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Types of multi-infarct dementia.

Acta Neurologica Scandinavica

|June 1, 1987

Summary

This study differentiates multi-infarct dementia (MID) into cortical and subcortical types based on CT scans. Clinical and imaging findings show distinct features but also overlap, questioning if they are separate entities.

Area of Science:

Neurology
Neuroimaging
Dementia Research

Background:

Multi-infarct dementia (MID) is a significant cause of cognitive impairment.
Distinguishing between cortical and subcortical subtypes of MID is crucial for understanding its pathophysiology and clinical presentation.

Purpose of the Study:

To investigate the clinical and neuroimaging differences between cortical and subcortical multi-infarct dementia.
To determine if these subtypes represent distinct disease entities or variations of a common pathogenesis.

Main Methods:

Classification of 79 MID patients into cortical MID and subcortical MID groups based on computed tomography (CT) findings of cortical infarcts and white matter low attenuation (WMLA).
Detailed clinical assessment including stroke history, neurological signs, and cognitive function.

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Analysis of CT scans for infarcts and WMLA severity.

Main Results:

Cortical MID presented with atherothrombotic/cardiogenic strokes, hemiparesis, severe aphasia, and abrupt cognitive decline.
Subcortical MID was characterized by lacunar strokes, bulbar signs, pure motor hemiparesis, depression, and emotional lability.
While distinct clinical features were observed, both groups showed overlap in stroke risk factors, ischemic scores, and neurological/CT findings. Cortical infarcts were more frequent in cortical MID (92%) than subcortical MID (44%) when stratified by WMLA severity.

Conclusions:

Cortical and subcortical MID exhibit differing clinical manifestations and neuroimaging characteristics.
Significant overlap in risk factors and overall findings suggests that these subtypes may not be entirely distinct entities.
Further research is needed to clarify the etiopathogenesis and nosological status of cortical and subcortical MID, including lacunar state and Binswanger's disease.