Differentiating Dementias

Alzheimer's disease and multiple infarct dementia (MID) are the two most common causes of dementia. While they share some features, they also have some differences. Because the progression of multiple infarct dementia can be slowed by measures to inhibit vascular disease, such as smoking cessation, control of hypertension, and aspirin or other platelet aggregate inhibitors, it is important to recognize multiple infarct dementia when it presents.

Memory impairment and one or more additional cognitive deficits are present in either type of dementia, but there are other differences. Be suspicious of multiple infarct dementia if any combination of the following findings accompanies the memory impairment and cognitive deficits:

• Focal neurological signs or symptoms, e.g., exaggerated deep tendon reflexes, gait abnormalities, weak extremity
• Abrupt onset
• Persistent, progressive, stepwise deterioration
• Somatic complaints
• History of hypertension
• History of arterial disease
• Imaging evidence of cerebrovascular disease

Remember, unlike Alzheimer's disease, the progression of MID can be slowed. If you suspect MID, control all identified risk factors for arterial disease.

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