Elsevier

The Lancet

Volume 304, Issue 7874, 27 July 1974, Pages 207-209
The Lancet

Mental Health
MULTI-INFARCT DEMENTIA: A CAUSE OF MENTAL DETERIORATION IN THE ELDERLY

https://doi.org/10.1016/S0140-6736(74)91496-2Get rights and content

Abstract

The typical, insidious, slowly progressive dementia of old age (primary senile dementia) is not due to atherosclerosis. Most cases show Alzheimer-like degeneration of the brain at necropsy. There is no relationship between these parenchymal degenerative changes and arterial disease; hence the term "cerebral atherosclerosis" as applied to mental deterioration in the elderly is misleading and inaccurate. When vascular disease is responsible for dementia it is through the occurrence of multiple small or large cerebral infarcts (multi-infarct dementia). The investigation and precise diagnosis of all cases of dementia allow a more accurate prognosis and more rational management of the significant number of cases in which dementia is due to treatable conditions.

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      In one study, the presence of one or more macroscopic infarctions independently increased the odds of an Alzheimer's type (amnestic) dementia and impaired global cognitive functions and five cognitive domains [10]. Many community-based studies suggest that the larger volumes [11,112] and a higher number of territorial or small subcortical macroscopic infarcts [11,34,113-115] are associated with increased likelihood of dementia and worse cognitive performances. However, there is no clear threshold for determining what volume or number of infarcts require for the development of VCI or dementia.

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