What is Multi-Infarct Dementia?
Multi-infarct dementia is the second most common cause of dementia
in older people. Sometimes it is difficult to distinguish from
Alzheimer's disease, which is the most common cause of dementia in
older persons. It is possible for a person to have both multi-infarct
dementia and Alzheimer's disease, making it hard for the doctor to
diagnose either.
Causes Of Multi-Infarct Dementia
Multi-infarct dementia is caused by a series of strokes that
damage or destroy brain tissue. A stroke occurs when blood cannot get
to the brain. A blood clot or fatty deposits (called plaques) can
block the vessels that supply blood to the brain, causing a stroke.
Who is Affected?
Multi-infarct dementia usually affects people between the ages of
60 and 75. Men are slightly more likely than women to have this
disease. However, the most important risk factor for multi-infarct
dementia is high blood pressure. It is rare for a person without high
blood pressure to develop multi-infarct dementia.
Symptoms
Symptoms that begin suddenly may be a sign of multi-infarct dementia.
In addition to confusion and problems with recent memory, symptoms of
multi-infarct dementia may include:
- wandering or getting lost in
familiar surroundings.
- moving with rapid, shuffling steps.
- loss of bladder or bowel control.
- laughing or crying inappropriately.
- difficulty following instructions.
- problems handling money.
Multi-infarct dementia is often a
result of a series of small strokes, called ministrokes or TIAs
(transient ischmic attacks). The symptoms of a TIA often are very
slight. They may include:
- mild weakness in an arm or a leg.
- slurred speech.
- dizziness.
The symptoms generally do not last for
more than a few days. Several TIAs may occur before the person notices
any symptoms of multi-infarct dementia. People with muti-infarct
dementia may improve for short periods, then decline upon having
further strokes.
Diagnosis
People who show signs of dementia or who have a history of strokes
should have a complete physical exam. The doctor will ask the patient
and the family about:
- the patient's diet
- medications
- sleep patterns
- personal habits
- past strokes
- other medical problems
- recent illnesses
- stressful events
To look for signs of stroke, the doctor
will check for weakness or numbness in the arms or legs, difficulty
with speech, or dizziness. To check for other health problems that
could cause symptoms of dementia, the doctor may order office or
laboratory tests. Tests may include:
- blood pressure reading.
- an electroencephalogram (EEG).
- a test of thyroid function.
- blood tests.
- x-rays.
- computerized tomography (CT) scan.
- magnetic resonance imaging (MRI).
Both CT scans and MRI tests take
pictures of sections of the brain. The pictures are then displayed on
a computer screen to allow the doctor to see inside the brain. (CT
scans and MRI tests are painless and do not require surgery.) In
addition, the doctor may send the patient to a psychologist or
psychiatrist to test reasoning, learning ability, memory, and
attention span.
Treatment
While no treatment can reverse damage that has already been done,
treatment to prevent additional strokes is very important. High blood
pressure, the primary risk factor for multi-infarct dementia, can be
treated successfully. Diabetes also is a treatable risk for stroke. To
prevent additional strokes, doctors may prescribe medicines to control
high blood pressure, high cholesterol, heart disease, and diabetes.
They will counsel patients about good health habits such as
exercising, avoiding smoking and drinking alcohol. The patient may
require a special diet.
Doctors sometimes prescribe aspirin or
other drugs to prevent clots from forming in the small blood vessels.
Drugs also can be prescribed to relieve restlessness or depression or
to help the patient sleep better. Sometimes doctors recommend a
surgery known as carotid endartectomy. This surgery is done to remove
blockage in the carotid artery, the main blood vessel to the brain.
Studies are under way to see how well this surgery works in treating
patients with multi-infarct dementia. Some scientists are also
studying drugs that increase the flow of blood to the brain.
Helping Someone with Multi-Infarct
Dementia
Family members and friends can help the patient cope with mental
and physical problems. They can encourage daily routines and regular
social and physical activities. By talking about events and daily
activities they can help reinforce mental abilities. Lists, alarm
clocks, and calendars may help to remind the patient of important
times and events.
Source: National Mental Health
Association
