The symptoms of post-stroke dementia depend on its cause. Post-stroke dementia is most often the result of vascular changes, but it can also be caused by Alzheimer's disease. In each of these cases, not only does the symptoms differ, but also the nature of the development of dementia.

The symptoms of post-stroke dementiadepend on its cause. PSD is most often the result of vascular changes (so-called vascular dementia) or degenerative changes (so-called Alzheimer's). If the cognitive deficit is due to vascular disease and other potential causes of dementia have been ruled out, it may be presumed that post-stroke dementia is vascular dementia. However, as research shows, vascular changes often coexist with degenerative changes characteristic of Alzheimer's disease, which is why it is often difficult to determine.

Post-stroke dementia - symptoms

Vascular changes

Binswanger's disease belongs to the group of vascular dementias. Characteristic for her is the abrupt nature of the disease development, with the initial dominance of the symptoms from the frontal lobes: apathy, balance disorders, slowing down of thought processes, disorders of executive functions accompanied by neurological deficits, such as:

  • dysarthria (speech disorder resulting from dysfunction of the executive apparatus - tongue, palate, pharynx, larynx)
  • dysphagia (difficult passage of food from the mouth through the esophagus to the stomach)
  • gait disturbance
  • imbalance
  • urinary incontinence
  • pathological laughing or crying
  • parkinsonism in the form of muscle stiffness

Another form of vascular post-stroke dementia is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The most common clinical manifestation of the disease are subcortical lacunar strokes (minor damage to the postural nuclei, thalamus and pons), occurring between the ages of 40 and 50, which is followed by dementia around the age of 60, which occurs in 90% of patients before death. In most cases, the development of dementia is abrupt, associated with subsequent strokes, and in the clinical picture it is undermined by the above-mentioned. symptoms from the frontal lobes andmemory impairment. Accompanying symptoms are increasing neurological deficits, mainly:

  • pyramidal symptoms (increased tension, very lively reflexes, pathological symptoms, e.g. of Babinski's)
  • pseudo-bulbar symptoms (speech, swallowing disorders, increased palatal, pharyngeal and mandibular reflexes)
  • gait disturbance
  • urinary incontinence

As is characteristic of vascular dementia, the behavior and personality of the sufferer remain relatively unchanged.

Degenerative changes (so-called Alzheimer's)

The gradual development of dementia symptoms after a stroke indicates the presence of a degenerative (Alzheimer's) process. Then the symptoms characteristic of Alzheimer's disease appear, i.e. problems with memory, mood changes, disorders of the so-called cognitive functions, i.e. impaired concentration and attention as well as speech problems. Behavior and personality changes occur in the later stages of Alzheimer's disease, e.g. the person may become aggressive.

Cognitive dysfunction after stroke

The profile of the cognitive deficit after stroke depends primarily on the location of the vascular damage. For example, damage around the angular gyrus manifests itself as a sudden onset of sensory dysphasia, visual-spatial disturbances, memory impairment, and agraphia (impairment or complete loss of writing ability).

The symptom complex related to subcortical lesions mainly consists of: slower information processing speed, executive function deficit and emotional lability. These symptoms may be accompanied by disorders of the cortical functions, i.e. disorders of the ability to read, count, write or gnosia, i.e. the ability to recognize.

It is estimated that 3 months after the onset of the onset of the disease, the impairment of at least one cognitive function occurs in 61.7% of respondents, and the incidence of cognitive deficits increases with age. The most common disorders concern memory, orientation, language skills, attention, constructional and visual-spatial abilities, and to the least extent, executive functions.

Based on: Klimkowicz-Morawiec A., Szczudlik A.,Post-stroke dementia , [in:]Dementia. Theory and practice , pp. edited by Leszek J., Wrocław 2011

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