Health Encyclopedia

Multi-infarct dementia

Definition

Multi-infarct dementia (MID) is a form of vascular dementia -- damage in mental function caused by strokes.

Alternative Names

MID

Causes, incidence, and risk factors

Multi-infarct dementia (MID) is the most common form of vascular dementia, and the second most common cause of dementia (after Alzheimer's disease) in people over age 65.

An estimated 10 - 20% of all dementias are caused by strokes. MID affects men more often than women. The disorder usually affects people between ages 55 and 75.

"Multi-infarct" means that many areas in the brain have been injured due to a lack of blood.

Risk factors for MID include a history of:

Hardening of the arteries (atherosclerosis)
High blood pressure (hypertension)
Smoking
Stroke

Some research suggests that MID may cause Alzheimer's disease or make it get worse faster. MID may be misdiagnosed as Alzheimer's, or may be found along with Alzheimer's.

Symptoms

Confusion at night
Decreased ability to function independently
Decreased interest in daily living activities
Difficulty making judgments
Extreme emotional disturbance (agitation)
Frustration, depression, anxiety, stress, and tension from loss of mental function
Inability to be spontaneous
Lack of emotion
Memory loss
Numbness or tingling
Slowly worsening memory loss (dementia) and:
- Confusion, disorientation
- Decline in many brain functions that gets worse
- Difficulties with attention, concentration, judgment, and behavior
- Difficulty thinking
- False beliefs (delusions)
- Hearing sounds or seeing things that are not there (hallucinations)
- Personality changes
- Problems with language (aphasia)
- Uncoordinated or weak movements
Swallowing difficulty
Sudden involuntary laughing or crying
Urinary incontinence
Withdrawal from social interaction
- Inability to interact in social or personal situations
- Inability to keep a job

Signs and tests

Diagnosis rules out other causes of dementia, including dementia due to metabolic causes.

Signs of multi-infarct dementia include:

Abnormal reflexes
Local nervous system (neurologic) signs (on the modified Hachinski ischemia scale)
Past stroke or high blood pressure
Periods of quick worsening alternating with stable periods of very little change
Quick onset
Weakness or loss of function on one side, one area, or many areas

Tests may include:

Treatment

There is no treatment for MID. The goal is to control symptoms and correct risk factors such as high blood pressure and high cholesterol. The health care provider may recommend other treatments.

DIAGNOSIS AND TREATMENT

The diagnosis and treatment environment should be pleasant, comfortable, nonthreatening, and physically safe. Some patients may need to stay in the hospital for a short time. The health care provider will try to find the cause and treat it.

Stopping or changing medications that worsen or cause confusion may improve mental function. Medications that may cause confusion include:

Anticholinergics (including antidepressants such as amitriptyline or imipramine)
Central nervous system depressants
Cimetidine
Lidocaine
Pain relievers

Disorders that may contribute to confusion include:

Anemia
Heart failure
Infections
Low oxygen (hypoxia)
Mental conditions such as depression
Nutritional disorders
Thyroid disorders

Treating medical and mental disorders often greatly improves function.

Medications may be needed to control aggressive, agitated, or dangerous behaviors. The health care provider will usually prescribe these medicines in very low doses and adjust the dose as needed. Such medications may include:

Antipsychotics (olanzapine, quetiapine)
Beta blockers
Serotonin-affecting drugs (trazodone, buspirone, or fluoxetine).

Medications used to treat Alzheimer's disease have not been shown to work for MID.

Hearing aids, glasses, or cataract surgery may be needed if the person has sensory problems.

LONG-TERM TREATMENT

The following may be helpful in caring for a person with MID:

Adult day care
Adult protective services
Boarding homes
Community resources
Convalescent homes
Family counseling
Homemakers
In-home care
Visiting nurses or aides
Volunteer services

Other care tips:

Keep familiar objects and people around.
Leave lights on at night.
Stick to a simple schedule of activities.
Use behavior modification to help control unacceptable or dangerous behaviors.
Use reality orientation with environmental cues to help reduce disorientation.

Seek legal advice early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.

Expectations (prognosis)

The disorder gets worse over time.

Death may occur from:

Heart disease
Pneumonia or other infection
Stroke

Complications

Heart disease
Infections anywhere in the body
Loss of ability to function or care for self
Loss of ability to interact
Pneumonia
Reduced lifespan
Side effects of medications
Stroke

Calling your health care provider

Call your health care provider if symptoms of vascular dementia occur. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status. This is an emergency symptom of stroke.

Treatment that is started within 3 hours after symptoms begin may reduce damage caused by strokes.

Prevention

Control conditions that increase the risk of hardening of the arteries (atherosclerosis) by:

Controlling high blood pressure
Controlling weight
Reducing saturated fats and salt in the diet
Treating related disorders

Review Date:2/13/2008
Reviewed By:Luc Jasmin, MD, PhD, Departments of Anatomy & Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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