Long-term experience of a trial in multi-infarct dementia

A report is given on the natural history of multi-infarct dementia (MID) in 94 patients over a period of 5 years and describes neuroimaging criteria that may be used in order to more reliably separate vascular (VD) from primary degenerative types of dementia (DTD). The annual mortality rate of MID patients was 13%. Age and nocturnal confusion were found to be the most efficient predictors for fatal prognosis. Psychosocial adjustment, in contrast, indicated better outcome. In respect to differential diagnosis MRI revealed infarcts, basal ganglia lacunes and confluent white matter lesions as the most effective discriminators between VD and DTD. The typical patchy pattern found in almost half of the patients with VD, and significant differences in 5-7 Hz range as shown by EEG mapping can also be used for increasing the accuracy of the clinical diagnosis.