Hardening of the arteries in the brain vessels leads to multiple smaller infarcts that in turn can cause mental impairment from vascular dementia.
Usually this happens more often in males, after the age of 70. There often is a history of smoking, prior heart attack, high blood pressure or diabetes. This dementia develops stepwise getting worse after each mini-stroke. This link shows what diagnostic procedures (thanks to www.nhs.uk for this link) are available to work up a patient with vascular dementia.
The vascular dementia might start with tiredness and some confusion and then progress to different neurological signs depending on where the mini-stroke lesions are located. This can grow into a full fledged stroke with paralysis of one body half (=hemiplegia).
Initially insight and personality are better preserved than with Alzheimers disease, but in later stages the symptoms are indistinguishable from Alzheimers.
Sometimes with vascular dementia pathological laughing and crying develops and there might be signs of Parkinson disease like gait problems and muscle shaking. This is due to closing off of blood vessels to the basal ganglia (a condition called “pseudobulbar palsy”). Sometimes a CT or MRI scan helps to depict multi small brain infarcts, but often even these tests are normal.
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