Complications of vascular dementia

What is Vascular Dementia?

Vascular dementia, also called multi-infarct dementia or vascular cognitive impairment, is the second most common form of dementia in the United States and Europe, after Alzheimer’s disease. In Asia, it is more common. It is more common in men than in women, and its prevalence increases with age.

Vascular dementia is not one single disease but rather a name given to a group of syndromes associated with different vascular mechanisms.

This condition can be prevented, so it is very important to diagnose it in its early stages.

Vascular Dementia Risk Factors and Consequences

Risk factors include stroke, obesity, high cholesterol, hypertension, alcoholism, smoking, family history of dementia, and Down syndrome. The progression of vascular dementia can be very quick. It is believed that vascular dementia has higher mortality compared to Alzheimer, probably because it carries more cardiovascular risk factors.

Rates of dementia are increasing dramatically, which imposes a substantial social and economic burden in China. Due to the large population of cerebrovascular stroke patients in East Asia, cognitive impairment by vascular aetiology is one of the leading causes of dementia in that region. Patients and their caregivers are concerning about poststroke dementia, since possibility of poststroke dementia in 1 year reaches nearly 50 times higher than general population. About 1 in 10 patients develop poststroke dementia in 12 months after the first stroke hit. Two million new stroke cases appeared every year in China. The prevalence of vascular dementia (VaD) has risen since 1999. The burden is increasing due to physical disability secondary to stroke and cognitive impairment related to stroke.

This study was a hospital population-based cohort study, and data were acquired from the Hospital Quality Monitoring System, a Chinese national database that covers 1531 tertiary hospitals in China. The medical records in the HIS included demographic information, diagnoses, procedures, expenses, etc. VaD was diagnosed by hospital attending physicians and identified by the International Classification of Diseases (ICD) 10 code (F01.0-F01.9).
1259 (82.23%) tertiary hospitals were included in this study, and 274 230 hospitalisation records of 123 700 VaD patients from 2016 to 2018 were identified for analysis. VaD (51.27%) was the most common type of dementia in hospitalised patients. The age-adjusted and sex-adjusted hospital incidence of VaD was estimated to be 2.97 per 100 000 person-years (95% CI 2.92 to 3.02). The mean age of VaD patients admitted to hospitals was 74.13±10.88, with more male (61.0%) patients.
The main comorbidities were hypertension (67.2%), heart disease (63.6%) and cerebral infarction (55.5%). The mortality rate of VaD in hospital was 28.91‰ (95% CI 28.0 to 29.9) between 2016 and 2018. The top 1 cause of death due to VaD was pneumonia and other respiratory disorders.

✓ Fact confirmed: Vascular dementia has the highest hospitalisation rate in China: a nationwide hospital information system study Yue Wang, Shiping Li, Qi Zhou, Yongjun Wang, Jiong Shi; February 24, 2023

This condition shortens the life expectancy by 50 percent in men, in persons with lower educations, and in those who had poor results on neuropsychological tests.

Death results from complications of dementia and cardiovascular disease.

Diagnosing and Treating Vascular Dementia

Vascular dementia can be diagnosed following several different criteria. Most commonly, the screening used is the Folstein Mini-Mental State Examination, where the patient is asked to perform a series of tasks to test his or her orientation, recall, language, and registration.

The treatment for vascular dementia mostly aims to prevent further cerebrovascular lesions, which are responsible for this disease, with antiplatelet drugs and similar. The patients at later stages require constant care and supervision by their family, spouse, partner, or another caregiver, or by medical professionals in specialized homes.

Complications

Patients with vascular dementia may have behavioral problems, they may be disorientated and wander or get lost, and they may suffer from hallucinations and delusions, and poor judgment. Depression may also occur.

Patient may be likely to fall due to problems with movement, so injury is a possible complication.

Physically, the patient may become more prone to aspiration pneumonia. Because of limited mobility, vascular dementia patients often suffer from decubitus or bedsores, which are lesions at the parts of the body where the pressure is most intense. Another possible complication is an infection of bedsores.

Patients may neglect their hygiene as well as their eating routine. Dehydration is possible if a person keeps forgetting to drink water or if he or she is neglected by the caregiver. Weight loss is fairly common in dementia patients.

A particular aspect of dementia complications is the caregiver burden and stress. It can be very difficult to take constant care of a dementia patient, and it may result in medical and psychological problems for the caregiver.

There is also the risk of caregiver abuse, which can be financial, emotional, or physical.