Clinical Manifestations and Diagnosis of Vascular Dementia

Vascular dementia attack occurs suddenly, preceded by a transient ischemic attack (TIA) or stroke, the risk of vascular dementia 9 times in the first year after the attack and declined to 2 times as long as 25 years later. A history of risk factors, cerebrovascular disease should be aware of the possibility of the occurrence of vascular dementia.
     Clinical manifestations of vascular dementia patients showed a combination of focal neurologic symptoms, neuro psychological disorders and neuropsychiatric symptoms. Focal neurologic symptoms may include motor disorders, sensory impairments, and hemianopsia. Neuro psychological disorders such as memory impairment accompanied by two or more cognitive disorders, such as attention, language, and executive function visuospasial.
       Neuropsychiatric symptoms common in vascular dementia may be personality changes (most common), depression, mood instability, delusion, apathy, abulia, lack of spontaneity. Major depression occurs in 25-50% of patients and more than 60% had depressive syndrome with symptoms most often are sadness, anxiety, psychomotor retardation or somatic complaints. Psychosis with delusional ideas such as occurs in ± 50%, including suspicious mind, Capgras syndrome. Delusion is most common in lesions involving the temporoparietal structures.

A. Diagnostic Criterias
The diagnosis of vascular dementia is made through two phases, the first diagnosis of dementia itself, the second stage of looking for underlying vascular process. There are several diagnostic criteria for the diagnosis of vascular dementia, namely:

1. Diagnostic and Statistical Manual of Mental Disorder fourth edition (DSM-IV)
2. Guidelines for Classification and Diagnosis of Mental Disorders
3. International Classification of Diseases (ICD-10)
4. The state of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC)
5. National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN)

The diagnosis of vascular dementia according to DSM-IV is using the following criteria:
a) The multiplex cognitive deficits characterized by memory impairment and one or more of the following cognitive disturbances:
1) Aphasia (language disturbance)
2) apraxia (impaired ability to carry out motor activity, while normal mototik function).
3) agnosia (can not recognize or identify objects despite a normal sensory function).
4) Disturbance in executive functioning (designing, organizing, power of abstraction, and made to order).
b) the criteria for a cognitive deficit) that cause social and occupational functioning clearly.
c) focal neurologic signs and symptoms (increased physiological reflex, positive pathologic reflexes, pseudobulbar paralysis, impaired move, paralysis of the limbs), and radiological or laboratory evidence that proves the existence of cerebral blood circulation disorders (gpod), such as myocardial multiplex involving the cortex and subcortical , which may explain the relation to the appearance of interference.
d) the existing deficit did not occur during delirium.

       By using different diagnostic criteria, the prevalence of different vascular dementia, where the highest prevalence obtained when using DSM-IV criteria and the lowest when using the NINDS-AIREN criteria. Consortium of Canadian Centers for Clinical Cognitive Research states that there is no better diagnostic criteria of the various criteria. DSM-IV has high sensitivity but low specificity. ADDTC use is more limited in the types of ischemic vascular dementia while the NINDS-AIREN can be used for all mechanisms of vascular dementia (hypoxia, ischemia, or bleeding). Criteria and NINDS-AIREN ADDTC has three levels of certainty (probable, possible, definite), requires a relationship between stroke and dementia as well as morphological evidence of a stroke.

B. Identification of Vascular Dementia
Identifying vascular dementia is not always easy. Vascular dementia patients have relatively long-term verbal memory were better but frontal lobe executive function worse than patients with Alzheimer's dementia. Can also be used as a scoring system Hachinski ischemic scores and scores of dementia by Loeb and Gondolfo. Recognized that the scoring system is not adequate, there is still the risk of error and in this way can not determine the existence of mixed dementia (vascular and Alzheimer's).

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