Binswanger's disease is an older name for dementia caused by vasculature disorders, such as chronic hypertension and diabetes. It is now referred to as vasculature dementia or multi-infarct dementia or MID. In older people, MID is the second most common form of dementia. Alzheimer's disease is the first. However, these types of dementia often coexist. A review in the journal "Haemostasis" notes that the prevalence of vascular dementia ranges from 2.2 percent to over 16 percent and its occurrence is increased with advancing age and in those people who have had a stroke.
Multi-Infarct Dementia
MID is caused by a series of mild strokes that damages brain tissue. There are two different kinds of strokes that lead to brain damage, ischemic in which a lack of blood supply causes brain tissue to be deprived of oxygen, and hemorrhage, in which blood vessels rupture in the brain. A review article in the July 2010 issue of the "British Medical Journal" reports that these events cause lesions in the white matter of the brain primarily in the subcortical region. The lesions can be detected by MRI or a CT scan.
Primary Symptoms
According to Mental Health America, the primary symptoms of MID are confusion and problems recalling recent memories. Additionally, people with MID may get easily lost, laugh or cry inappropriately, move with shuffling steps and have loss of bladder or bowel control. A review in the journal "Topics in Stroke Rehabilitation" notes that patients with lesions in the subcortical white matter may also have problems with motor skills and walking, experience personality changes and have difficulty speaking.
Psychosis Prevalence
A study in the July 2010 issue of the "Journal of Geriatric Psychiatry and Neurology" reports that the prevalence of psychotic symptoms in elderly people with vasculature dementia is 54 percent, compared to 36 percent with Alzheimer's disease.
Psychosis Symptoms
Elderly people with vasculature dementia may exhibit symptoms of psychosis including delusions and hallucinations. The delusions and hallucinations are often of theft by caregivers, spouse infidelity, abandonment, abuse and neglect. The behavioral manifestations of psychosis are anxiety, severe agitation, irritability and paranoia.
Treatment
There is no cure for MID and the brain damage is irreversible; however it is essential to prevent further brain injury by treating the underlying risk factors of the disease. Chronic hypertension is the most prevalent risk factor. Others risk factors include heart disease, diabetes, obesity, high levels of cholesterol and smoking. The review in the journal "Topics in Stroke Rehabilitation" reports that people who took antihypertensive medications were less likely to develop vasculature dementia. This review also purports that statins are effective in treating recurrent strokes, but there is no evidence that they decrease the risk of acquiring vasculature dementia. A clinical trial study in the December 2005 issue of the "International Journal of Geriatric Psychiatry" reports that psychosis symptoms were markedly reduced in patients who had Alzheimer's disease or mixed dementia treated with the antipsychotic risperidone.
References
- "Haemostasis"; Epidemiology of Vascular Dementia; D. Leys et al.; May-August 1998
- "British Medical Journal"; The Clinical Importance of White Matter Hyperintensities on Brain Magnetic Resonance Imaging: Systematic Review and Meta-Analysis; S. Debette and H. Markus; July 2010
- Mental Health America: Fact Sheet: Multi-Infarct Dementia
- "Journal of Geriatric Psychiatry and Neurology"; Psychotic Symptoms in a Population-Based Sample of 85-Year-Old Individuals With Dementia; S. Ostling et al.; July 2010
- "International Journal of Geriatric Psychiatry"; Risperidone for Psychosis of Alzheimer's Disease and Mixed Dementia: Results of a Double-blind, Placebo-controlled Trial December 2005
