Does vascular dementia always follow a stroke?
My wife had a stroke diagnoised as hemiparasis. After treatment she regained her waliking. But after six months she got vascular dementia.I would like to know if dementia invariably follows stroke? If this dementia is curable?
Expert Answer
To answer your first question, no, dementia does not invariably follow a stroke. However, dementia is more commonly seen in stroke patients, for a variety of reasons. First, the damage done by the stroke causes scarring of the brain tissue, thereby reducing the total amount of viable brain available for cognition. Second, often people with symptomatic strokes will also have evidence on MRI scanning of multiple much smaller strokes that they have suffered over the years, leading to a weakened brain.
Other issues to consider is whether or not she might have a depression, which can cause a dementia, and is very common after a stroke. You can assess this fairly easily by looking on the internet for a "geriatric depression scale". This is a 15 point scale that is very helpful for diagnosing a hidden depression, which would be treated quite differently than a dementia. I also typically screen for thyroid and vitamin B12 levels to be sure that there is no medical reason for the cognitive slowing.
Assuming the above tests are normal, and that she has vascular dementia, often a cholinesterase inhibitor, such as donepezil, is effective in helping cognition. I have had good success with those medications, and would recommend using them in her situation.
Finally, it is critically important to control her stroke risk factors, most notably high blood pressure, as further small strokes can lead to a deterioration of her situation.
Good luck!