NPsy Lec5 CH13

Vascular cognitive impairment

Prevalence of strokes rising or decreasing?

Rising (due to older age expectancy)

How old are people usually when suffering a stroke?

What % between 18 and 50?

Generally 65 years old

15%

Mean age difference cerebral infarct and haemorrhage?

Lower in haemorrhage

Ratio haemorrhage and infarcts?

80% infarct, 60% haemorrhage

What is a cerebral infarct?

blood clot (embolism) closes an artery in the brain or the bloodstream becomes obstructed by local stenosis of a blood vessel

• → Reduced oxygen supply

What is done in acute phase of Infarct?

Brain imaging

• CT (no contrast) to rule out haemorrhage and other things

• CT (contrast) to determine location

intravenous thrombolytic therapy:

• Blood-thinners to dissolve clot

Endovascular treatment:

• Blood cloth removed mechanically

Risk factors ischemic stroke?

Conditions

• Hypertension, hypercholesterolaemia, type 2 diabetes, obesity, arteriosclerosis, and atrial fibrillation

Behavioural

• smoking, an inactive life-style and unhealthy eating habits

What is a Transient Ischaemic Attack (TIA)?

a temporary reduction in blood flow to a small part of the brain occurs

• Neurological symptoms disappear within 24 hours!

Warning sign for real stroke!

What is a lacunar infarct?

An infarct in the small penetrating arteries that supply the brain's deeper structures, after which a small cavity ('lacuna') forms.

• Often no clear clinical manifestation

  • may lead to motor impairments, loss of sensation or dysarthria (when in certain area’s)

Risk factor for vascular dementia

What is a cerebral haemorrhage?

SAH?

blood vessel in the brain ruptures → bleeding into the brain tissue (intracerebral)

• When bleeding is in subarachnoid space = SAH

What causes brain damages during cerebral haemorrhage?

• Increased intracranial pressure,

• mass effect of the haemorrhage

• Oedema (fluid in the brain tissue surrounding the haemorrhage)

Details of SAH: Mortality, cause?

• 50% of people die before reaching the hospital

• 85% is due to burst aneurysm, called aneurysmal SAH (aSAH)

  • Lasting 15% is unknown cause; angiography-negative SAH (anSAH)

Treatment options if aneurysm is present in SAH?

Coiling: Aneurysm closed with platinum coils in the blood vessel.

Clipping: Aneurism closed with metal clip

Major risk factor for cerebral haemorrhage?

Hypertension

What % of people have cognitive impairment after stroke? (short and long term)

50% first three weeks

40-75% long term

What determines cognitive disorders after haemorrhage and infarct?

• Haemorrhage: Severity and size, not location.

• Infarct: Location

How does the risk of vascular dementia increase with each vascular risk factor?

What are the risk factors?

type 2 diabetes, hypertension, obesity and high cholesterol

• x1,5 for each

What % of dementia can be attributed to hypertension?

30%

Why is there an association between vascular risk factors and dementia

Consideration?

Small vessels get damaged → cerebral small vessel disease (CSVD)

• Damage to small vessels is part of normal aging

  • Extend and location determine disease development.

Cognitive defects after lacunar infarct? %?

33%, characterised by a decrease in mental capacity

• Domain depends on location

Cognitive defects after TIA?

namely deficits in information processing speed, attention, working memory, and executive functions.

Cognitive impairment after Major stroke? %?

66%

• Domain depends on location and severity

• Diaschisis can happen

Deficits in attention and information processing speed most often.

• Especially when under time pressure.

Anterograde amnesia also common in acute phase

• (Learning of new information)

Executive function also often.

What is Diaschisis?

an infarct in one brain area can cause damage and therefore loss of function in another area by (temporarily) disrupting connections

MCA Infarct: Where? | %? | Consequences?

• Frontal, temporal and parietal areas of the brain / deep brain structures

• 80% of infarcts.

• Memory impairments, apraxia, aphasia (when left). Neglect (other right side infarct)

What is Apraxia?

Inability to perform meaningful tasks or voluntary movements on command.

PCA Infarct: Where? | %? | Consequences?

• Occipital and temporal lobes

• 15% of infarcts

• Disturbances in perception:

  • Hemianopsia = Loss of half the visual field

  • Visual agnosia = inability to recognise objects

  • Prosopagnosia = Inability to recognise fases (including own)

ACA Infarct: Where? | %? | Consequences?

• Dorsal and medial parts of the frontal and parietal lobes

• 5% of infarcts

• Executive functions and social cognition

• Changes in behaviour and emotion

  • → decreased self-criticism, lability, apathy

Psychological consequences of stroke?

• Depression: ⁓ 30%

• Anxiety: ⁓ 30%

• Fatigue: ⁓ 50%

• Sensory hypersensitivity: ? %

Either due to direct or secondary consequences of stroke

Vascular dementia / vascular cognitive impairment.

Defining symptoms? | Disease course?

1. Cognitive impairment in at least one domain

2. Significant interference with activities of daily living, which cannot be explained by motor or sensory problems

• Course does not have to be progressive like dementia.