When a Loved One Has Multi-infarct Dementia

Alzheimer's Disease Education and Referral Center

Alzheimer’s disease is not the only cause of dementia. Though Alzheimer’s disease is the most common cause of dementia in older people, the second most common cause is vascular dementia, which affects the blood vessels in the brain. Multi-infarct dementia, the most common form of vascular dementia, accounts for 10-20% of all cases of progressive, or gradually worsening, dementia. It usually affects people between the ages of 60-75, and is more likely to occur in men than women.

What Are the Symptoms?

Sudden onset of any of the following symptoms may be a sign of multi-infarct dementia:

• confusion and problems with recent memory
• wandering or getting lost in familiar places
• moving with rapid, shuffling steps
• loss of bladder or bowel control
• laughing or crying inappropriately
• difficulty following instructions
• problems handling money

Multi-infarct dementia is often the result of a series of small strokes. Some of these small strokes produce no obvious symptoms and are noticed only on brain imaging studies, so they are sometimes called "silent strokes." A person may have several small strokes before noticing serious changes in memory or other signs of multi-infarct dementia.

How Is It Diagnosed?

People who show signs of dementia and who have a history of strokes should be evaluated for possible multi-infarct dementia. The doctor usually will ask the patient and the family about the person’s diet, medications, sleep patterns, personal habits, history of stroke, and other risk factors (such as high blood pressure, diabetes, high cholesterol, and heart disease). The doctor also may ask about recent illnesses or stressful events, like the death of someone close or problems at home or work, which may account for the symptoms.

To look for signs of stroke, the doctor will check for weakness or numbness in the arms and legs, difficulty with speech, or dizziness. Tests may be ordered, such as a blood pressure reading, an electroencephalogram (EEG), a test of thyroid function, blood tests, x-rays, a computerized tomography (CT) scan or  magnetic resonance imaging (MRI) scan. In addition, the doctor may send the patient to a psychologist or psychiatrist to assess reasoning, learning ability, memory, and attention span.

Sometimes multi-infarct dementia is difficult to distinguish from Alzheimer’s disease, because their symptoms can be very similar. It is possible for a person to have both diseases, making it hard for the doctor to diagnose either.

What Are the Treatment Options?

Prevention. While no treatment can reverse brain damage that has already been caused by a stroke, treatment to prevent further strokes is very important. For example, risk factors like high blood pressure, high cholesterol and diabetes should be carefully managed. Also important are good health habits such as exercising, avoiding smoking and drinking alcohol, and eating a low-fat diet.

Medication. To reduce symptoms of dementia, doctors may change or stop medications that can cause confusion, such as sedatives, antihistamines and strong painkillers. Some patients also may have to be treated for additional medical conditions that can increase confusion, such as heart failure, thyroid disorders, anemia, or infections. Drugs may be prescribed to prevent clots from forming in small blood vessels. Medications also can be prescribed to relieve restlessness or depression or to help patients sleep better. Promising new drugs are also under study.

Surgery. To improve blood flow or remove blockages in blood vessels, doctors may recommend surgical procedures, such as carotid endarterectomy, angioplasty, or stenting. Studies are under way to see how well these treatments work for patients with multi-infarct dementia.

Family Caregiving for Someone with Multi-Infarct Dementia

Family members and friends can help someone with multi-infarct dementia cope with mental and physical problems. They can encourage their loved one to maintain a daily routine and regular social and physical activities. By talking with them about events and daily experiences, family caregivers can help their loved ones use their mental abilities as much as possible. Some families find it helpful to use reminders such as lists, alarm clocks, and calendars to help the person remember important times and dates.

Help for home caregivers is available from a variety of sources, including nurses, family doctors, social workers, and physical and occupational therapists. Home health care and respite or neighborhood day care services can provide much-needed relief to caregivers. Support groups offer emotional support for family members caring for a person with dementia. A state or local health department, a local hospital, or the patient’s doctor may be able to provide telephone numbers for such services.

Source: Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging.

See previous issues of the Caring Right at Home E-News for more information for family caregivers of seniors who have dementia.

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