and other behavior changes are not a normal part
of aging. Some of these changes are caused by problems that can
be treated or corrected, like a poor diet or lack of sleep. Sometimes
too many medicines cause these symptoms in older people. However,
Multi-infarct dementia usually affects people between the ages
of 60 and 75. Men are slightly more likely than women to have
multi-infarct dementia. Multi-infarct dementia is caused by a
series of strokes that damage or destroy brain tissue. A stroke
occurs when blood cannot get to the brain. A blood clot or fatty
deposits, called plaques, can block the vessels that supply blood
to the brain, causing a stroke. A stroke also can happen when
a blood vessel in the brain bursts. The main causes of strokes
are untreated high blood pressure, high blood cholesterol, diabetes,
and heart disease. Of these, the most important risk factor for
multi-infarct dementia is high blood pressure. It is rare for
a person without high blood pressure to develop multi-infarct
dementia.
