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Dementia is the loss of a person's cognitive, or intellectual, function. those conscious mental tasks that we perform every waking second of every day, from remembering our name to performing complicated mathematical calculations. Memory is one of the most essential cognitive functions, and it is the often the first and most crucial one that dementia impairs. Dementia also affects problem-solving ability, decision making, judgment, our ability to orient ourselves in space, and our ability to put together simple sentences and understand and communicate with words. It is also often associated with personality change. Dementia is a permanent, progressive disease that affects mostly the elderly. People who suffer from dementia eventually are unable to take care of themselves and require round-the-clock care.

Vascular dementia:

Is the second most common cause of dementia, accounting for about 20 per cent of all cases by itself and up to another 20 per cent in combination with Alzheimer’s Disease. It usually affects people between the ages of 60 and 75 and is slightly more common in men than women. Vascular dementia is a term for dementia associated with problems in the circulation of blood to the brain (cerebrovascular disease). It encompasses a wide range of diseases or disorders, the principal feature of which is loss of intellectual abilities.

Binswanger's Disease

Binswanger’s Disease is a subcortical vascular dementia which was once considered rare but is now being reassessed, and may be relatively common. As with other vascular dementias, it is associated with stroke-related changes. It is the ‘white matter’ deep within the brain that is affected. It is caused by high blood pressure, thickening of the arteries and inadequate blood flow.

Symptoms often include slowness and lethargy, difficulty walking, emotional ups and downs and lack of bladder control early in the course of the disease, with gradually progressive dementia developing later. Most people with Binswanger’s disease have or have had high blood pressure.

Multi-Infarct Dementia:

Among the different types of vascular dementia that have been identified, multi-infarct dementia (MID) is probably the most common. MID is caused by a number of small strokes, called ministrokes. These strokes may be silent in that no one may be aware they have occurred, but they can be seen on various brain scans. Sometimes the brain is damaged but not dead as a result of inadequate blood flow. This is called ischaemia. If ischaemia is severe, it causes an infarct. Some people also incorrectly use MID as a term for all types of vascular dementia.

Differential Diagnosis 

Some disorders have similar 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.
Sometimes people experience symptoms that resemble dementia but are perfectly normal or associated with some other illness. Forgetfulness, for example, is something that can happen at any age. Isolated incidents of temporary memory loss or other temporary cognitive impairments are not considered dementia. A person, who has never been fully competent and has always had dementia-like symptoms, unless the symptoms progress, does not have dementia.


There are 50 different causes of dementia, including neurological disorders such as Alzheimer's disease, vascular disorders such as multi-infarct disease, inherited disorders such as Huntington's disease, and infections such as HIV.

The most common cause of dementia is Alzheimer's disease. It is estimated that as many as 50% to 70% of all people who suffer from dementia have Alzheimer's. However, some researchers suspect that this may be an overestimate due to the tendency for people to too quickly assume that if an elderly person is showing signs of dementia then they must have Alzheimer's. Diagnostic tests, ranging from neuropsychological exams to brain imaging studies, are essential for identifying the cause of dementia. Some forms of dementia are treatable, or partially treatable. A proper diagnosis allows for a more accurate prognosis and also helps prepare friends and family to cope better with the situation.

The most common causes of dementia include degenerative neurological diseases such as Alzheimer's, Parkinson's and Huntington's; vascular disorders as when multiple strokes in the brain lead to what is called multiple-infarct dementia; infections that affect the central nervous system, for example, dementia complex caused by the HIV virus and Creutzfeldt-Jakob disease; chronic drug use; depression ("pseudodementia"); and certain types of hydrocephalus, an accumulation of cerebrospinal fluid in the ventricles of the brain that can result from developmental abnormalities, infections, injury, or brain tumors.

Causes of Vascular Dementia:

Vascular dementia can be caused in several different ways. Most commonly there is blockage of small blood vessels (arteries) deep within the brain. When any part of the body is deprived of blood, which carries oxygen and nutrients, it dies - this is called an infarct. When brain tissue dies it is also called a stroke. Blockages may be caused by build up of plaque on the inside of the arterial wall or by clots which have broken off, jamming a smaller tributary upstream. Clots can also result from abnormal heart rhythms, or other heart pathology, or can form on the inside of the major cartoid arteries that run up the side of the neck and supply the brain.

Other Conditions Relating to the Cause of Dementia:

HIV related dementia
Parkinson's Disease
Down's Syndrome
Huntington's Disease (HD)
Transmissible Dementias
Creutzfeldt-Jakob Disease
Gerstmann-Straussler-Scheinker disease


Because vascular dementia is caused by strokes, the risk factors for vascular dementia are the same as those associated with stroke, high blood pressure, diabetes, high cholesterol and heart disease. To a large extent, these risk factors are controllable, unlike the only solidly established risk factors for Alzheimer’s disease, age, family history and Down syndrome and Apolipoprotein E status.

While no treatment can reverse damage that has already been done, treatment to prevent additional strokes is very important. To prevent additional strokes, medicines to control high blood pressure, high cholesterol, heart disease and diabetes can be prescribed.
However, a few causes of dementia are treatable. Treatable causes include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes. However, many of the disorders associated with dementia are progressive, irreversible, degenerative conditions.

Sometimes aspirin or other drugs are prescribed to prevent clots from forming in the small blood vessels. Drugs can also be prescribed to relieve restlessness or depression or to help the person with vascular dementia sleep better. In some cases, surgery known as carotid endarterectomy may be recommended to remove blockage in the carotid artery, the main blood vessel to the brain.

Counseling and Psychotherapy [ See Therapy Section ]:

The provision of a safe environment, control of aggressive or agitated behavior, and the ability to meet physiologic needs may require monitoring and assistance in the home or in an institutionalized setting. This may include in-home care, boarding homes, adult day care, or convalescent homes.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person with organic brain syndrome. In any care setting, there should be familiar objects and people. Lights that are left on at night may reduce disorientation. Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation. Family counseling may help in coping with the changes required for home care.

Pharmacotherapy [ See Psychopharmacology Section ] :

The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be required for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions (such as tumors).

Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning. Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required. Medications that may be considered for use include:

Beta Blockers if dementia is related to central nervous system lesions.
Serotonin-Affecting Drugs - lithium, trazodone, buspirone, clonazepam.
Dopamine Blockers.
Fuoxetine, Imipramine.
Stimulant drugs - such as methylphenidate- may improve mood.


DSM Code

294.8 Dementia Due to NOS

F02. Dementias

Disorder Sheets

Alzheimer's Society
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10 Greencoat Place
Tel: 020 7306 0606
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Care That Works: A Relationship Approach to Persons
with Dementia - Click Here to View



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