Objective: Vascular Dementia may be more frequent in developing countries than in developed countries. This may be more evident in cases with onset before the age of 65 years. The aim was to see if vascular dementia is an important cause of pre-senile dementia among out-patients attending a weekly dementia clinic.
Design: Consecutive cases of dementia attending a weekly dementia clinic at Medical College Thrissur, South India from April 2002 to March 2003 were assessed as part of a prospective study.
Materials and Methods: All patients attending the dementia clinic were assigned DSM IV diagnosis after detailed evaluation and relevant investigations. CT scan was done in 49 of 58 patients. Separate criteria were used for the diagnosis of dementia with Lewy bodies and fronto temporal dementia. Diagnosis was jointly made by a neurologist and a psychiatrist after assessing each case independently. All cases underwent further assessment using Everyday Activities Scale of India, Clinical Dementia Rating Scale, Addenbrooke’s Cognitive Examination (ACE) and Neuro-Psychiatric Inventory as part of an ongoing study. These patients were classified into 2 groups depending on the age of onset of their illness. This report describes the causes of dementia in the group with pre-senile onset.
Results: Out of the 58 patients with dementia, 25 had onset of dementia before the age of 65 years. CT scan was done in 23 of these patients. The most common cause was vascular dementia with 6 patients (24%) receiving this diagnosis. Their age of onset varied from 47 to 63 years and the duration of dementia prior to presentation in the clinic varied from 1 month to 5 years. Mean duration of dementia prior to presentation was 22 months. The score on ACE ranged from 19 to 62 with a mean of 46. All had hypertension and 4 had diabetes also. All of them had evidence of sub-cortical infarcts in the CT scan and two in addition had evidence of cortical infarctions. VDRL was non reactive in these patients. Other causes of dementia with pre-senile onset were, fronto temporal dementia (5), Alzheimer’s disease (3), dementia with Lewy bodies(3), Dementia due to B 12 deficiency (2), Dementia due to multiple etiology (2), Neurosyphilis (1), Huntington's disease (1), Post-traumatic (1), and unclassified degenerative dementia(1).
Conclusion: Vascular dementia may continue to be an important cause of dementia in developing countries especially in the pre-senile age group. Hypertension seems to be the commonest risk factor followed by diabetes. This finding, if supported by population based research, will have important public health implications.
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