128 Vascular Dementia (290.4x)

A video documentary of a man caring for his father who has Vascular Dementia can be found at http://current.com/groups/culture/85771461_julius-and-dementia.htm.

DSM-IV-TR criteria

A. The development of multiple cognitive deficits manifested by both

(1) memory impairment (impaired ability to learn new information or to recall previously learned information)

(2) one (or more) of the following cognitive disturbances:

• aphasia (language disturbances)
• apraxia (impaired ability to carry out motor activities despite intact motor function)
• agnosia (failure to recognize or identify object despite intact sensory function)
• disturbances in executive functioning (i.e. planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

C. Focal neurological signs and symptoms (e.g., exaggeration of deep tendon reflexes, extensor plantar response, pseudobulbar palsy, gait abnormalities, weakness of an extremity) or laboratory evidence indicative of cerebrovascular disease (e.g., multiple infarctions involving cortex and underlying white matter) that are judged to be etiologically related to the disturbance.

D. The deficits do not occur exclusively during the course of a delirium.

Code based on predominant features:

• 290.41 With Delirium: if delirium is superimposed on the dementia
• 290.42 With Delusions: if delusions are the predominant feature
• 290.43 With Depressed Mood: if depressed mood (including presentations that meet full symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given.
• 290.40 Uncomplicated: if none of the above predominates in the current clinical presentation

Specify if:

• With Behavioral Disturbance

Coding note: Also code cerebrovascular condition on Axis III.

Associated features

Individuals with Dementia may become spatially disoriented and have difficulty with spatial tasks. Poor judgment and poor insight is also fairly common in Dementia. Sometimes individuals with this disorder may display no awareness of the loss of their cognitive abilities. Suicidal tendencies have also been seen in individuals with Dementia. Disinhibited behavior, slurred speech, motor disturbances, and delusions have also been associated with Dementia.

Child vs. adult presentation

The age of onset of Vascular Dementia is typically earlier than that of Dementia of Alzheimer’s Type.

Gender and cultural presentation

This disorder seems to be more common in males than in females.

Epidemiology

Vascular Dementia is much less common than Dementia of Alzheimer’s Type

Empirically Supported Treatment

DSM 5 Changes: (DSM5.org)

Proposed Revision:The work group is recommending that this disorder be subsumed into a new disorder: Major Neurocognitive Disorder. Work on a subtype for vascular etiology is currently in progress.