Written by admin on 2009-04-02T04:03:30+0000">April 2, 2009 – 4:03 am
One of the most important features that helps to differentiate MID from other types of dementia is the stepwise nature of its progression. A person with multiple infarct dementia will function at a reasonably constant level between strokes, deteriorating suddenly each time there is another small stroke causing death of brain tissue. Very often there will be some minimal improvement in the few days, or fortnight even, after this has happened, but in general this isn’t sufficient to allow the subject to regain his or her former level of mental activity. Unlike other dementias therefore whose progression involves a slow and steady downward decline, MID follows a jerky course with fluctuations around the time of each additional episode.
Another feature of MID that is helpful in distinguishing it from other causes is the order in which symptoms develop. Most of the other dementias have a fairly standard course despite the variation between individuals. Alzheimer’s disease for instance usually starts with memory loss, progressing slowly to language difficulty, failure to recognize objects and people, and difficulty with everyday activities. The pattern of loss of function with multiple infarct dementia depends upon the parts of the brain that are affected by strokes. The pattern of deterioration can therefore be patchy, picking out certain aspects of intellectual function and leaving others preserved. An example of this occurred in an elderly woman who had severe memory loss and was unable to look after herself, but whose ability to use language was well-preserved. If she had had another condition like Alzheimer’s disease, her ability to use language would also have been severely affected by this stage in the disease.
A person with multiple infarct dementia also tends to retain insight into his or her condition until a much later stage in the disorder than occurs in some of the other conditions causing dementia. This often means that depression can be a major problem for much longer than it is in, say, Alzheimer’s disease. If this is the case, treatment with an anti-depressant medicine will often be helpful.
Many people suffering from MID will have had symptoms indicating that they have diseases of the cardiovascular system ranging from hypertension to an abnormal pulse rate. There is one particular irregularity of the pulse called atrial fibrillation. This is very likely to lead to small blood clots being thrown into the general circulation with a high chance that they will travel in the blood vessels up to the brain, resulting in strokes. If this irregularity is also associated with an abnormality of one of the heart valves, there is a serious possibility of strokes and it is essential that this condition is treated with blood-thinning medicines, unless there is a contrary indication to this, for example a stomach ulcer, in which case blood-thinning medicines would not be safe unless the ulcer was completely healed; even then it is risky in case of a recurrence. High blood pressure may also be treated, as can other conditions that may cause arteriosclerosis, for example diabetes. It is for this reason that anyone who is considered to have multiple infarct dementia should be carefully screened by a doctor for underlying causes that might be treatable. Although subsequent treatment is unlikely to lead to patients regaining their former mental powers, it may lead to some improvement or arrest further progress of the disease.
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