Vascular Dementia

• F01 Vascular Dementia
• F01.1 Vascular Dementia Of Acute Onset
• F01.1 Multi-Infarct Dementia
• F01.2 Subcortical Vascular Dementia
• F01.3 Mixed Cortical And Subcortical Vascular Dementia

F01 Vascular Dementia

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.

Diagnostic Guidelines

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.

Includes:
* arteriosclerotic dementia

Differential Diagnosis
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.

F01.1 Vascular Dementia Of Acute Onset

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.

F01.1 Multi-Infarct Dementia

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.

Includes:
* predominantly cortical dementia

F01.2 Subcortical Vascular 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 be used.)

F01.3 Mixed Cortical And Subcortical Vascular Dementia

Mixed cortical and subcortical components of the vascular dementia may be suspected from the clinical features, the results of investigations (including autopsy), or both.