Multi-Infarct Dementia
Multimedia
Definition
Multi-infarct dementia (MID) is a form of dementia caused by a series of small strokes.
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
Alternative Names
MID; Dementia - vascular; Dementia - poststroke
Causes, incidence, and risk factors
Multi-infarct dementia (MID) is the second most common cause of dementia (after Alzheimer's disease) in people over age 65. MID affects men more often than women. The disorder usually affects people between ages 55 and 75.
MID is caused by a series of small strokes.
A stroke is an interruption in or blockage of the blood supply to any part of the brain. A stroke is sometimes called an infarct. "Multi-infarct" means that many areas in the brain have been injured due to a lack of blood.
If blood flow is stopped for longer than a few seconds, the brain cannot get oxygen. Brain cells can die, causing permanent damage.
When these strokes affect a small area, there may be no symptoms of a stroke. These are often called silent strokes. Over time, as more areas of the brain are damaged, the symptoms of MID begin to appear.
Not all strokes need to be "silent." Larger strokes that have clear affects on strength, sensation, or other brain and nervous system (neurologic) function also can lead to MID.
Risk factors for MID include a history of:
See also: Stroke risk factors and prevention
Symptoms of dementia in any one person may be caused by either Alzheimer's disease or MID. The symptoms for each problem are very similar, and MID may be a risk factor for Alzheimer's disease.
References
Brewer JB, Gabrieli JDE, Preston AR, Vaidya CJ, Rosen AC. Memory. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 5.
DeKosky ST, Kaufer Di, Hamilton RL, Wolk DA, Lopez OL. The dementias. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 70.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
MID; Dementia - vascular; Dementia - poststroke
Symptoms
Symptoms may develop gradually or may progress after each small stroke.
The symptoms of the disorder may begin suddenly after each stroke. Some peole with MID may appear to improve for short periods of time, then decline after having more silent strokes.
The early symptoms of dementia can include:
Difficulty performing tasks that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
Getting lost on familiar routes
Language problems, such as trouble finding the name of familiar objects
Losing interest in things you previously enjoyed, flat mood
Misplacing items
Personality changes and loss of social skills
As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include:
Change in sleep patterns, often waking up at night
Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving
Forgetting details about current events
Forgetting events in your own life history, losing awareness of who you are
Having delusions, depression, or agitation
Having hallucinations, arguments, striking out, or violent behavior
Having more difficulty reading or writing
Having poor judgment and loss of ability to recognize danger
Using the wrong word, not pronouncing words correctly, or speaking in confusing sentences
Withdrawing from social contact
Any of the neurologic problems that occur with a stroke may also be present.
Signs and tests
Tests may be ordered to help determine whether other medical problems could be causing dementia or making it worse, such as:
Neuropsychological testing is often helpful to find out what parts of thinking have been affected, and to guide other tests.
Tests that can show evidence of previous strokes in the brain may include:
Head CT scan
MRI of the brain
References
Brewer JB, Gabrieli JDE, Preston AR, Vaidya CJ, Rosen AC. Memory. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 5.
DeKosky ST, Kaufer Di, Hamilton RL, Wolk DA, Lopez OL. The dementias. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 70.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
MID; Dementia - vascular; Dementia - poststroke
Treatment
There is no treatment to turn back damage to the brain caused by small strokes.
An important goal is to control symptoms and correct risk factors such as high blood pressure, smoking, and high cholesterol to prevent future strokes.
Avoid fatty foods. Follow a healthy, low-fat diet.
Do not drink more than 1 - 2 alcoholic drinks a day.
Keep blood pressure less than 130/80 mm/Hg (ask your doctor what your blood pressure reading should be).
Keep LDL "bad" cholesterol lower than 70 mg/dL.
Quit smoking.
Your doctor may suggest taking aspirin or another drug called clopidogrel (Plavix) to help prevent blood clots from forming in the arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without talking to your doctor first.
The goals of helping someone with dementia in the home environment are to:
Manage behavior problems, confusion, sleep problems, and agitation
Modify the home environment
Support family members and other caregivers
See dementia - homecare for information about taking care of a loved one with dementia.
Medications may be needed to control aggressive, agitated, or dangerous behaviors. The health care provider will usually prescribe these medicines in very low doses and adjust the dose as needed. Such medications may include:
Antipsychotics (olanzapine, quetiapine)
Serotonin-affecting drugs (trazodone, buspirone, or fluoxetine)
Medications used to treat Alzheimer's disease have not been shown to work for MID.
Hearing aids, glasses, or cataract surgery may be needed if the person has sensory problems.
Expectations (prognosis)
Some improvement may occur for short periods of time, but the disorder will generally get worse over time.
Complications
Complications include the following:
- Future strokes
- Heart disease
- Loss of ability to function or care for self
- Loss of ability to interact
- Pneumonia, urinary tract infections, skin infections
- Pressure sores
Calling your health care provider
Call your health care provider if symptoms of vascular dementia occur. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status. This is an emergency symptom of stroke.
References
Brewer JB, Gabrieli JDE, Preston AR, Vaidya CJ, Rosen AC. Memory. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 5.
DeKosky ST, Kaufer Di, Hamilton RL, Wolk DA, Lopez OL. The dementias. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 70.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
MID; Dementia - vascular; Dementia - poststroke
Prevention
Control conditions that increase the risk of hardening of the arteries (atherosclerosis) by:
See also: Stroke risk factors and prevention
References
Brewer JB, Gabrieli JDE, Preston AR, Vaidya CJ, Rosen AC. Memory. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 5.
DeKosky ST, Kaufer Di, Hamilton RL, Wolk DA, Lopez OL. The dementias. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 70.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 2/16/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.