|The ICD-10 Classification of Mental and Behavioural
World Health Organization, Geneva, 1992
Vascular (formerly arteriosclerotic) dementia, which includes
multi-infarct dementia, is distinguished from dementia in
Alzheimer's disease by its history of onset, clinical features,
and subsequent course. Typically, there is a history of transient
ischaemic attacks with brief impairment of consciousness, fleeting
pareses, or visual loss. The dementia may also follow a succession
of acute cerebrovascular accidents or, less commonly, a single
major stroke. Some impairment of memory and thinking then becomes
apparent. Onset, which is usually in later life, can be abrupt,
following one particular ischaemic episode, or there may be more
gradual emergence. The dementia is usually the result of
infarction of the brain due to vascular diseases, including
hypertensive cerebrovascular disease. The infarcts are usually
small but cumulative in their effect.
The diagnosis presupposes the presence of a dementia as
described above. Impairment of cognitive function is commonly
uneven, so that there may be memory loss, intellectual impairment,
and focal neurological signs. Insight and judgement may be
relatively well preserved. An abrupt onset or a stepwise
deterioration, as well as the presence of focal neurological signs
and symptoms, increases the probability of the diagnosis; in some
cases, confirmation can be provided only by computerized axial
tomography or, ultimately, neuropathological examination.
Associated features are: hypertension, carotid bruit, emotional
lability with transient depressive mood, weeping or explosive
laughter, and transient episodes of clouded consciousness or
delirium, often provoked by further infarction. Personality is
believed to be relatively well preserved, but personality changes
may be evident in a proportion of cases with apathy, disinhibition,
or accentuation of previous traits such as egocentricity, paranoid
attitudes, or irritability.
* arteriosclerotic dementia
Consider: delirium (F05.-); other dementia, particularly in
Alzheimer's disease (F00.-); mood [affective] disorders (F30-F39);
mild or moderate mental retardation (F70-F71); subdural
haemorrhage (traumatic (S06.5), nontraumatic (I62.0)).
Vascular dementia may coexist with dementia in Alzheimer's
disease (to be coded F00.2), as when evidence of a vascular
episode is superimposed on a clinical picture and history
suggesting Alzheimer's disease.
Usually develops rapidly after a succession of strokes from
cerebrovascular thrombosis, embolism, or haemorrhage. In rare
cases, a single large infarction may be the cause.
This is more gradual in onset than the acute form, following a
number of minor ischaemic episodes which produce an accumulation
of infarcts in the cerebral parenchyma.
* predominantly cortical dementia
There may be a history of hypertension and foci of ischaemic
destruction in the deep white matter of the cerebral hemispheres,
which can be suspected on clinical grounds and demonstrated on
computerized axial tomography scans. The cerebral cortex is
usually preserved and this contrasts with the clinical picture,
which may closely resemble that of dementia in Alzheimer's
disease. (Where diffuse demyelination of white matter can be
demonstrated, the term "Binswanger's encephalopathy" may
Mixed cortical and subcortical components of the vascular
dementia may be suspected from the clinical features, the results
of investigations (including autopsy), or both.
ICD-10 copyright © 1992 by World
AZ Psychiatry copyright
by Dr. Manaan Kar Ray