Mise au point sur les démences vasculaires

Cognitive Impairment in Strategic Infarct Dementia: A Report of Three Cases

Strokes involving specific areas regulating cognition and behavioral functions constitute strategic infarct vascular dementia. We present three patients with acute behavioral changes and cognitive impairment following a strategic infarct. Case 1 is of a 59-year-old male, a known patient of diabetes mellitus under treatment, who presented with acute onset of memory deficit along with difficulty in recognizing faces, and left hemispatial neglect. Case 2 is of a 62-year-old male, a smoker, who presented with acute onset of behavioral abnormalities, gait apraxia, and decreased word output. Case 3 is of a 64-year-old female, a known patient of type 2 diabetes mellitus and cerebrovascular accident with left hemiparesis, who presented with psychomotor withdrawal, depression, and cautious gait. One of the most prevalent forms of dementia in adults is vascular dementia, often caused by multiple small strokes, termed multi-infarct dementia. Strategic infarct dementia, on the other hand, is usually caused by a small, single cerebral infarct. The strategic brain regions specifically involved in post-stroke cognitive impairment requires detailed clinical examination along with radiological imaging for accurate localization. Thus the cognitive impact of ischemic strokes can be understood and predicted by clinicians with the help of maps of strategic brain regions associated with global and domain-specific cognitive functions.

[Vascular dementia]

Vascular dementias are the second leading cause of dementia after Alzheimer disease (AD). In recent years, the concept of "cognitive disorders of a vascular origin" has replaced that of vascular dementias. The new term combines vascular dementia in the strict sense of the term with milder cognitive disorders not including dementia but of vascular origins. Their diagnosis nonetheless remains difficult because of the diversity of vascular lesions that cause cognitive disorders and their frequent association with AD. The neuropsychological profile is frontal subcortical, with more marked damage to executive functions, and the possibility of damage to more cortical functions depending on the site of the vascular lesions. Beyond preventive treatments, there is no validated treatment and it remains essential to screen for risk factors to diminish the risk of onset of these cognitive disorders of vascular origin.