Multi-infarct dementia

(MID) is loss of brain

function caused by a series of
small strokes. A stroke (also
called a brain infarct) occurs
when the blood flow to any
part of the brain is interrupted
or blocked. Blood carries
oxygen to the brain, and
without oxygen, brain tissue
quickly dies.

The location of the stroke damage

determines the type of symptoms that
occur. Stroke increases the risk of
dementia as much as four to twelve
times. The mechanism of this is not fully
understood.
MID can cause the loss of memory and
cognitive function and can initiate
psychological problems. Treatment
focuses on controlling the symptoms
and reducing the risk for future strokes.

Vascular dementia affects different people in different

ways and the speed of the progression varies from person to
person. Some symptoms may be similar to those of other
types of dementia and usually reflect increasing difficulty to
perform everyday activities like eating, dressing, or
shopping.
Behavioral and physical symptoms can come on
dramatically or very gradually, although it appears in the a
prolonged perio of time.

Common Signs and Symptoms of Vascular Dementia

Mental and Emotional Signs and Symptoms
Slowed thinking
Memory problems; general forgetfulness
Unusual mood changes (e.g. depression, irritability)

Hallucinations and delusions

Confusion, which may get worse at night
Personality changes and loss of social skills

Physical Signs and Symptoms

Moving with rapid, shuffling steps
Balance problems
Loss of bladder or bowel control

Dizziness
Leg or arm weakness
Tremors

Behavioral Signs and Symptoms

Slurred speech
Language problems, such as difficulty finding the right words
for things
Getting lost in familiar surroundings
Laughing or crying inappropriately

Difficulty planning, organizing, or following instructions

Difficulty doing things that used to come easily (e.g. handling
money, paying bills, or playing a favorite card game)
Reduced ability to function in daily life

Vascular dementia results from conditions that damage your brain's blood
vessels, reducing their ability to supply your brain with the amounts of
nutrition and oxygen it needs to perform thought processes effectively.
Common conditions that may lead to vascular dementia include:
Stroke (infarction) blocking a brain artery. Strokes that block a brain
artery usually cause a range of symptoms that may include vascular
dementia. But some strokes don't cause any noticeable symptoms. These
"silent brain infarctions" still increase dementia risk.
With both silent and apparent strokes, the risk of vascular
dementia increases with the number of infarctions that
occur over time. One type of vascular dementia involving
many strokes is called multi-infarct dementia.

The risk factors for vascular dementia are similar to those

for stroke or heart disease, and include:
Increasing age. Vascular dementia is most common in
those over the age of 65. Risk increases the older you get.
High blood pressure (hypertension). Doctors estimate
that about 50 percent of cases of vascular dementia result
from hypertension. High blood pressure places extra stress
on blood flow throughout the body, including the brain.

 A history of heart attack or strokes may increase the risk of developing

blood flow problems in the brain.
High cholesterol. High LDL or "bad" cholesterol levels are linked with
an increased risk of vascular dementia.
Atherosclerosis occurs when deposits of cholesterol or plaques build up
in the arteries and narrow blood vessels, reducing blood flow to the
brain.
Diabetes. High glucose levels can damage blood vessels throughout the
body, including the brain.
Smoking directly damages the blood vessels that feed blood to the brain.
Atrial fibrillation. Abnormal heart rhythm can reduce blood flow to the
brain and increase the risk of blood clots forming.

 Biochemical Tests
Biochemical tests look for changes in:
superoxidase dismutatse (SOD): an enzyme that repairs cells
and reduces damage from free radicals
malondialdehyde (MDA): a marker for oxidative stress
homocysteine (HCY): an amino acid produced as a by-product
of eating meat. High levels may be associated with increased
risk for atherosclerosis, heart attack, blood clots, Alzheimers
disease, and stroke.
testosterone (T): a steroid hormone
17 beta-estradiol (E2): an estrogenic hormone

Mental Function Tests

Tests of mental ability include:
Barthel Index: assesses functional status
Fluid Object Memory Evaluation: looks at short-term
memory
clock test: assesses your ability to recognize and set time
cognitive (SS-IQCODE) test: the Informant
Questionnaire on Cognitive Decline in the Elderly,
which uses a close relative to obtain information on a
patients cognitive status

There are two main types of medication used for MID:

Cholinesterase inhibitors treat memory loss, confusion,
and problems thinking and reasoning. These include
donepezil
galantamine
Noncholinesterase inhibiting medications include:
memantine
nimodipine
hydrergine
folic acid

 Alternative Therapies
Herbal supplements have grown in popularity as treatments for MID. However, not
enough studies have been done to prove a significant amount of success through their
use. Examples of herbal supplements that are currently being studies for use in
treating MID include
Artemisia absinthium (wormwood): used to improve cognitive function
Melissa officinalis (lemon balm): used to restore memory
Bacopa monnieri (water hyssop): used to improve memory and intellectual function
Be sure to discuss these supplements with your doctor before taking them, as they can
interfere with other medications.
Nonpharmacological options for treatment include:
regular exercise to build muscle strength
cognitive training to regain mental function
rehabilitation for mobility issues