Multi-Infarct
Dementia Fact Sheet
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Contents
Serious
forgetfulness, mood swings, and other behavioral changes are not
a normal part of aging. They may be caused by poor diet, lack of
sleep, or too many medicines, for example. Feelings of loneliness,
boredom, or depression also can cause forgetfulness. These problems
are serious and should be treated. Often they can be reversed.
Sometimes,
however, mental changes are caused by diseases that permanently damage
brain cells. The term dementia describes a medical condition that
is caused by changes in the normal activity of very sensitive brain
cells. These changes in the way the brain works can affect memory,
speech, and the ability to carry out daily activities.
Alzheimers
disease is the most common cause of dementia in older people (see
box below). The second most common cause of dementia in older adults
is vascular dementia, which affects the blood vessels in the brain.
What
is Alzheimers disease?
Alzheimers
disease (AD) affects approximately 4 million people in the
U.S. Abnormal proteins collect in the brain and appear to
cause loss of nerve cells in the areas vital to memory and
thinking.
Alzheimers
disease develops slowly. At first, people with AD may have
trouble remembering recent events, or the names of familiar
people or things. Skills are lost continuously and gradually,
though some people decline faster than others. As the disease
goes on, symptoms become more easily noticed and serious enough
to cause people with AD or their family members to seek medical
help.
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Multi-infarct
dementia is the most common form of vascular dementia, and accounts
for 10-20% of all cases of progressive, or gradually worsening, dementia.
It usually affects people between the ages of 60-75, and is more likely
to occur in men than women.
Multi-infarct
dementia is caused by a series of strokes that disrupt blood flow
and damage or destroy brain tissue. A stroke occurs when blood cannot
get to part of the brain. Strokes can be caused when a blood clot
or fatty deposit (called plaque) blocks the vessels that supply blood
to the brain. A stroke also can happen when a blood vessel in the
brain bursts.
Some
of the main causes of strokes are:
-
untreated high blood pressure (hypertension)
- diabetes
-
high cholesterol
-
heart disease
Of
these, the most important risk factor for multi-infarct dementia is
high blood pressure.
Because
strokes occur suddenly, loss of thinking and remembering skills
the symptoms of dementia also occurs quickly and often in a
step-wise pattern. People with multi-infarct dementia may even appear
to improve for short periods of time, then decline again after having
more strokes.
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Symptoms
Sudden
onset of any of the following symptoms may be a sign of multi-infarct
dementia:
-
confusion and problems with recent memory
-
wandering or getting lost in familiar places
-
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 the result of a series of small strokes. Some of
these small strokes produce no obvious symptoms and are noticed only
on brain imaging studies, so they are sometimes called "silent
strokes." A person may have several small strokes before noticing
serious changes in memory or other signs of multi-infarct dementia.
Transient
ischemic attacks, or TIAs, are caused by a temporary blockage of blood
flow. Symptoms of TIAs are similar to symptoms of stroke and include
mild weakness in an arm or leg,
slurred speech, and dizziness. Symptoms generally do not last for
more than 20 minutes. A recent history of TIAs greatly increases a
persons chance of suffering permanent brain damage from a stroke.
Prompt medical attention is required to determine what may be causing
the blockage in blood flow and to start proper treatment (such as
aspirin or warfarin).
If
you believe someone is having a
stroke if a person experiences sudden weakness or numbness
on one or both sides of the body, or difficulty speaking, seeing,
or walking call 911 immediately.
If the physician
believes the symptoms are caused by a blocked blood vessel, treatment
with a "clot buster," such as t-PA (tissue plasminogen activator),
within 3 hours can reopen the vessel and may reduce the severity of
the stroke.
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Diagnosis
People
who show signs of dementia and who have a history of strokes should
be evaluated for possible multi-infarct dementia. The doctor usually
will ask the patient and the family about the persons diet,
medications, sleep patterns, personal habits, past strokes, and other
risk factors (such as high blood pressure, diabetes, high cholesterol,
and heart disease). The doctor also may ask about recent illnesses
or stressful events, like the death of someone close or problems at
home or work, which may account for the symptoms. To look for signs
of stroke, the doctor will check for weakness or numbness in the arms
and 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. These tests may include a blood
pressure reading, an electroencephalogram (EEG), a test of thyroid
function, or blood tests.
The
doctor also may ask for x-rays or special tests such as a computerized
tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Both
CT scans and MRI scans take pictures of sections of the brain. The
pictures are displayed on a computer screen to allow the doctor to
see inside the brain and check for signs of stroke, tumors, or other
sources of brain injury. Specialists called radiologists and neurologists
interpret these scans. In addition, the doctor may send the patient
to a psychologist or psychiatrist to assess reasoning, learning ability,
memory, and attention span.
Sometimes
multi-infarct dementia is
difficult to distinguish from AD because their symptoms can be very
similar. It is possible for a person to have both diseases, making
it hard for the doctor to diagnose either.
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Treatment
While
no treatment can reverse brain damage that has already been caused
by a stroke, treatment to prevent further strokes is very important.
For example, high blood pressure, the primary risk factor for multi-infarct
dementia, and diabetes are treatable. To prevent more 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,
and eating a low-fat diet.
To
reduce symptoms of dementia, doctors may change or stop medica-tions
that can cause confusion, such as sedatives, antihistamines, strong
painkillers, and other medications. Some patients also may have to
be treated for additional medical condi-tions that can increase confusion,
such as heart failure, thyroid disorders, anemia, or infections.
Doctors
sometimes prescribe aspirin, warfarin, or other drugs to prevent clots
from forming in small blood vessels. Medications also can be prescribed
to relieve restlessness or depression or to help patients sleep better.
To
improve blood flow or remove blockages in blood vessels, doctors may
recommend surgical procedures, such as carotid endarterectomy, angioplasty,
or stenting. Studies are under way to see how well these treatments
work for patients with multi-infarct dementia. Scientists are also
studying drugs that can improve blood flow to the brain, such as anti-platelet
and anti-coagulant medications; drugs to treat symptoms of dementia,
including Alzheimers disease medica-tions; as well as drugs
to reduce the risk of TIAs and stroke, such as cholesterol-lowering
statins and blood pressure medications.
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Helping
Someone With Multi-Infarct Dementia
Family
members and friends can help someone with multi-infarct dementia cope
with mental and physical problems. They can encourage individuals
to maintain their daily routines and regular social and physical activities.
By talking with them about events and daily experiences, family members
can help their loved ones use their mental abilities as much as possible.
Some families find it helpful to use reminders such as lists, alarm
clocks, and calendars to help the patient remember important times
and dates.
A
person with multi-infarct dementia should see their primary care doctor
regularly. Health problems such as high blood pressure, diabetes,
high cholesterol, and heart disease should be carefully monitored.
If a person has additional medical conditions, such as depression,
mental health experts may be consulted as well.
Help
for home caregivers is available from a variety of sources, including
nurses, family doctors, social workers, and physical and occupational
therapists. Home health care and respite or neighborhood day care
services can provide much-needed relief to care-givers. Support groups
offer emotional support for family members caring for a person with
dementia. A State or local health department, a local hospital, or
the patients doctor may be able to provide telephone numbers
for such services.
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For
More Information
The
organizations listed below offer more information about some of the
topics mentioned in this fact sheet.
Alzheimers Association
A
free information packet about multi-infarct dementia and information
about support groups for families are available from:
225
North Michigan Avenue
Suite 1700
Chicago, Illinois 60601
1-800-272-3900
www.alz.org
e-mail: info@alz.org
Alzheimers
Disease Education and Referral (ADEAR) Center
The
ADEAR Center is a service of the National Institute on Aging, funded
by the Federal Government. It offers information and publications
on diagnosis, treatment, patient care, caregiver needs, long-term
care, education and training, and research related to AD and dementia.
Staff answer telephone and written requests and make referrals to
local and national resources. Additional copies of this fact sheet,
the Alzheimers Disease Fact Sheet, and single copies
of the National Institute on Aging Age Pages, Stroke: Prevention
and Treatment, Forgetfulness: Its Not Always What You Think,
and Depression: A Serious But Treatable Illness are available
by contacting:
P.O.
Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
www.alzheimers.org
e-mail: adear@alzheimers.org
American
Stroke Association (a division of the American Heart Association)
Information
about stroke and recovery, as well as related research, programs,
and events is available from:
7272
Greenville Avenue
Dallas, TX 75231
1-888-4-STROKE (478-7653)
www.strokeassociation.org
National
Institute of Neurological Disorders and Stroke
Information
about stroke and current research on stroke-related conditions is
available from:
P.O.
Box 5801
Bethesda, MD 20824
1-800-352-9424
www.ninds.nih.gov
National
Stroke Association
Information
about stroke and support for stroke survivors and their families is
available from:
9707
E. Easter Lane
Englewood, CO 80112
1-800-STROKES (787-6537)
www.stroke.org
National
Heart, Lung, and Blood Health Information Center
Information
about preventing stroke, including information about risk factors
such as high blood pressure, high cholesterol, heart disease, and
smoking, is available from:
P.O.
Box 30105
Bethesda, MD 20824-0105
1-800-575-9355
www.nhlbi.nih.gov
e-mail: NHLBIinfo@rover.nhlbi.nih.gov
National
Diabetes Information Clearinghouse
Information
about controlling diabetes is available from:
1
Information Way
Bethesda, MD 20892-3560 (please
use full, 9-digit zip code)
1-800-860-8747
www.niddk.nih.gov/health/diabetes/ndic.htm
e-mail: ndic@info.niddk.nih.gov
Eldercare
Locator
Information
about services and resources in your area, such as adult day care
programs, transportation, and meal services, is available from:
1-800-677-1116
www.eldercare.gov
e-mail: eldercare_locator@aoa.gov
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U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Institute on Aging
NIH
Publication No. 02-3433
July
2003
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