What Is Multi-Infarct Dementia?

Multi-infarct dementia (MID) is loss of brain function caused by a series of small strokes. A
stroke (also called a brain infarct) occurs when the blood flow to any part of the brain is
interrupted or blocked. Blood carries oxygen to the brain, and without oxygen, brain tissue
quickly dies.
The location of the stroke damage determines the type of symptoms that occur. Stroke increases
the risk of dementia as much as four to twelve times. The mechanism of this is not fully
understood.
MID can cause the loss of memory and cognitive function and can initiate psychological
problems. Treatment focuses on controlling the symptoms and reducing the risk for future
strokes.
Signs and symptoms of vascular dementia
Vascular dementia affects different people in different ways and the speed of the progression
varies from person to person. Some symptoms may be similar to those of other types of dementia
and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or
shopping.
Behavioral and physical symptoms can come on dramatically or very gradually, although it
appears that a prolonged period of TIAsthe mini-strokes discussed aboveleads to a gradual
decline in memory, whereas a bigger stroke can produce profound symptoms immediately.
Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise
fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only
to give way to further decline.

Common Signs and Symptoms of Vascular Dementia

Mental and Emotional Signs and Symptoms
Slowed thinking

Hallucinations and delusions

Memory problems; general

forgetfulness

Confusion, which may get worse at night

Personality changes and loss of social skills

Unusual mood changes (e.g.

depression, irritability)
Physical Signs and Symptoms
Dizziness

Moving with rapid, shuffling steps

Leg or arm weakness

Balance problems

Tremors

Loss of bladder or bowel control

Behavioral Signs and Symptoms

Slurred speech
Language problems, such as difficulty
finding the right words for things
Getting lost in familiar surroundings
Laughing or crying inappropriately

Difficulty planning, organizing, or following

instructions
Difficulty doing things that used to come easily (e.g.
handling money, paying bills, or playing a favorite card
game)
Reduced ability to function in daily life

Causes of Vascular Multi-infarct Dementia

Vascular dementia results from conditions that damage your brain's blood vessels, reducing their
ability to supply your brain with the amounts of nutrition and oxygen it needs to perform thought
processes effectively.
Common conditions that may lead to vascular dementia include:

Stroke (infarction) blocking a brain artery- Strokes that block a brain artery usually cause
a range of symptoms that may include vascular dementia. But some strokes don't cause
any noticeable symptoms. These "silent brain infarctions" still increase dementia risk.
With both silent and apparent strokes, the risk of vascular dementia increases with the
number of infarctions that occur over time. One type of vascular dementia involving
many strokes is called multi-infarct dementia.

Narrowed or chronically damaged brain blood vessels- Conditions that narrow or inflict
long-term damage on your brain blood vessels also can lead to vascular dementia. These
conditions include the wear and tear associated with aging; high blood pressure;
hardening of the arteries; diabetes; lupus erythematosus; brain hemorrhage; and temporal
arteritis.

Multi-infarct dementia: The most common type of vascular dementia

Multi-infarct dementia (MID) is caused by a series of small strokes (sometimes called "ministrokes" or "silent strokes") that often go unnoticed. These mini-strokes, also referred to as
transient ischemic attacks (TIAs), result in only temporary, partial blockages of blood supply and
brief impairments in consciousness or sight. Over time, however, as more areas of the brain
become damaged, the symptoms of vascular dementia begin to appear. MID usually affects
people between the ages of 60 to 75, and is more common in men than women.

Risk factors of Vascular Multi- infarct Dementia

The risk factors for vascular dementia are similar to those for stroke or heart disease, and
include:

Increasing age. Vascular dementia is most common in those over the age of 65. Risk
increases the older you get.
High blood pressure (hypertension). Doctors estimate that about 50 percent of cases of
vascular dementia result from hypertension. High blood pressure places extra stress on
blood flow throughout the body, including the brain.
A history of heart attack or strokes may increase the risk of developing blood flow
problems in the brain.
High cholesterol. High LDL or "bad" cholesterol levels are linked with an increased risk
of vascular dementia.
Atherosclerosis occurs when deposits of cholesterol or plaques build up in the arteries
and narrow blood vessels, reducing blood flow to the brain.
Diabetes. High glucose levels can damage blood vessels throughout the body, including
the brain.
Smoking directly damages the blood vessels that feed blood to the brain.

Atrial fibrillation. Abnormal heart rhythm can reduce blood flow to the brain and
increase the risk of blood clots forming.

Medical Management

Doctors diagnose MID with radiological imaging and biochemical and cognitive tests. Each case
of MID is different. Memory may suffer serious impairment in one case and only mild
impairment in another. To gain an understanding of the damage done, doctors will use multiple
tests.
Imaging Tests
Radiological imaging tests can include:

brain computed tomography (CT): a detailed, cross-sectional X-ray of the brain

magnetic resonance imaging (MRI) of the brain: a detailed image of the brain obtained
using a magnetic field and pulses of radio wave energy

electroencephalogram (EEG): measures the electrical activity of the brain

transcranial Doppler (TCD): measures the velocity of blood flow through the brains
blood vessels

Biochemical Tests
Biochemical tests look for changes in:

superoxidase dismutatse (SOD): an enzyme that repairs cells and reduces damage from
free radicals

malondialdehyde (MDA): a marker for oxidative stress

homocysteine (HCY): an amino acid produced as a by-product of eating meat. High

levels may be associated with increased risk for atherosclerosis, heart attack, blood clots,
Alzheimers disease, and stroke.

testosterone (T): a steroid hormone

17 beta-estradiol (E2): an estrogenic hormone

Mental Function Tests

Tests of mental ability include:

Barthel Index: assesses functional status

Fluid Object Memory Evaluation: looks at short-term memory

clock test: assesses your ability to recognize and set time

cognitive (SS-IQCODE) test: the Informant Questionnaire on Cognitive Decline in the

Elderly, which uses a close relative to obtain information on a patients cognitive status

Medicine used in treating Alzheimers disease:

How Is MID Treated?
Treatment is tailored to the individual. Both medicinal and nonpharmacological treatments
are used.
Medication
There are two main types of medication used for MID:
Cholinesterase inhibitors treat memory loss, confusion, and problems thinking and
reasoning. These include

donepezil

rivastigmine

galantamine
Noncholinesterase inhibiting medications include:

memantine

nimodipine

hydrergine

folic acid

CDP-choline
Other medication options include:

selective serotonin reuptake inhibitors (SSRIs): antidepressants that may also help
neurons grow and reestablish connections in the brain

calcium channel blockers for short-term cognitive function

ACE inhibitor anti-hypertensive therapy to lower blood pressure

Alternative Therapies
Herbal supplements have grown in popularity as treatments for MID. However, not
enough studies have been done to prove a significant amount of success through their
use. Examples of herbal supplements that are currently being studies for use in treating
MID include

Artemisia absinthium (wormwood): used to improve cognitive function

Melissa officinalis (lemon balm): used to restore memory

Bacopa monnieri (water hyssop): used to improve memory and intellectual function
Be sure to discuss these supplements with your doctor before taking them, as they can
interfere with other medications.
Nonpharmacological options for treatment include:

regular exercise to build muscle strength

cognitive training to regain mental function

rehabilitation for mobility issues

What Is the Long-Term Outlook for MID?

MID has no cure. While medications and cognitive training may help preserve mental
function, the patient will continue to decline. The speed and advance of dementia varies.
Some patients die soon after an MID diagnosis, and others survive for years.

Prevention of Vascular Multi-infarct Dementia

How Can MID Be Prevented?
There is no evidence of any completely effective measure to avoid MID. As with many
conditions, the best prevention is to take care of your body:

visit the doctor regularly

eat a balanced diet

begin or maintain a regular exercise program