Vaskulär demens
Senast uppdaterad: Senast reviderad:
Sakkunnig:Anna Nager
Definition:
Allmänna kriterier för demens ska vara uppfyllda. Det finns olika uppsättningar av diagnoskriterier. De flesta kräver bilddiagnostisk bekräftelse på cerebrovaskulär sjukdom och tidsmässigt samband mellan stroke och debut av kognitiv svikt.
Förekomst:
I Sverige beräknas cirka 130 000–150 000 personer ha en demenssjukdom. Upp till 50 % av dessa kan utgöras av blanddemens och vaskulär demens.
Symtom
Kognitiv svikt där nedsättningen av de högre kognitiva funktionerna är ojämn med en del funktioner drabbade och andra relativt väl bevarade. Således kan minnet vara ganska påtagligt påverkat medan tänkande, resonerande och informationsbearbetning kanske bara visar en mindre nedgång.
Kliniska fynd:
Kognitiv svikt som visas med kliniska bedömningsinstrument; MMSE i kombination med klocktest, alternativt RUDAS (vid annat modersmål/kulturell bakgrund eller låg utbildning). Eventuellt fokalneurologiska fynd.
Diagnostik:
Bedömning av kognitiv svikt med kliniska bedömningsinstrument (se ovan). Anhörigintervju. Strukturerad utredning av funktions- och aktivitetsförmåga. CT hjärna och blodprover för att utesluta reversibla orsaker till kognitiv svikt. Vid eventuell utvidgad utredning görs neuropsykologiska test och ibland lumbalpunktion och/eller ytterligare bilddiagnostiska undersökningar av hjärnan.
Behandling:
Huvudsaklig behandling är organiserade stödåtgärder, personcentrerad omvårdnad och multiprofessionellt omhändertagande. Läkemedelsbehandling med kolinesterashämmare eller memantin kan bli aktuellt vid samtidig Alzheimers sjukdom (blanddemens). Behandling av kardiovaskulära riskfaktorer. Antikoagulantia vid eventuellt förmaksflimmer.
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- Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet