What to Look for: Signs and Symptoms of Vascular Dementia

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What to Look for Signs and Symptoms of Vascular
Dementia

• Pamela Jarrett MD FRCPC
• Clinical Department Head Geriatric Medicine
• Atlantic Health Sciences Corporation
• Saint John, NB
• May 22, 2009

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Objectives

• What is Dementia?
• What are the different types of Dementia?
• How does dementia usually present?
• How to make the diagnosis?
• What are the treatment options?

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What can happen to our Memory as we age ?

• No change
• Age Associated Memory changes normal for aging
• Mild Cognitive Impairment
• Dementia

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Is the Brain and Heart Related to each other?
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What is Dementia ?

• Memory Loss Progressive
• One or more problems in the following areas
• Language problems
• Agnosia - sensory
• Apraxia - motor
• Executive Function
• Must result in functional changes from baseline
  for the person
• No other medical illness ongoing that could
  explain cognitive problems

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Prevalence Today
Approx. 25 of those diagnosed with pure AD
developed a vascular component within 3 years
n308
Agüero-Torres et al. Dem Geriatr Cog Disord, 2006
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Interactions between Pure Vascular dementia and
Pure Alzheimers disease
ADCVD
Pure AD
Pure VaD
80 of all dementias
Erkinjuntti T.
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The Doubling Rule (Think 2) For Dementia Risk

• Risk Doubles every 5 years.

• But each additional risk factor approximately
  doubles the risk

• ve family history
• doubles the risk.

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Dementia Risk Calculator
Risk _______ (age)

• Family history (Risk doubles for each first
  degree relative)

? Mother ? Father ? Brother ? Sister

• ? X 1 (no family history)
• ? X 2 (1 relative)
• ? X 4 (2 relatives)

Risk _______ (age family history)
Risk
Vascular risk factors (Risk doubles for each
vascular risk factor)
? Atrial Fibrillation ? Diabetes ? Heart
Disease (MI/CAD) ? Hyperlipidemia ?
Hypertension ? Smoking ? Stroke ? Obesity
? X 1 (no vascular risk factors) ? X 2 (1
vascular risk factor) ? X 4 (2 vascular risk
factor2)
Risk _______ (age family history vascular
risk factors)
Risk
Overall risk _______
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Screening Tests
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MMSE
MMSE 29/30
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Clock Drawing
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MOCA
www.mocatest.org
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Case Studies
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Case 1

• 82 year old
• No past medical history
• No medications
• Lives with husband
• Son visiting from away house is a mess, spoiled
  food in the fridge, bills unpaid.
• He calls every week and all seems to be fine

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Case 1

• Investigations
• CBC, B12, Calcium, Glucose, Creatinine,
  Electrolytes, Liver function tests all normal
• CT Scan of head some mild atropy but no
  vascular changes

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Case 1 Diagnosis

• ???

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Case 2

• 78 year old
• Lives alone in own apartment
• Daughter from away comes home for a visit
• Still driving, numerous pill bottles, limited
  food in fridge.
• History of falls calls to 911 and has life line
  but does not use it.

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Case 2

• Past medical History
• Diabetes
• Hypertension
• Medications
• Metoprolol
• HCTZ
• Metformin bid
• MMSE 23/30 MOCA 16/30

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Case 2

• Investigations Blood work normal
• CT Scan head microvascular changes,
  periventricular white matter changes and some
  small lacunar infarcts.

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Case 2

• Diagnosis?????

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Case 3

• 75 year old man
• Well physically and mentally until stroke 12
  months ago following that more difficulties
  remembering things.
• Remained stable until 6 months ago when he had
  another Spell (TIA, CVA?) and has got worse since
  then.
• MMSE 26/30 MOCA 17/30

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Case 3

• Investigations
• Blood work Normal
• CT Scan of head two old infarctions present in
  right temporal and parietal lobes.

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Case 3

• Diagnosis????

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Treatment of Vascular or Mixed Alzheimers
Vascular Dementia

• Manage Vascular Risk Factors
• Blood pressure below 160/90 (140 systolic)
• Proper diet
• Lipid lowering agent????
• Antiplatelet agent ECASA 81 mg OD
• Cholinesterase Inhibitor
• Donepezil, Galantamine and Rivastigmine can all
  be considered in the treatment of Vascular/Mixed
  Alzheimers Vascular Dementia.

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Is the Brain and Heart Related to each other?

• Thank you!!!