Vascular Dementia

Case Report: Fifty-two year old male with PMH of heavy smoking, chronic kidney disease (CKD), obesity, type 2 diabetes complicated with retinopathy, nephropathy and peripheral neuropathy, and depression presented with poorly controlled diabetes, recent ICU admission with hypoglycemia and loss of consciousness. He has positive pin brick sensation stock-glove in the upper and lower extremities, on neuro exam and antalgic gait, he ambulates with point cane. On CGA (Comprehensive Geriatric Comprehensive), he was found to have 3 impaired IADL domains (driving, financing and handling insulin). MMSE: 20/30, impaired clock drawing test impaired speed, attention and executive skills, geriatric depression scale (GDS) was 4/15, FRAIL scale was 4/5. His lab reports revealed CKD stage III, he has normal B12, folate and Hba1C average above 8. His MRI revealed white matter disease, pontine infarct, right thalamic lacunar infarct and left lenticular lacune as well. Patient was assigned a care taker to supervise his insulin and his glycemic control improved as well as his overall compliance.

 

Conclusion: Failure to identify dementia in frail younger population with high vascular risk constitutes health hazards and poor disease control. Primary care clinicians may fail to recognize cognitive impairment during clinic visits using routine history and physical white matter disease and non-strategically located infarct may be completely asymptomatic, however early identification in high risk for dementia group can detect early executive dysfunction and subsequently eliminate health hazard and prevent further deterioration.