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Vascular (Multi-Infarct) Dementia

Vascular (Multi-Infarct) Dementia
American Description

Diagnostic Criteria
The development of multiple cognitive deficits manifested by both:
Memory impairment (impaired ability to learn new information or to recall previously learned information)
One (or more) of the following cognitive disturbances:
Aphasia (language disturbance)
Apraxia (impaired ability to carry out motor activities despite intact motor function)
Agnosia (failure to recognize or identify objects despite intact sensory function)
Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
The cognitive deficits (above) cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning
Focal neurological signs and symptoms (e.g., exaggeration of deep tendon reflexes, extensor plantar response, pseudobulbar palsy, gait abnormalities, weakness of an extremity) or laboratory evidence indicative of cerebrovascular disease (e.g., multiple infarctions involving cortex and underlying white matter) that are judged to be etiologically related to the disturbance.
The cognitive deficits do not occur exclusively during the course of a delirium.

Problem Areas (When Initially Diagnosed)
Socio-Economic:
Moderately impaired homemaking
Moderately impaired money management
Requires voluntary institutional care (placement in supervised residence or nursing home)
Depression:
Significant loss of interest and motivation
Significant problem with concentration
Intellectual Impairment:
Significant problem with memory or learning
Significant decrease in speech and movement
Significant problem with grooming and hygiene
Significant confusion as to date, place, or person

Onset and Course
The onset of Vascular Dementia is typically earlier than that of Alzheimer's Dementia, but much less common.
Onset is typically abrupt, followed by a stepwise and fluctuating course that is characterized by rapid changes in functioning rather than slow progression.
The course, however, may be highly variable, and an insidious onset with gradual decline is also encountered.

Differential Diagnosis
Delirium
Amnestic Disorder
Alzheimer's Dementia
Alcoholic Dementia, or other Substance-Induced Persisting Dementia
Substance Intoxication, or Substance Withdrawal
Dementia Due to Other General Medical Conditions:
Brain Tumor
Creutzfeldt-Jakob Disease
HIV Infection
Huntington's Disease
Hypercalcemia
Hypothyroidism
Neurosyphilis
Normal-Pressure Hydrocephalus
Parkinson's Disease
Pick's Disease
Subdural Hematoma
Traumatic Brain Injury
Vitamin B12 Deficiency, Folic Acid Deficiency, Niacin Deficiency
Mental Retardation
Schizophrenia
Major Depressive Disorder
Malingering and Factitious Disorder
Age-Related Cognitive Decline

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