Vaskulær demens
Sist revidert:
Sist revidert av:Peter D. Jost
Definisjon:
Vaskulær demens er et demenssyndrom forårsaket av cerebrovaskulær eller kardiovaskulær sykdom som medfører hjerneskade eller -funksjonsforstyrrelse. Noe uenighet om kriteriene for diagnosen
Forekomst:
Etter Alzheimers demens er vaskulær demens nest hyppigste demensform i Norge med ca. 15-20 % av demenstilfellene. Debuterer vanligvis sent i livet. Hyppig komorbiditet med Alzheimers sykdom.
Symptomer:
Tilstanden kjennetegnes ved psykomotorisk svekkelse, oppmerksomhetsproblemer, tap av eksekutive funksjoner og personlighetsendringer
Funn:
Kliniske demenskriteriene er oppfylt. Tegn på cerebrovaskulær lidelse og tidsmessig sammenheng med den kognitive svikten. Ujevn fordeling av den kognitive svikten og tegn til fokal hjernelidelse
Diagnostikk:
Utredning av vaskulær årsak til demenssyndromet er forutsetning for vurdering av sekundærprevensjon. MR eller CT cerebrum. EKG og blodprøver. Ev. tilleggsundersøkelser for å avdekke sekundære demensformer. Vurdering av blandingstilstand med Alzheimers demens
Behandling:
Kontroll og ved behov behandling av kardiovaskulære risikofaktorer og -sykdommer (sekundærprofylakse). Organisering av støttetiltak. Ved blandet Alzheimers- og vaskulær demens gjelder samme terapianbefalinger som ved Alzheimers demens
- Helsedirektoratet: Nasjonal faglig retningslinje om demens. Først publisert: 16. august 2017. Sist faglig oppdatert: 03. januar 2020. Helsedirektoratet.no
- Helsedirektoratet: Nasjonal faglig retningslinje om demens. Først publisert: 16. august 2017. Sist faglig oppdatert: 03. januar 2020. helsedirektoratet.no
- Smith EE. Clinical presentations and epidemiology of vascular dementia. Clin Sci (Lond) 2017; 131(11): 1059-1068. pmid:28515342 PubMed
- Direktoratet for e-helse. ICD-10. Sist revidert 07.02.2020. Kode F01 Vaskulær demens. finnkode.ehelse.no
- Wiederkehr S, Simard M, Fortin C, van Reekum R. Validity of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part II. J Neuropsychiatry Clin Neurosci 2008; 20(2): 162-77. pmid:18451187 PubMed
- Chui H. Vascular dementia, a new beginning: shifting focus from clinical phenotype to ischemic brain injury. Neurol Clin 2000; 18(4): 951. pmid:11072269 PubMed
- Akiguchi I, Budka H, Shirakashi Y, et al. . MRI features of Binswanger's disease predict prognosis and associated pathology. Ann Clin Transl Neurol 2014 Oct; 1(10): 813-21. pmid:25493272 PubMed
- Jellinger KA, Attems J, et al. Neuropathological evaluation of mixed dementia. J Neurol Sci 2007 Jun; 15;257(1-2): 80-7. pmid:17324442 PubMed
- Tatemichi TK, Desmond DW, Paik M, et al. Clinical determinants of dementia related to stroke. Ann Neurol. 1993;33:568-575. PMID 8498836
- Whitmer RA, Gunderson EP, Quesenberry CP, et al. Body mass index in midlife and risk of Alzheimer's disease and vascular dementia. Curr Alzheimer Res. 2007;4:103-109. PMID 17430231
- Llewellyn DJ, Lang IA, Langa KM, et al. Exposure to second hand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement. BMJ 2009; 338: b462. BMJ (DOI)
- Godefroy O, GRECOG-VASC study group, Leclercq C, et al. Neuropsychological assessment and cerebral vascular disease: the new standards. Rev Neurol (Paris) 2013; 169(10): 779-85. pmid:23999023 PubMed
- Sachdev P, Kalaria R, O'Brien J, et al. Diagnostic Criteria for Vascular Cognitive Disorders: A VASCOG Statement. Alzheimer Dis Assoc Disord 2014; 28(3): 206-18. pmid:24632990 PubMed
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- 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 Sep; 42(9): 2672-713. pmid:21778438 PubMed
- Bowler JV. Modern concept of vascular cognitive impairment. Br Med Bull 2007; 83: 291-305. pmid:17675645 PubMed
- Hachinski VC, Iliff LD, Zilkha E et al. (1975) Cerebral blood flow in dementia. Arch Neurol, 32, 632–637. PMID 1164215
- Moroney JT, Bagiella E, Desmond DW, et al. Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias. Neurology 1997; 49(4): 1096. pmid:9339696 PubMed
- Martínez-Pérez R, Paredes I, Munarriz PM, et al. Chronic traumatic encephalopathy: The unknown disease. Neurologia 2017 Apr; 32(3): 185-191. pmid:25534950 PubMed
- O’Sullivan M, Morris RG, Markus HS (2005) Brief cognitive assessment for patients with cerebral small vessel disease. J Neurol Neurosurg Psychiatry, 76, 1140–1145. PMID 16024894
- Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ (2005) Subcortical vascular dementia: Integrating neuropsychological and neuroradiologic data. Neurology, 65, 376–382. PMID 16087901
- Fürst Medisinsk Laboratorium. Analyse og Klinikk: Borrelia burgdorferi IgM/IgG. Status 12.02.2020 www.furst.no
- Tonby K, Berilde D, Lind A. Lyme borreliose. Håndbok infeksjonsmedisin, v. 1.2. Publisert 17.07.2019. www.prosedyrer.no
- Passmore P. Vascular dementia. Last reviewed January 2020. BMJ Best Practice. bestpractice.bmj.com
- Mortimer AM, Likeman M, Lewis TT. Neuroimaging in dementia: a practical guide. Pract Neurol. 2013; 13: 92-103. PMID: 23468560 PubMed
- Ahmed RM, Paterson RW, Warren JD, et al.: Biomarkers in dementia: clinical utility and new directions. J Neurol Neurosurg Psychiatry. 2014; Dec;85(12):: 1426-34. pmid:25261571 PubMed
- Ritchie C, Smailagic N, Noel-Storr AH, et al.. CSF tau and the CSF tau/ABeta ratio for the diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2017; Mar 22;3: CD010803. pmid:28328043 PubMed
- O'Brien JT, Thomas A. Vascular dementia. Lancet. 2015 ;386:1698-706. doi: 10.1016/S0140- 6736(15)00463-8.
- Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J 2017 . pmid:29077849 PubMed
- Roman GC, Salloway S, Black SE, et al. Randomized, placebo-controlled, clinical trial of donezepil in vascular dementia: differential effects by hippocampal size. Stroke 2010; 41: 1213-21. Stroke
- McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003154. DOI: 10.1002/14651858.CD003154.pub5. DOI
- Ruths S, Straand J. Antipsykotiske midler mot uro ved demens - medisinsk behandling eller kjemisk atferdsregulering?. Tidsskr Nor Lægeforen 2005; 125: 1672-5. PubMed
- Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294: 1934-43. Journal of the American Medical Association
- Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer`s disease. N Engl J Med. 2006; 355: 1525-38. PubMed
- Douglas IJ, Smeeth L. Exposure to antipsychotics and risk of stroke: self controlled case series study. BMJ 2008; 337: a1227. BMJ (DOI)
- Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360: 225-35. New England Journal of Medicine
- Graff MJ, Vernooij-Dassen MJ, Thijssen M et al. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ 2006; 333: 1196 201.
- Guure CB, Ibrahim NA, Adam MB, et al. Impact of Physical Activity on Cognitive Decline, Dementia, and Its Subtypes: Meta-Analysis of Prospective Studies. Biomed Res Int 2017; 9016924: Epub Feb 7. pmid:28271072 PubMed
- Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry 2012; 169: 946-53. PMID 22952073
- Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD005562. DOI: 10.1002/14651858.CD005562.pub2. DOI
- Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. BJPsych 2014. doi:10.1192/bjp.bp.113.141119 DOI
- Chang YS, Chu H, Yang CY, et al. The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials. J Clin Nurs 2015. doi:10.1111/jocn.12976 DOI
- Forrester LT, Maayan N, Orrell M, et al. Aromatherapy for dementia. Cochrane Database of Syst Rev 2014; 2: CD003150. doi:10.1002/14651858.CD003150.pub2 DOI
- Forbes D, Blake CM, Thiessen EJ, et al. Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Cochrane Database Syst Rev. 2014;2:CD003946. doi: 10.1002/14651858.CD003946.pub4 DOI
- National institutes of health. NIH State-of-the-Science Conference: Preventing Alzheimer's disease and cognitive decline. April 2010 consensus.nih.gov
- Baumgart M, Snyder HM, Carrillo MC, et al. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement 2015;11:718-26. pmid:26045020 PubMed
- Sydenham E, Dangour AD, Lim WS. Omega 3 fatty acid for the prevention of cognitive decline and dementia. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD005379. DOI: 10.1002/14651858.CD005379.pub3 DOI
- Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003; 348: 2508-16. New England Journal of Medicine
- Kua EH, Ho E, Tan HH, Tsoi C, Thng C, Mahendran R. The natural history of dementia. Psychogeriatrics. 2014;14(3):196-201. PMID: 25323961 PubMed
- Sibolt G, Curtze S, Melkas S, et al. Poststroke dementia is associated with recurrent ischaemic stroke. J Neurol Neurosurg Psychiatry 2013 Feb 16. pmid:23418214 PubMed
- Peter D. Jost, spesialist i allmennmedisin, redaktør NEL
Tidligere fagmedarbeidere
- Bjørnar Grenne, PhD, konst. overlege, Klinikk for hjertemedisin, St. Olavs Hospital, Trondheim
- Ivar B. Mediås, spesialist i allmennmedisin, leder for NSAM referansegruppe i geriatri, Sørum legesenter, Sørumsand