Vascular Dementia. Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center

Size: px
Start display at page:

Download "Vascular Dementia. Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center"

Transcription

1 Vascular Dementia Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center

2 none Disclosures

3 Objectives To review the definition of Vascular Cognitive Impairment (VCI); To understand the anatomy and pathophysiology of CNS vascular disease; To review patterns of damage leading to VCI; To review clinical presentation, risk factors for, and management of VCI

4 Vascular dementia: epidemiology Second most common form of dementia, after AD, in the North America and Europe Prevalence % in the general population Accounts for 10 20% of dementia cases Possibly higher in Asian populations Increasing prevalence with age Risk factors Cardiovascular risk factors (HTN, DM/metabolic syndrome, dyslipidemia) Stroke Age Low education Potentially preventable dementia

5 A bit of Background: What is dementia? An acquired cognitive and functional decline involving one or more cognitive domains, sufficient to interfere with independence in everyday activities, Not occurring in the context of delirium or better explained by another mental disorder Currently conceived as part of a spectrum Normal Cognition Normal cognitive aging Mild cognitive impairment Dementia Increasing cognitive and functional impairment

6 A bit of background: How the brain supports cognition Cognitive domains : independently testable cognitive functions associated with a defined neuroanatomical substrate: Language (dominant perisylvian) Visuoperceptive (occipital cortices) Visuospatial (parietal) Memory (mesial temporal) Attention (distributed parietal, frontal, brainstem/thalamic RAS) Executive (frontal-subcortical circuits)

7 A bit of background: How the vascular system supports the brain Vessels of origin: Anterior circulation (carotid arteries) Posterior circulation (vertebrobasilar) Circle of Willis Surface arteries: pial vessels Deep structures: penetrating arteries Cerebral autoregulation Blood-brain barrier

8 How things can go wrong: Vascular dementia (VaD) 19 th Century: Senile dementia : Binswanger and Alzheimer describe cerebrovascular pathology underlying dementia 1896: Kraepelin descibes arteriosclerotic dementia 1907: Alzheimer describes neurodegenerative changes associated with Alzheimer s disease 1974: Hachinski introduces the concept of multi-infarct dementia 1994: NINDS-AIREN criteria for Vascular Dementia (VaD) formulated Iadecola, Neuron, 2013

9 How things can go wrong: VaD and VCI Definition VaD: A syndrome with evidence of clinical stroke or subclinical vascular brain injury and cognitive impairment affecting at least one cognitive domain NINDS-CSN VCI Harmonization standards: Cognitive impairment caused by or associated with vascular factors Again recognizes a spectrum, incorporating VCIND (Vascular Cognitive Impairment, No Dementia)

10 Diagnostic heuristics Hachinski scale 13-item scale Assesses clinical features and risk factors suggestive of vascular disease Antedates sophisticated neuroimaging DSM-V Impairment in one or more cognitive domains With evidence of cerebrovascular disease Focal neurological signs/symptoms Neuroimaging Cognitive profile Judged to be etiologically related to the dementia NINDS-AIREN criteria Evidence of: Dementia Cerebrovascular disease Clinical signs/symptoms Neuroimaging (specified patterns A relationship between the two Incorporates neuroimaging parameters Classifies VaD as definite, probable or possible

11 Mechanisms Iadecola, Neuron, 2013

12 Single-stroke dementia Pervasive multi-domain cognitive impairment following a single stroke Lesions disrupt key circuitry Frontal-subcortical circuits -> executive dysfunction; Multimodal cortical association areas -> language, memory, visuospatial deficits Clinical presentation: Abrupt onset; Deficits reflect lesion location; Elemental neurological deficits may or may not be present

13 Multi-infarct Dementia Progressive cognitive and functional decline due to accumulation of ischemic disease: Location, rather than volume of tissue loss is crucial Clinical presentation: Stepwise progression Often with sensory and/or motor abnormalities

14 Subcortical Ischemic Vascular Progressive cognitive and functional decline due to recurrent small-vessel ischemic strokes Deficits due to: Disruption of frontalsubcortical circuits; Cholinergic deficit Clinical presentation: Stepwise or gradually progressive; Motor and sensory deficits may be present; Frontal-executive dysfunction dominates the profile Dementia (SIVD)

15 Binswangers Disease Chronic hypoperfusion results in thinning and attenuation of the white matter without complete infarction Pathophysiology Clinical presentation: Gradually progressive onset; Subcortical dementia with psychomotor slowing, impaired executive function; Gait abnormalities and pseudobulbar affect (emotional lability) common Iadecola, Neuron, 2013

16 CADASIL Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Autosomal dominant syndrome Pathology Smooth muscle deterioration, granular osmiophilic deposits Leukoariosis and lacunar infarcts Clinical presentation: Early onset (age 30 50) Seizures Migraine with aura Recurrent subcortical stroke Subcortical dementia

17 What about bleeds? Intracerebral hemorrhage (ICH) Lobar ICH Subcortical ICH Risk factors: Hypertension Amyloid angiopathy Cognitive and functional decline due to: Local tissue destruction Deafferentation Inflammatory reaction Hydrocephalus Cerebral microbleeds (MB) Manno Mayo Clin Proc 2005

18 Evaluation History Vascular risk factors Stepwise progression Physical examination Cardiovascular examination Focal neurological deficits Motor Sensory Reflex Laboratory evaluation Neuroimaging (MRI) Vascular imaging Cardiac evaluation Neurocognitive evaluation Dysexecutive profile Memory: retrieval>encoding deficits Psychomotor slowing, impairment of attention

19 Management: control of risk factors Prevention is key! Risk factor management Atrial fibrillation Hypertension Dyslipidemia Diabetes Lifestyle changes (diet, physical activity, smoking cessation) Role and efficacy of early vs late risk factor control

20 Management: pharmacotherapy No specific therapies exist Cholinesterase inhibitors Donepezil: modest cognitive and global effects in VaD and mixed dementia Galantamine: modest cognitive (executive) and functional benefits, lower rate of decline in mixed (AD/VaD) dementia Rivastigmine: less clear benefits, modest benefits in some measures of executive function Memantine: unclear benefit Other agents Symptomatic treatment (e.g. comorbid depression)

21 Key Points Vascular dementia (VaD) is the extreme end of a spectrum of vascular cognitive impairment, cognitive and functional decline consequent on interrupted blood supply to the brain VCI is a heterogeneous phenomenon The cognitive profile is different from that of AD and reflects the pathophysiology of the syndrome VCI is a potentially preventable condition, and early intervention may be key

22 /*

September 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by

September 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by September 26 28, 2013 Westin Tampa Harbour Island Co-sponsored by From Brains at Risk to Cognitive Dysfunction: The Role of Vascular Pathology Ralph Sacco, MD, MS, FAHA, FAAN Miller School of Medicine

More information

Cerebrovascular Disorders. Blood, Brain, and Energy. Blood Supply to the Brain 2/14/11

Cerebrovascular Disorders. Blood, Brain, and Energy. Blood Supply to the Brain 2/14/11 Cerebrovascular Disorders Blood, Brain, and Energy 20% of body s oxygen usage No oxygen/glucose reserves Hypoxia - reduced oxygen Anoxia - Absence of oxygen supply Cell death can occur in as little as

More information

Clinical Diagnosis. Step 1: Dementia or not? Diagnostic criteria for dementia (DSM-IV)

Clinical Diagnosis. Step 1: Dementia or not? Diagnostic criteria for dementia (DSM-IV) Step 1: Dementia or not? Diagnostic criteria for dementia (DSM-IV) A. The development of multiple cognitive deficits manifested by both 1 and 2 1 1. Memory impairment 2. One (or more) of the following

More information

Delirium & Dementia. Nicholas J. Silvestri, MD

Delirium & Dementia. Nicholas J. Silvestri, MD Delirium & Dementia Nicholas J. Silvestri, MD Outline Delirium vs. Dementia Neural pathways relating to consciousness Encephalopathy Stupor Coma Dementia Delirium vs. Dementia Delirium Abrupt onset Lasts

More information

Silent Cerebral Strokes: Clinical Outcomes and Management

Silent Cerebral Strokes: Clinical Outcomes and Management Silent Cerebral Strokes: Clinical Outcomes and Management Nagaendran Kandiah Senior Consultant Neurologist, National Neuroscience Institute, Singapore Clinician Scientist, National Medical Research Council,

More information

University of Bristol - Explore Bristol Research

University of Bristol - Explore Bristol Research Skrobot, O. A., O'Brien, J., Black, S., Chen, C., DeCarli, C., Erkinjuntti, T.,... Kehoe, P. G. (2016). The vascular impairment of cognition classification consensus study. Alzheimer's and Dementia. DOI:

More information

Dementia. Assessing Brain Damage. Mental Status Examination

Dementia. Assessing Brain Damage. Mental Status Examination Dementia Assessing Brain Damage Mental status examination Information about current behavior and thought including orientation to reality, memory, and ability to follow instructions Neuropsychological

More information

Small Vessel Disease and Dementia:

Small Vessel Disease and Dementia: KDA Programme lecture October 2005 Small Vessel Disease and Dementia: Prof Raj N Kalaria FRCP University of Newcastle upon Tyne Wolfson Research Centre Newcastle General Hospital United Kingdom Email:

More information

UNIVERSITY OF WESTERN ONTARIO

UNIVERSITY OF WESTERN ONTARIO UNIVERSITY OF WESTERN ONTARIO Vladimir Hachinski, CM, MD, FRCPC, DSc Department of Clinical Neurological Sciences University of Western Ontario London, Ontario, Canada Vladimir.hachinski@lhsc.on.ca ALZHEIMER

More information

VASCULAR COGNITIVE IMPAIRMENT/DEMENTIA SETTING THE STAGE

VASCULAR COGNITIVE IMPAIRMENT/DEMENTIA SETTING THE STAGE VASCULAR COGNITIVE IMPAIRMENT/DEMENTIA SETTING THE STAGE Larry B. Goldstein, MD, FAAN, FANA, FAHA University of Kentucky Lexington, KY Issues in the Diagnosis of Vascular Cognitive Impairment and Dementia

More information

Dementia. Stephen S. Flitman, MD Medical Director 21st Century Neurology

Dementia. Stephen S. Flitman, MD Medical Director 21st Century Neurology Dementia Stephen S. Flitman, MD Medical Director 21st Century Neurology www.neurozone.org Dementia is a syndrome Progressive memory loss, plus Progressive loss of one or more cognitive functions: Language

More information

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology Diagnosis and management of non-alzheimer dementias Melissa Yu, M.D. Department of Neurology AGENDA Introduction When to think of alternate diagnoses Other forms of dementia Other reasons for confusion

More information

Patient with vertigo, dizziness and depression

Patient with vertigo, dizziness and depression Clinical Case - Test Yourself Neuro/Head and Neck Radiology Patient with vertigo, dizziness and depression Michael Mantatzis, Paraskevi Argyropoulou, Panos Prassopoulos Radiology Department, Democritus

More information

Correspondence Address: Dr. Touseef Anwar. MBBS, FCPS Assistant Professor of Medicine Independent University Hospital, Faisalabad

Correspondence Address: Dr. Touseef Anwar. MBBS, FCPS Assistant Professor of Medicine Independent University Hospital, Faisalabad Indep Rev Jan-Mar 2016;18(1-3) IR-414 VASCULAR DEMENTIA Dr. Touseef Anwar MBBS, FCPS Assistant Professor of Medicine Independent University Hospital, Faisalabad Correspondence Address: Dr. Touseef Anwar

More information

Non Alzheimer Dementias

Non Alzheimer Dementias Non Alzheimer Dementias Randolph B Schiffer Department of Neuropsychiatry and Behavioral Science Texas Tech University Health Sciences Center 9/11/2007 Statement of Financial Disclosure Randolph B Schiffer,,

More information

Dementia. Aetiology, pathophysiology and the role of neuropsychological testing. Dr Sheng Ling Low Geriatrician

Dementia. Aetiology, pathophysiology and the role of neuropsychological testing. Dr Sheng Ling Low Geriatrician Dementia Aetiology, pathophysiology and the role of neuropsychological testing Dr Sheng Ling Low Geriatrician Topics to cover Why is dementia important What is dementia Differentiate between dementia,

More information

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient DEMENTIA WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient Progressive and disabling Not an inherent aspect of

More information

Neuropathology lecture series. III. Neuropathology of Cerebrovascular Disease. Physiology of cerebral blood flow

Neuropathology lecture series. III. Neuropathology of Cerebrovascular Disease. Physiology of cerebral blood flow Neuropathology lecture series III. Neuropathology of Cerebrovascular Disease Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output: 15-20% Percentage of O

More information

The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging

The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging REBECCA F. GOTTESMAN, MD PHD ASSOCIATE PROFESSOR OF NEUROLOGY AND EPIDEMIOLOGY JOHNS HOPKINS UNIVERSITY OCTOBER 20, 2014 Outline

More information

Form D1: Clinician Diagnosis

Form D1: Clinician Diagnosis Initial Visit Packet Form D: Clinician Diagnosis NACC Uniform Data Set (UDS) ADC name: Subject ID: Form date: / / Visit #: Examiner s initials: INSTRUCTIONS: This form is to be completed by the clinician.

More information

[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD]

[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD] 2015 PHYSICIAN SIGN-OFF (1) STUDY NO (PHY-1) CASE, PER PHYSICIAN REVIEW 1=yes 2=no [strictly meets case definition] (PHY-1a) CASE, IN PHYSICIAN S OPINION 1=yes 2=no (PHY-2) (PHY-3) [based on all available

More information

Neuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia

Neuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia 86 Neuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia Pai-Yi Chiu 1,3, Chung-Hsiang Liu 2, and Chon-Haw Tsai 2 Abstract- Background: Neuropsychiatric profile

More information

POST STROKE DEMENTIA: DIAGNOSIS & INTERVENTION. Danielle E. Eagan, Ph.D. Barrow Neurological Institute Stroke Symposium October 13, 2018

POST STROKE DEMENTIA: DIAGNOSIS & INTERVENTION. Danielle E. Eagan, Ph.D. Barrow Neurological Institute Stroke Symposium October 13, 2018 POST STROKE DEMENTIA: DIAGNOSIS & INTERVENTION Danielle E. Eagan, Ph.D. Barrow Neurological Institute Stroke Symposium October 13, 2018 Overview Stroke & Cognitive Impairment The VCI continuum & terminology

More information

Dementia is an overall term for a set of symptoms that is caused by disorders affecting the brain.

Dementia is an overall term for a set of symptoms that is caused by disorders affecting the brain. Vascular Dementia Vascular Dementia Other Dementias This information sheet provides an overview of a type of dementia known as vascular dementia. In this information sheet you will find: An overview of

More information

Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes. Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville

Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes. Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville Disclosure Statement of Financial Interest Within the

More information

AHA/ASA Scientific Statement

AHA/ASA Scientific Statement AHA/ASA Scientific Statement Vascular Contributions to Cognitive Impairment and Dementia A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association The American

More information

Cerebral small vessel disease

Cerebral small vessel disease Cerebral small vessel disease What is it? What are the clinical syndromes? How do we diagnose it? What is the pathophysiology? New insights from genetics? Possible therapies? Small Vessel disease Changes

More information

Carol Manning, PhD, ABPP-CN Director, Memory Disorders Clinic University of Virginia

Carol Manning, PhD, ABPP-CN Director, Memory Disorders Clinic University of Virginia Carol Manning, PhD, ABPP-CN Director, Memory Disorders Clinic University of Virginia Case Study Mr. S. is a 74 year old man who has smoked for 20 years. He is overweight, has high cholesterol and high

More information

Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective

Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center

More information

Next patient please Dementia Clare Hawley 2018

Next patient please Dementia Clare Hawley 2018 Next patient please Dementia Clare Hawley 2018 I have no conflict of interest to declare Dr Clare Hawley Associate Specialist Cardiology Chesterfield Royal Hospital GPwSI Refractory Angina Hon Clinical

More information

Cerebrovascular Disease

Cerebrovascular Disease Neuropathology lecture series Cerebrovascular Disease Kurenai Tanji, M.D., Ph.D. December 11, 2007 Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output:

More information

HYPERTENSIVE ENCEPHALOPATHY

HYPERTENSIVE ENCEPHALOPATHY HYPERTENSIVE ENCEPHALOPATHY Reversible posterior leukoencephalopathy syndrome Cause Renal disease Pheochromocytoma Disseminated vasculitis Eclampsia Acute toxemia Medications & illicit drugs (cocaine)

More information

It s Always a Stroke; Except For When It s Not..

It s Always a Stroke; Except For When It s Not.. It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when

More information

Acute stroke. Ischaemic stroke. Characteristics. Temporal classification. Clinical features. Interpretation of Emergency Head CT

Acute stroke. Ischaemic stroke. Characteristics. Temporal classification. Clinical features. Interpretation of Emergency Head CT Ischaemic stroke Characteristics Stroke is the third most common cause of death in the UK, and the leading cause of disability. 80% of strokes are ischaemic Large vessel occlusive atheromatous disease

More information

A Neuropsychiatric, Neuroradiological, and Neuropsychological Profile of a Cohort of Patients with Vascular Dementia

A Neuropsychiatric, Neuroradiological, and Neuropsychological Profile of a Cohort of Patients with Vascular Dementia A Neuropsychiatric, Neuroradiological, and Neuropsychological Profile of a Cohort of Patients with Vascular Dementia Moises Gaviria, MD University of Illinois at Chicago Advocate Christ Medical Center

More information

Dementia Update. October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada

Dementia Update. October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Dementia Update October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Outline New concepts in Alzheimer disease Biomarkers and in vivo diagnosis Future trends

More information

Cerebrovascular Disease

Cerebrovascular Disease Neuropathology lecture series Cerebrovascular Disease Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output: 15-20% Percentage of O 2 consumption (resting):

More information

Vascular Cognitive Impairment

Vascular Cognitive Impairment Vascular Cognitive Impairment Sandra E. Black MD, FRCP(C) Brill Professor of Neurology Dept of Medicine Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada N&EGTA Stroke Care Workshop

More information

Neuroanatomy of a Stroke. Joni Clark, MD Professor of Neurology Barrow Neurologic Institute

Neuroanatomy of a Stroke. Joni Clark, MD Professor of Neurology Barrow Neurologic Institute Neuroanatomy of a Stroke Joni Clark, MD Professor of Neurology Barrow Neurologic Institute No disclosures Stroke case presentations Review signs and symptoms Review pertinent exam findings Identify the

More information

Nicolas Bianchi M.D. May 15th, 2012

Nicolas Bianchi M.D. May 15th, 2012 Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the

More information

Significant cognitive improvement with cholinesterase inhibition in AD with cerebral amyloid angiopathy

Significant cognitive improvement with cholinesterase inhibition in AD with cerebral amyloid angiopathy Paterson, Abdi 1 Significant cognitive improvement with cholinesterase inhibition in AD with cerebral amyloid angiopathy Ross W Paterson MRCP 1 *, Zeinab Abdi MRCP 1 *, Amanda Haines RMN 1, Jonathan M

More information

Dementia Prepared by: Joanne Leung Psychiatry Resident, University of Toronto

Dementia Prepared by: Joanne Leung Psychiatry Resident, University of Toronto Dementia Prepared by: Joanne Leung Psychiatry Resident, University of Toronto Dementias are acquired neurodegenerative disorders involving a syndrome of cognitive impairment accompanied with social and

More information

Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE

Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE ESUS Progression of haematoma Anticoagulation Large ICH

More information

DEMENTIA 101: WHAT IS HAPPENING IN THE BRAIN? Philip L. Rambo, PhD

DEMENTIA 101: WHAT IS HAPPENING IN THE BRAIN? Philip L. Rambo, PhD DEMENTIA 101: WHAT IS HAPPENING IN THE BRAIN? Philip L. Rambo, PhD OBJECTIVES Terminology/Dementia Basics Most Common Types Defining features Neuro-anatomical/pathological underpinnings Neuro-cognitive

More information

PROJECTION: Worlds dementia population is expected to triple by 2050

PROJECTION: Worlds dementia population is expected to triple by 2050 DEMENTIA C L I S K C O N S U LTA N T P H Y S I C I A N I N A C U T E M E D I C I N E A N D G E R I AT R I C M E D I C I N E, B A R N E T H O S P I TA L, R O YA L F R E E N H S F O U N D AT I O N T R U

More information

Is PET/CT really helpful in diagnosing Alzheimer s Disease?

Is PET/CT really helpful in diagnosing Alzheimer s Disease? Is PET/CT really helpful in diagnosing Alzheimer s Disease? J. Rudolf MD Ph.D. Consultant in Neurology, Dept. of Neurology, General Hospital Papageorgiou Thessaloniki, Greece Conflict of Interest PET/CT

More information

DISCLOSURES. Objectives. THE EPIDEMIC of 21 st Century. Clinical Assessment of Cognition: New & Emerging Tools for Diagnosing Dementia NONE TO REPORT

DISCLOSURES. Objectives. THE EPIDEMIC of 21 st Century. Clinical Assessment of Cognition: New & Emerging Tools for Diagnosing Dementia NONE TO REPORT Clinical Assessment of Cognition: New & Emerging Tools for Diagnosing Dementia DISCLOSURES NONE TO REPORT Freddi Segal Gidan, PA, PhD USC Keck School of Medicine Rancho/USC California Alzheimers Disease

More information

CNS VASCULAR DISEASE. Reid R. Heffner, M.D. Department of Pathology/Anatomy UB Jacobs School of Medicine January 15, 2019

CNS VASCULAR DISEASE. Reid R. Heffner, M.D. Department of Pathology/Anatomy UB Jacobs School of Medicine January 15, 2019 CNS VASCULAR DISEASE Reid R. Heffner, M.D. Department of Pathology/Anatomy UB Jacobs School of Medicine January 15, 2019 I HAVE NO CONFLICTS OF INTEREST OR ANY DISCLOSURES TO DECLARE. I HAVE NO FINANCIAL

More information

FILE / PERIVENTRICULAR MICROVASCULAR ISCHEMIC CHANGES EBOOK

FILE / PERIVENTRICULAR MICROVASCULAR ISCHEMIC CHANGES EBOOK 07 June, 2018 FILE / PERIVENTRICULAR MICROVASCULAR ISCHEMIC CHANGES EBOOK Document Filetype: PDF 365.11 KB 0 FILE / PERIVENTRICULAR MICROVASCULAR ISCHEMIC CHANGES EBOOK I recently had a MRI last week with

More information

Dementia and Delirium

Dementia and Delirium Dementia and Delirium LPT Gondar Mental Health Group www.le.ac.uk Dementia and Delirium WTINP Chapter 4.6 Introduction - areas to be covered Delirium Definition and causes Clinical features Management

More information

Caring Sheet #11: Alzheimer s Disease:

Caring Sheet #11: Alzheimer s Disease: CARING SHEETS: Caring Sheet #11: Alzheimer s Disease: A Summary of Information and Intervention Suggestions with an Emphasis on Cognition By Shelly E. Weaverdyck, PhD Introduction This caring sheet focuses

More information

Neuroimaging for dementia diagnosis. Guidance from the London Dementia Clinical Network

Neuroimaging for dementia diagnosis. Guidance from the London Dementia Clinical Network Neuroimaging for dementia diagnosis Guidance from the London Dementia Clinical Network Authors Dr Stephen Orleans-Foli Consultant Psychiatrist, West London Mental Health NHS Trust Dr Jeremy Isaacs Consultant

More information

Consensus statement for diagnosis of subcortical small vessel disease

Consensus statement for diagnosis of subcortical small vessel disease Review Article Consensus statement for diagnosis of subcortical small vessel disease Gary A Rosenberg 1, Anders Wallin 2, Joanna M Wardlaw 3, Hugh S Markus 4, Joan Montaner 5, Leslie Wolfson 6, Costantino

More information

DEMENTIA. Szabolcs Szatmári. Tg. Mureş Marosvásárhely Romania 4/18/ :59 AM

DEMENTIA. Szabolcs Szatmári. Tg. Mureş Marosvásárhely Romania 4/18/ :59 AM DEMENTIA Szabolcs Szatmári Tg. Mureş Marosvásárhely Romania Dementia from Latin de- "apart, away" + mens (genitive mentis) "mind" MORE GRAY HAIR AND LESS GRAY MATTER Daryl R. Gress Cognitive decline

More information

CEREBRO VASCULAR ACCIDENTS

CEREBRO VASCULAR ACCIDENTS CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA

More information

Do not copy or distribute without permission. S. Weintraub, CNADC, NUFSM, 2009

Do not copy or distribute without permission. S. Weintraub, CNADC, NUFSM, 2009 Sandra Weintraub, Ph.D. Clinical Core Director, Cognitive Neurology and Alzheimer s Disease Center Northwestern University Feinberg School of Medicine Chicago, Illinois Dementia: a condition caused by

More information

Downloaded from Binswanger s Disease. Binswanger s Disease

Downloaded from  Binswanger s Disease. Binswanger s Disease Medrech ISSN No. 2394-3971 Review Article Binswanger s Disease Ramoju Kishore Kumar 1*, N. Sri Ram 2, I. Sree Harsha 3. 1,3 Pharm. D 3 rd Year, Holy Mary College of Pharmacy, 2 Associate professor, Holy

More information

Clinical Applications of fmri

Clinical Applications of fmri Clinical Applications of fmri Benjamin M. Hampstead, Ph.D., ABPP/CN Associate Professor Department of Psychiatry University of Michigan VA Ann Arbor Healthcare System No Disclosures or Conflicts Hampstead

More information

Assessment at the bedside or in the clinic using the history, examination and laboratory tests to distinguish between different types of dementia

Assessment at the bedside or in the clinic using the history, examination and laboratory tests to distinguish between different types of dementia Assessment at the bedside or in the clinic using the history, examination and laboratory tests to distinguish between different types of dementia AP Passmore Content Common dementia syndromes (older people)

More information

Stroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine

Stroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine Stroke - Intracranial hemorrhage Dr. Amitesh Aggarwal Associate Professor Department of Medicine Etiology and pathogenesis ICH accounts for ~10% of all strokes 30 day mortality - 35 45% Incidence rates

More information

OLD AGE PSYCHIATRY. Dementia definition TYPES OF DEMENTIA. Other causes. Psychiatric disorders of the elderly. Dementia.

OLD AGE PSYCHIATRY. Dementia definition TYPES OF DEMENTIA. Other causes. Psychiatric disorders of the elderly. Dementia. Psychiatric disorders of the elderly OLD AGE PSYCHIATRY Dementia Depression Delusional disorder/late onset schizophrenia Delirium Dementia definition LOCALISATION OF CEREBRAL FUNCTION Impairment of multiple

More information

If searching for a book Vascular Dementia in pdf format, then you've come to the correct site. We furnish utter version of this ebook in doc, DjVu,

If searching for a book Vascular Dementia in pdf format, then you've come to the correct site. We furnish utter version of this ebook in doc, DjVu, Vascular Dementia If searching for a book Vascular Dementia in pdf format, then you've come to the correct site. We furnish utter version of this ebook in doc, DjVu, epub, txt, PDF forms. You may read

More information

Alzheimer's disease (AD), also known as Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer s is the most common form of dementia.

Alzheimer's disease (AD), also known as Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer s is the most common form of dementia. CHAPTER 3 Alzheimer's disease (AD), also known as Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer s is the most common form of dementia. This incurable, degenerative, terminal disease

More information

Clinical Research on Treating Senile Dementia by Combining Acupuncture with Acupoint-Injection

Clinical Research on Treating Senile Dementia by Combining Acupuncture with Acupoint-Injection Clinical Research on Treating Senile Dementia by Combining Acupuncture with Acupoint-Injection Yemeng Chen, M.D. Acupuncture Department, Huashan Hospital Shanghai Medical University, Shanghai 20040, P.

More information

Stroke Awareness. Presented by: Duane Anderson, MD Snoqualmie Valley Hospital Emergency Department Medical Director

Stroke Awareness. Presented by: Duane Anderson, MD Snoqualmie Valley Hospital Emergency Department Medical Director Stroke Awareness Presented by: Duane Anderson, MD Snoqualmie Valley Hospital Emergency Department Medical Director What is a stroke? Stroke can happen to anyone. Stroke is the fourth leading cause of death

More information

An Introduc+on to Stroke

An Introduc+on to Stroke An Introduc+on to Stroke Elizabeth Huntoon MS, MD Assistant Professor Department of Physical Medicine and Rehabilita>on Vanderbilt University School of Medicine Defini+on Sudden focal neurologic deficit

More information

SUPPLEMENTAL MATERIAL

SUPPLEMENTAL MATERIAL SUPPLEMENTAL MATERIAL Cognitive impairment evaluated with Vascular Cognitive Impairment Harmonization Standards in a multicenter prospective stroke cohort in Korea Supplemental Methods Participants From

More information

Commi ee Lecture: Neurocogni ve Disorders TBI : Trauma c Brain Disorders. William L. Bograkos, MA, DO, FACOEP

Commi ee Lecture: Neurocogni ve Disorders TBI : Trauma c Brain Disorders. William L. Bograkos, MA, DO, FACOEP Commi ee Lecture: Neurocogni ve Disorders TBI : Trauma c Brain Disorders Toxic Brain Disorders William L. Bograkos, MA, DO, FACOEP TBI: Traumatic Brain Injury / Toxic Brain Injury (Trauma and Substance

More information

What Do You Think of My Posterior?

What Do You Think of My Posterior? What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures

More information

Imaging of Alzheimer s Disease: State of the Art

Imaging of Alzheimer s Disease: State of the Art July 2015 Imaging of Alzheimer s Disease: State of the Art Neir Eshel, Harvard Medical School Year IV Outline Our patient Definition of dementia Alzheimer s disease Epidemiology Diagnosis Stages of progression

More information

Initial symptom or syndrome: (1) FOCAL WEAKNESS OR NUMBNESS

Initial symptom or syndrome: (1) FOCAL WEAKNESS OR NUMBNESS View the referenced DVD patient cases, especially if few hospital or clinic patients are encountered for any one symptom or syndrome. The DVD patient cases are referenced by initial symptom or syndrome

More information

Consensus statement for diagnosis of subcortical small vessel disease

Consensus statement for diagnosis of subcortical small vessel disease Journal of Cerebral Blood Flow & Metabolism (2015), 1 13 2015 ISCBFM All rights reserved 0271-678X/15 $32.00 www.jcbfm.com REVIEW ARTICLE Consensus statement for diagnosis of subcortical small vessel disease

More information

Supplementary Note. Patient #1 Additional Details

Supplementary Note. Patient #1 Additional Details Supplementary Note Patient #1 Additional Details Past medical history: The patient was ambidextrous. She had a history of hypertension, hyperlipidemia, migraines, and remote history of an ANA-positive

More information

Moving Targets: An Update on Diagnosing Dementia in the Clinic

Moving Targets: An Update on Diagnosing Dementia in the Clinic Moving Targets: An Update on Diagnosing Dementia in the Clinic Eric McDade DO Department of Neurology School of Medicine Alzheimer Disease Research Center Disclosures No relevant financial disclosures

More information

BGS Spring Risk Factors and Preventative Strategies for Dementia

BGS Spring Risk Factors and Preventative Strategies for Dementia Risk Factors and Preventative Strategies for Dementia Dr Blossom Stephan Senior Lecturer (in Risk Prediction) Newcastle University Institute for Ageing and Institute of Health and Society BGS Spring Meeting

More information

INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU

INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU CEREBRAL BYPASS An Innovative Treatment for Arteritis INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU CASE 1 q 1 year old girl -recurrent seizure, right side limb weakness, excessive cry and irritability.

More information

Treatment of Vascular Cognitive Impairment Aaron Ritter, MD 1 Jagan A. Pillai, MBBS, PhD 2,*

Treatment of Vascular Cognitive Impairment Aaron Ritter, MD 1 Jagan A. Pillai, MBBS, PhD 2,* Curr Treat Options Neurol (2015) 17:35 DOI 10.1007/s11940-015-0367-0 Dementia (E McDade, Section Editor) Treatment of Vascular Cognitive Impairment Aaron Ritter, MD 1 Jagan A. Pillai, MBBS, PhD 2,* Address

More information

Vague Neurological Conditions

Vague Neurological Conditions Vague Neurological Conditions Dr. John Lefebre, MD, FRCPC Chief Regional Medical Director Europe, India, South Africa, Middle East and Turkey Canada 2014 2 3 4 Agenda Dr. John Lefebre, M.D., FRCPC 1. TIA

More information

brain MRI for neuropsychiatrists: what do you need to know

brain MRI for neuropsychiatrists: what do you need to know brain MRI for neuropsychiatrists: what do you need to know Christoforos Stoupis, MD, PhD Department of Radiology, Spital Maennedorf, Zurich & Inselspital, University of Bern, Switzerland c.stoupis@spitalmaennedorf.ch

More information

Appendix K: Evidence review flow charts

Appendix K: Evidence review flow charts K.1 Dementia diagnosis K.1.1 Dementia diagnosis What are the most effective methods of primary assessment to decide whether a person with suspected dementia should be referred to a dementia service? What

More information

Mentis Cura November

Mentis Cura November Mentis Cura November 29 2012 www.mentiscura.com New Facts on Alzheimer s Death rank nr. 2-5 in western countries Fastest growing disease in: Cost Incedence Death rate People with Alzheimer s 2012 36 million

More information

As life span rises, dementia has become a growing public. Stroke Compendium. Vascular Cognitive Impairment. Circulation Research Compendium on Stroke

As life span rises, dementia has become a growing public. Stroke Compendium. Vascular Cognitive Impairment. Circulation Research Compendium on Stroke Stroke Compendium Circulation Research Compendium on Stroke Introduction to the Stroke Compendium Global Burden of Stroke Cerebral Vascular Disease and Neurovascular Injury in Ischemic Stroke Stroke Risk

More information

Cognitive impairment after acute stroke represents a

Cognitive impairment after acute stroke represents a Vascular Cognitive Impairment, Part 1 Cognitive impairment after acute stroke is likely under-appreciated despite its impact. Cognitive impairment after acute stroke represents a very real source of disability

More information

Migraine and Stroke: What s the link? Christine Lay, MD, FAHS Associate Professor (Neurology) University of Toronto Director, Headache

Migraine and Stroke: What s the link? Christine Lay, MD, FAHS Associate Professor (Neurology) University of Toronto Director, Headache Migraine and Stroke: What s the link? Christine Lay, MD, FAHS Associate Professor (Neurology) University of Toronto Director, Headache Disclosures Objectives Consultant Novartis, Aralez Research/educational

More information

Alan Barber. Professor of Clinical Neurology University of Auckland

Alan Barber. Professor of Clinical Neurology University of Auckland Alan Barber Professor of Clinical Neurology University of Auckland Presented with Non-fluent dysphasia R facial weakness Background Ischaemic heart disease Hypertension Hyperlipidemia L MCA branch

More information

How to Think like a Neurologist Review of Exam Process and Assessment Findings

How to Think like a Neurologist Review of Exam Process and Assessment Findings Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 5:10 PM - 5:40 PM How to Think like a Neurologist Review

More information

Brain Perfusion: Physiology and Role in Dementia

Brain Perfusion: Physiology and Role in Dementia Brain Perfusion: Physiology and Role in Dementia E. Rostrup, Functional Imaging Unit & Centre for Healthy Aging University of Copenhagen, Glostrup Hospital Outline Anatomy of brain vasculature Neurovascular

More information

Recommendations for the Diagnosis and Treatment of Dementia 2012

Recommendations for the Diagnosis and Treatment of Dementia 2012 Recommendations for the Diagnosis and Treatment of Dementia 2012 Based on the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (4 th CCCDTD) 2012 Gauthier S, Patterson C, Chertkow

More information

11/2/2016. Stroke. Carl F. McComas, M.D. November 3, Disclosures. None (of any kind)

11/2/2016. Stroke. Carl F. McComas, M.D. November 3, Disclosures. None (of any kind) Stroke Carl F. McComas, M.D. November 3, 2016 None (of any kind) Disclosures 1 HYPERTENSION Stroke The seat of apoplexy seems to be within the same portion of the of the brain.... Both affects, the imagination,

More information

Memory Matters: Learning Objectives: Synapses, Age, and Health. Neuronal Synapses DISCLOSURE DECLARATION. Cognition and Normal Aging

Memory Matters: Learning Objectives: Synapses, Age, and Health. Neuronal Synapses DISCLOSURE DECLARATION. Cognition and Normal Aging Standard Deviations from Mean Memory Matters: Preventing and Treating Late-Life, Cognitive Decline Daniel L. Murman, MD, MS Director, Behavioral and Geriatric Neurology Program Professor & Vice Chair,

More information

DEMENTIA, THE BRAIN AND HOW IT WORKS AND WHY YOU MATTER

DEMENTIA, THE BRAIN AND HOW IT WORKS AND WHY YOU MATTER OVERCOMING THE CHALLENGES OF MANAGING CHRONIC DISEASES IN PERSONS WITH DEMENTIA DEMENTIA, THE BRAIN AND HOW IT WORKS AND WHY YOU MATTER LEARNING OBJECTIVES Be familiar with the diagnostic criteria for

More information

Hypertensive Haemorrhagic Stroke. Dr Philip Lam Thuon Mine

Hypertensive Haemorrhagic Stroke. Dr Philip Lam Thuon Mine Hypertensive Haemorrhagic Stroke Dr Philip Lam Thuon Mine Intracerebral Haemorrhage Primary ICH Spontaneous rupture of small vessels damaged by HBP Basal ganglia, thalamus, pons and cerebellum Amyloid

More information

8/14/2018. The Evolving Concept of Alzheimer s Disease. Epochs of AD Research. Diagnostic schemes have evolved with the research

8/14/2018. The Evolving Concept of Alzheimer s Disease. Epochs of AD Research. Diagnostic schemes have evolved with the research The Evolving Concept of Alzheimer s Disease David S. Geldmacher, MD, FACP Warren Family Endowed Chair in Neurology Department of Neurology UAB School of Medicine Epochs of AD Research Epoch Years Key Event

More information

A Case of Vascular MCI

A Case of Vascular MCI A Case of Vascular MCI Charles DeCarli, MD Victor and Genevieve Orsi Chair in Alzheimer s Research Director Alzheimer s Disease Center University of California at Davis Initial Evaluation 78 y.o. Rt. Handed

More information

Introduction: what is vascular cognitive impairment?

Introduction: what is vascular cognitive impairment? Part 1 Chapter1 Vascular cognitive impairment Introduction: what is vascular cognitive impairment? José G. Merino and Vladimir Hachinski Introduction Vascular cognitive impairment (VCI) refers to a heterogeneous

More information

Cryptogenic Strokes: Evaluation and Management

Cryptogenic Strokes: Evaluation and Management Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG

More information

Neurosurgical Management of Stroke

Neurosurgical Management of Stroke Overview Hemorrhagic Stroke Ischemic Stroke Aneurysmal Subarachnoid hemorrhage Neurosurgical Management of Stroke Jesse Liu, MD Instructor, Neurological Surgery Initial management In hospital management

More information

Dementia Diagnosis Guidelines Primary Care

Dementia Diagnosis Guidelines Primary Care Dementia Diagnosis Guidelines Primary Care Dementia Diagnosis Primary Care Guidelines Introduction Dementia is a long term condition, which primarily affects people over the age of 65 (late on-set dementia)

More information

Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS

Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS 11-8-18 Outline 1. Background 2. Anatomy of patent foramen ovale (PFO) 3. Relationship between PFO and

More information

Symptoms of small vessel strokes. Small Vessel stroke. What is this? Treatment. Large Vessel stroke 6/1/2018

Symptoms of small vessel strokes. Small Vessel stroke. What is this? Treatment. Large Vessel stroke 6/1/2018 Stroke Stroke Megan Stevens MD Vascular Neurology SUDDEN Maximal at onset Lateralized weakness, lateralized numbness, vision loss (one eye or portion of field in both eyes), double vision, slurred speech,

More information