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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What are the signs and symptoms of vascular dementia?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7096 Questions

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Posted on Fri, 26 Aug 2016 in Hypertension and Heart Disease
Question: Dear Doctor, In respect to vascular dementia would I be correct in assuming that if I'm compromised in the cranial area there could also be concern in my cardio vascular region together with aortic and iliac peripherial arterial vessels branching into the deep vein of my legs, I am also concerned about blood clots due to atherosclerosis ...If so how would I go about checking my whole vascular system, thank you in turn for answering this complex question.
doctor
Answered by Dr. Ilir Sharka 3 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that vascular dementia is related to repeated occlusion of small arteries in the brain, leading to progressive loss of the brain cells (neurons).

It is called vascular dementia, because in MRI or CT we can see different types of vascular lesions (while in Alzheimer disease there is only progressive brain atrophy).

This can be related to atherosclerosis (which is a generalized process) or cardiac causes (atrial fibrillation or any other cardiac arrhythmia, valvular heart disease, etc.).

Hypertension is the major cause of diffuse disease, and in many patients, both focal and diffuse disease are observed together.

The 3 most common mechanisms of vascular dementia are multiple cortical infarcts (repeated brain ischemic events), a strategic single infarct (related to occlusion of the large vessels), and small vessel disease (usually related to progressive atherosclerosis of the small vessels).

The diagnosis of this disorder is based on different tests:

1- medical history consisting of progressive memory loss with acute deteriorations
2- brain MRI showing the presence of brain infarcts
3- vascular and cardiac studies:

- a Doppler ultrasound of the cervical vessels to examine the blood flow in the neck arteries and the types of atherosclerotic plaques
- an angio CT scan of the supraaortic vessels, examining the blood flow in the aorta, carotid arteries, vertebral arteries, and intracranial arteries, circulus Willis
- a cardiac ultrasound to examine the heart structure and function
- an ambulatory 24-48 hours ECG monitoring to rule in/out possible cardiac arrhythmia

4- Some blood lab tests (complete blood count, blood lipid profile, kidney and liver function tests, fasting glucose and HbA1C, blood electrolytes)

Regarding the peripheral vessels, when peripheral arteriopathy is suspected ( no pulse in the lower limbs or cold feet), a Doppler ultrasound of the leg vessels is performed (coupled with an Angio CT scan of these vessels if needed).

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 21 hours later
Dear Doctor .Thank you for your reply..from the attached CT report would you suggest that this is the start of vascular dementia as the report confirms
ischaemic changes of small vessels disease and moderate central cerebral atrophy..if its vascular then i should have tests on the heart and peripheral arteries disease location..thank you for you assistance in this matter.
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I carefully reviewed your uploaded CT scan reports and would explain that they could indicate a subcortical vascular dementia.

These CT scan findings should also be coupled with a history of memory problems, related to the short term memory (problems that you deal with in your every day life)and not old memories.

I recommend performing the above mentioned tests to investigate for the possible causes.

A close monitoring of blood pressure is necessary to exclude possible uncontrolled high blood pressure.

I would also recommend performing a brain MRI study as it is more specific for these brain changes than normal CT scan.

You should discuss with your doctor on the above tests.

Hope you will find this answer helpful!

Best wishes,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 days later
Thank you Doctor, one last question if i may. An old scelotic lesions identified in the cortex of the temporal lobes possubly from a previous head injury....can this be the cause of vasular dementia or any other dementia suge as alzheimers
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I would explain that post traumatic lesions are not included in vascular or alzheimer dementia.

But, you should know that the temporal lobes play an important role in the memory function.

Damage to the temporal lobes can cause memory impairment mimicking dementia.

But these damage does not cause progressive memory problems, like in Alzheimer or vascular dementia.

The memory deficits are usually non progressive and can also improve.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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