Multi-infarct dementia

MID

• Awareness of mental deterioration, which may cause frustration, depression, anxiety, stress, and tension
• Dementia (slowly progressive memory loss) with lack of awareness of mental deterioration and:
  • Difficulties with attention, concentration, judgment, and behavior
  • Confusion, disorientation
  • Hallucinations (hearing sounds or seeing things which are not there) and delusions
  • Uncoordinated or weak movements
  • Aphasia (impaired language ability)
  • Personality changes
  • Progressive decreases in multiple brain functions
• Withdrawal from social interaction
  • Inability to interact in social or personal situations
  • Inability to maintain employment
• Decreased ability to function independently
• Decreased interest in daily living activities
• Lack of spontaneity
• Localized numbness or tingling
• Swallowing difficulty
• Sudden involuntary laughing or crying (emotional instability)
• Urinary incontinence

The disorder is diagnosed based on history, symptoms, signs, and tests, and by ruling out other causes of dementia, including dementia due to metabolic causes. History may include a past stroke or hypertension. History of the dementia often shows stepwise progression of the condition -- periods of abrupt decline alternating with stable periods of minimal decline. Other characteristics that suggest multi-infarct dementia rather than Alzheimer's disease include: abrupt onset, physical complaints, emotional changes, and localized neurologic signs (modified Hachinski ischemia scale).

A neurologic examination shows variable deficits depending on the extent and location of damage. There may be multiple, localized areas with specific loss of function. Weakness or loss of function may occur on one side or only in one area. Abnormal reflexes may be present. There may be signs of cerebellar dysfunction such as loss of coordination.

A head CT scan, and even more likely, MRI of the brain may show changes that suggest multi-infarct dementia because areas of dead tissue may be visible.