• Clinical science

Vascular dementia (Multi-infarct dementia…)


  • Second most common type of dementia (10–20% of cases).
  • Prevalence increases with age (∼ 1–4% in patients ≥ 65 years)


Epidemiological data refers to the US, unless otherwise specified.




Lesions of the smaller (microangiopathy) and larger (macroangiopathy) cerebral arteries share common risk factors and pathological features but produce distinct clinical entities.

Small vessel disease

Large vessel disease


Clinical features

Symptoms depend on the location of ischemic events and therefore vary widely between individuals, but a progressive impairment of daily life is common. Because of the diverse clinical picture, the term “vascular cognitive impairment” is gaining popularity over VD .

Dementia due to small vessel disease

  • Symptoms tend to progress gradually or stepwise and comparatively slower than in multi-infarct dementia
  • Generally associated with signs of subcortical pathology
    • Early symptoms
    • Later symptoms:
      • Further cognitive decline: loss of judgement, disorientation
      • Mood disorders (e.g., euphoria, depression)
      • Behavioral changes (e.g., aggressiveness)
    • Advanced stages:

Dementia due to large vessel disease

  • Usually sudden onset
  • Multi-infarct dementia: typically, stepwise deterioration
  • Generally associated with signs of cortical pathology
    • Cognitive impairment in combination with asymmetric or focal deficits (e.g., unilateral visual field defects, hemiparesis, Babinski reflex present)
    • Symptoms depend on the affected cerebral region(s): see “Clinical features” of stroke



VD is a clinical diagnosis (as with all dementias; see the Mini-mental state examination) based on medical history and clinical features, which is supported by imaging findings.

  • Ultrasound
    • Doppler examination of critical vessels (particularly the carotid arteries) for signs of cerebrovascular risk (e.g., atherosclerosis)
    • Echocardiography to evaluate the risk of cardioembolic events
  • Cranial CT: microangiopathic lesions located in white matter, multiple lacunar lesions
  • Functional imaging (PET-CT): may be helpful in distinguishing between VD and Alzheimer's disease (AD).
    • VD: hypoperfusion and hypometabolism more pronounced in the frontal lobe
    • AD: hypoperfusion and hypometabolism more pronounced in the parietal and temporal lobes
  • Cranial MRI: : multiple lacunar and white matter lesions (periventricular and in the semioval center)
  • Conduct laboratory tests to rule out other potential causes or comorbidities (e.g., glucose levels, TSH)


Differential diagnoses

The differential diagnoses listed here are not exhaustive.


VD results in an irreversible loss of cognitive skills; management is therefore aimed at symptomatic treatment of dementia (e.g., memory therapy) and prevention of additional ischemic events.


  • 1. Wright CB. Etiology, clinical manifestations, and diagnosis of vascular dementia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/etiology-clinical-manifestations-and-diagnosis-of-vascular-dementia. Last updated July 11, 2016. Accessed December 29, 2016.
  • 2. Caplan LR, Siesjo BK, Weir B et al. Primer on Cerebrovascular Diseases. ACADEMIC PRESS; 1997.
  • 3. Jellinger KA. Pathology and pathogenesis of vascular cognitive impairment-a critical update. Frontiers in Aging Neuroscience. 2013; 5. doi: 10.3389/fnagi.2013.00017.
  • 4. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42(9): pp. 2672–713. doi: 10.1161/STR.0b013e3182299496.
  • 5. Alagiakrishnan K. Vascular Dementia. In: Welton RS. Vascular Dementia. New York, NY: WebMD. http://emedicine.medscape.com/article/292105. Updated November 1, 2016. Accessed December 29, 2016.
  • 6. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill Education; 2015.
last updated 07/20/2020
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