Multi-Infarct Dementia

Multi-Infarct Dementia

Multi-Infarct Dementia

Multi-infarct dementia (MID), a type of vascular dementia, happens when a number of small strokes causes damage in the blood vessels in the brain, resulting in the gradual reduction in brain function.

The mini strokes or transient ischemic attacks (TIA) that lead to MID show temporary symptoms that may be experienced as:

  • Dizziness or loss of coordination
  • Impact to speech, like slurring words
  • Appearance of moderate weakness in a leg or arm

A sudden appearance of symptoms — from misplacing items to getting lost to the inability to perform tasks completed frequently in the past — could point to multi-infarct dementia. As with the progression in damage from the subsequent strokes, the severity of the symptoms in the individual can frighten or harm others, but there are ways to alleviate symptoms and provide effective care for both the individual and the caregivers.

Prevalence

Vascular dementia is the second most common cause of dementia, following Alzheimer’s disease, in people over the age of 65.

Symptoms of Multi-Infarct Dementia:

The clinical features of dementia include:

  • Fragmentation of memory – not remembering details about events in one’s past, not remembering specifics regarding current news or events
  • Language problems – comprehension and expression, trouble reading, problems pronouncing words correctly, difficulty choosing the right words, increasing difficulty writing
  • Reduced efficiency with activities of daily living, loss of executive function needed for tasks like planning or scheduling
  • Behavioral and psychological symptoms – aggression, wandering, depression, anxiety, apathy, anger, or violent or physically threatening acts, crying or laughing at inappropriate times
  • Personality and intellectual breakdown
  • Experiencing hallucinations – seeing things or people who are not there
  • Difficulty identifying danger, decline in the ability to have sound judgement, believing things that are not true
  • Wandering off
  • Changes to sleeping pattern
  • Reduced capacity to focus or pay attention
  • Bladder and or bowel control issues, tingling or numbness, balance issues, tremors

For people with MID, the symptoms can present suddenly after a small stroke; and despite potentially showing some small improvements for a time, subsequent strokes will compound the damage from earlier strokes as well as damage new areas. It is not uncommon to see small bursts of accelerated deterioration, and typically the outlook is not good because of the rate of decline and degree of damage.

Causes of Multi-Infarct Dementia:

Multi-infarct dementia is caused by a repeated, reduced flow of blood to the brain usually as a result of a series of small strokes. Multi-infarct means that more than one area in the brain has been damaged.

Brain cells can be damaged or die if the flow of blood is stopped or reduced significantly for a few seconds or more, and typically the damage sustained is permanent.

A stroke can be silent, which means it affects such a small area of the brain that it goes unnoticed. Over time, many silent strokes can lead to MID. Large strokes that cause noticeable physical and neurological symptoms can also lead to MID.

Risk Factors for Multi-Infarct Dementia:

The following medical conditions are risk factors that render a person more vulnerable to developing multi-infarct dementia:

  • Diabetes
  • Atherosclerosis – a furring or hardening of the arteries that can result in narrowing and blockage
  • Other issues related to blood clotting or thickening
  • High blood pressure
  • Stroke, history of strokes
  • Decline in cognitive function
  • Heart failure, heart issues like atrial fibrillation which can result in clots
  • Obesity
  • Use of oral contraceptives

One of the most significant impacts a person can make on their own health to reduce their risk of multi-infarct dementia is to look after their heart and general health. The earlier in life a person takes preventative steps, the better.

Risk factors from a person’s lifestyle include:

  • Lack of nutrition
  • Alcohol use or dependency
  • Cigarette smoking
  • Being physically inactive
  • Substandard education level

Prevention

Reduce the risk of hardening of the arteries (atherosclerosis) by:

  • High blood pressure management
  • Stopping smoking
  • Moderation or stopping alcohol use
  • Exercise and diet for overall health and to address any unhealthy weight, minimizing dietary salt and saturated fats
  • Management and/or treatment of any coexisting conditions such as diabetes

Diagnosing Multi-Infarct Dementia:

Multi-infarct dementia is diagnosed in a specialist setting and usually by an older-age or later-life psychiatrist. Each individual is different, so the impact on their faculties and the severity of the symptoms will vary tremendously from person to person.

There is no single test doctors can use that is specific to MID to establish a diagnosis, and a doctor will usually use a combination of the following:


  • Physical exams and lab tests to eliminate other causes like blood pressure, diabetes, and cholesterol issues
  • History of notable jumps in cognitive deterioration
  • Brain imaging including MRI, FDG-PET, or CT scans – to look for evidence of prior strokes or detect metabolically active malignant lesions
  • Electroencephalogram – to analyze electric activity inside the brain
  • Transcranial doppler – to measure blood flow velocity through the blood vessels in the brain
  • Carotid ultrasound – to determine the condition of and flow through carotid arteries
  • Neurological exams – a set of tests to determine the presence of disorders in the brain
  • Neuropsychological testing – different types of tests to assess cognitive processing, including measured responses to hypothetical scenarios, creating strategies to solve problems, math problems, written tests, reading assignments, and speaking

Ruling Out Other Causes of Dementia
It is not uncommon for your doctor to order lab tests to find out if any other condition is contributing to or causing the dementia. Possible causes include:

  • Depression
  • Brain tumor
  • Severe infection
  • Drug use or a reaction to medical prescription combinations
  • Issues with the thyroid
  • Blood issues, including anemia
  • Nutrition deficiency

Ruling Out Other Types of Vascular Dementia
Brain scans are the most likely indicators of the type of vascular dementia an individual has — related to where the blood flow blockages are situated and how many there are — including:

  • Multi-infarct dementia
  • Single-infarct dementia
  • Post-stroke dementia
  • Stroke-related dementia
  • Subcortical vascular dementia
  • Mixed dementia – multi-infarct or vascular dementia can coexist with Alzheimer’s disease.

Treatment of Multi-Infarct Dementia:

Multi-infarct dementia currently has no cure, and the aim of therapy is to treat risk factors and to prevent future strokes. This can be achieved by a number of medical approaches and lifestyle changes.

Medications

  • Anti-hypertensive medication – for high blood pressure
  • Statins – for getting cholesterol under control
  • High dose omega-3 or statins – to lower triglycerides
  • Blood thinners – like aspirin, to help prevent clots from forming and clogging up arteries
  • Antidepressants – to address depression, panic, anxiety, phobias, and more
  • Stenting, angioplasty, and other procedures – might be necessary to widen veins and arteries to increase the flow of blood to the brain

It is important to note that medicines used to treat Alzheimer’s disease are ineffective at treating multi-infarct dementia.


Lifestyle changes

  • Improving diet
  • Regular exercise
  • Moderating or eliminating alcohol consumption
  • Stopping smoking

Home setting
Providing support to people with multi-infarct dementia in the home setting helps them cope. This can usually be achieved by:

  • Prescribing low doses of medications for sleep problems, agitation, and aggression for short periods of times
  • Removal of safety hazards
  • Installation of security features to stop individual from wandering
  • Assisting family members and other caregivers with a community support network

In addition to the range of symptoms a person with multi-infarct dementia can experience, and the different ways this can impact their life, it is also possible that the individual can experience additional medical complications that cause the individual to require full-time in-home or residential care.

Symptoms of Multi-Infarct Dementia:

The clinical features of dementia include:

  • Fragmentation of memory – not remembering details about events in one’s past, not remembering specifics regarding current news or events
  • Language problems – comprehension and expression, trouble reading, problems pronouncing words correctly, difficulty choosing the right words, increasing difficulty writing
  • Reduced efficiency with activities of daily living, loss of executive function needed for tasks like planning or scheduling
  • Behavioral and psychological symptoms – aggression, wandering, depression, anxiety, apathy, anger, or violent or physically threatening acts, crying or laughing at inappropriate times
  • Personality and intellectual breakdown
  • Experiencing hallucinations – seeing things or people who are not there
  • Difficulty identifying danger, decline in the ability to have sound judgement, believing things that are not true
  • Wandering off
  • Changes to sleeping pattern
  • Reduced capacity to focus or pay attention
  • Bladder and or bowel control issues, tingling or numbness, balance issues, tremors

For people with MID, the symptoms can present suddenly after a small stroke; and despite potentially showing some small improvements for a time, subsequent strokes will compound the damage from earlier strokes as well as damage new areas. It is not uncommon to see small bursts of accelerated deterioration, and typically the outlook is not good because of the rate of decline and degree of damage.

Causes of Multi-Infarct Dementia:

Multi-infarct dementia is caused by a repeated, reduced flow of blood to the brain usually as a result of a series of small strokes. Multi-infarct means that more than one area in the brain has been damaged.

Brain cells can be damaged or die if the flow of blood is stopped or reduced significantly for a few seconds or more, and typically the damage sustained is permanent.

A stroke can be silent, which means it affects such a small area of the brain that it goes unnoticed. Over time, many silent strokes can lead to MID. Large strokes that cause noticeable physical and neurological symptoms can also lead to MID.

Risk Factors for Multi-Infarct Dementia:

The following medical conditions are risk factors that render a person more vulnerable to developing multi-infarct dementia:

  • Diabetes
  • Atherosclerosis – a furring or hardening of the arteries that can result in narrowing and blockage
  • Other issues related to blood clotting or thickening
  • High blood pressure
  • Stroke, history of strokes
  • Decline in cognitive function
  • Heart failure, heart issues like atrial fibrillation which can result in clots
  • Obesity
  • Use of oral contraceptives

One of the most significant impacts a person can make on their own health to reduce their risk of multi-infarct dementia is to look after their heart and general health. The earlier in life a person takes preventative steps, the better.

Risk factors from a person’s lifestyle include:

  • Lack of nutrition
  • Alcohol use or dependency
  • Cigarette smoking
  • Being physically inactive
  • Substandard education level

Prevention

Reduce the risk of hardening of the arteries (atherosclerosis) by:

  • High blood pressure management
  • Stopping smoking
  • Moderation or stopping alcohol use
  • Exercise and diet for overall health and to address any unhealthy weight, minimizing dietary salt and saturated fats
  • Management and/or treatment of any coexisting conditions such as diabetes

Diagnosing Multi-Infarct Dementia:

Multi-infarct dementia is diagnosed in a specialist setting and usually by an older-age or later-life psychiatrist. Each individual is different, so the impact on their faculties and the severity of the symptoms will vary tremendously from person to person.

There is no single test doctors can use that is specific to MID to establish a diagnosis, and a doctor will usually use a combination of the following:


  • Physical exams and lab tests to eliminate other causes like blood pressure, diabetes, and cholesterol issues
  • History of notable jumps in cognitive deterioration
  • Brain imaging including MRI, FDG-PET, or CT scans – to look for evidence of prior strokes or detect metabolically active malignant lesions
  • Electroencephalogram – to analyze electric activity inside the brain
  • Transcranial doppler – to measure blood flow velocity through the blood vessels in the brain
  • Carotid ultrasound – to determine the condition of and flow through carotid arteries
  • Neurological exams – a set of tests to determine the presence of disorders in the brain
  • Neuropsychological testing – different types of tests to assess cognitive processing, including measured responses to hypothetical scenarios, creating strategies to solve problems, math problems, written tests, reading assignments, and speaking

Ruling Out Other Causes of Dementia
It is not uncommon for your doctor to order lab tests to find out if any other condition is contributing to or causing the dementia. Possible causes include:

  • Depression
  • Brain tumor
  • Severe infection
  • Drug use or a reaction to medical prescription combinations
  • Issues with the thyroid
  • Blood issues, including anemia
  • Nutrition deficiency

Ruling Out Other Types of Vascular Dementia
Brain scans are the most likely indicators of the type of vascular dementia an individual has — related to where the blood flow blockages are situated and how many there are — including:

  • Multi-infarct dementia
  • Single-infarct dementia
  • Post-stroke dementia
  • Stroke-related dementia
  • Subcortical vascular dementia
  • Mixed dementia – multi-infarct or vascular dementia can coexist with Alzheimer’s disease.

Treatment of Multi-Infarct Dementia:

Multi-infarct dementia currently has no cure, and the aim of therapy is to treat risk factors and to prevent future strokes. This can be achieved by a number of medical approaches and lifestyle changes.

Medications

  • Anti-hypertensive medication – for high blood pressure
  • Statins – for getting cholesterol under control
  • High dose omega-3 or statins – to lower triglycerides
  • Blood thinners – like aspirin, to help prevent clots from forming and clogging up arteries
  • Antidepressants – to address depression, panic, anxiety, phobias, and more
  • Stenting, angioplasty, and other procedures – might be necessary to widen veins and arteries to increase the flow of blood to the brain

It is important to note that medicines used to treat Alzheimer’s disease are ineffective at treating multi-infarct dementia.


Lifestyle changes

  • Improving diet
  • Regular exercise
  • Moderating or eliminating alcohol consumption
  • Stopping smoking

Home setting
Providing support to people with multi-infarct dementia in the home setting helps them cope. This can usually be achieved by:

  • Prescribing low doses of medications for sleep problems, agitation, and aggression for short periods of times
  • Removal of safety hazards
  • Installation of security features to stop individual from wandering
  • Assisting family members and other caregivers with a community support network

In addition to the range of symptoms a person with multi-infarct dementia can experience, and the different ways this can impact their life, it is also possible that the individual can experience additional medical complications that cause the individual to require full-time in-home or residential care.