Vascular Dementia
David B. Reuben, MD
Professor and Archstone Foundation Endowed Chair, Department of Medicine, University of California, Los Angeles; Chief, Division of Geriatrics, UCLA Medical Center, Santa Monica, California

This article is a bit technical but in layman’s terms, vascular dementia is caused by a variety of issues that impact blood flow to the brain or within the brain. The Gorilla in the room is a stroke which is a major blockage of blood to one or more parts of the brain. A stroke is also called an ‘infarct’. Vascular can also result from narrowing of the arteries for a variety of reasons.

There are all sizes of strokes depending on how big the blood vessel is. A very subtle and slow dementia comes from “micro-infarcts”. They are subtle because they are hard to detect without some invasive xrays – slow because they are small and tend to recur unnoticed and the impact accumulates over time.

Micro-infarcts can result from weakness in blood vessels, a blockage (clot) or from high level of  exertion due to laughing, crying, coughing, lifting or strangulation.

The way I like to explain an infarct is the example of someone you have seen with a small blood burst in their eye. That is a micro-infarct except that in the brain, the neurons fed by that artery don’t grow back.

Other terms that may apply to vascular dementia include TIAs (Trans Ischemic Attacks) or just plain ischemia.

“The temporal relationship between stroke and the onset of cognitive impairment is important in establishing the diagnosis of vascular dementia. For example, dementia occurring within 3 months of a recognized stroke or a pattern of stepwise progression of cognitive deficits strongly supports the diagnosis.”

The article cites the Hachinski Ischemic Score and provides the short version of that test. Check it out. And always remember – get a second opinion whatever version of dementia you are told you have. And make sure the doctor has leading edge training on the topic of dementia. We see a fair share of misdiagnoses or missed-diagnoses.