Multi-Infarct Dementia

What is multi-infarct dementia?

Multi-infarct dementia (MID) is a type of vascular dementia that results from a series of small strokes. “Multi” means “many,” and “infarct” means “stroke.” The strokes damage your brain tissue due to improper blood flow and a lack of oxygen and nutrients.

Dementia is a decline in mental function from a previously higher level that’s severe enough to interfere with daily living. A person with dementia has two or more of these specific difficulties, including a decline in:

• Memory.
• Reasoning.
• Language.
• Coordination.
• Mood.
• Behavior.

High blood pressure is a major risk factor for multi-infarct dementia.

How common is multi-infarct dementia?

Multi-infarct dementia is common. It’s a common cause of dementia after Alzheimer’s disease and can sometimes co-exist with Alzheimer’s disease.

MID typically affects people between the ages of 60 and 75. Men and people assigned male at birth are slightly more likely than women and people assigned female at birth to have this condition.

What are the symptoms of multi-infarct dementia?

Symptoms of multi-infarct dementia (MID) may begin suddenly. They include:

• Confusion or problems with short-term memory.
• Wandering or getting lost in familiar places.
• Walking with rapid, shuffling steps.
• Loss of bladder or bowel control.
• Laughing or crying at inappropriate times.
• Difficulty following instructions.
• Issues counting money and making monetary transactions.

Some people with MID seem to have an improvement in their symptoms for short periods but then decline after having more strokes.

Symptoms of stroke

Multi-infarct dementia results from several small strokes, or transient ischemic attacks (TIAs). The symptoms of TIA and stroke don’t differ, but they may be milder in TIA. Symptoms generally come on suddenly and can include:

• Difficulty seeing from one or both of your eyes.
• Numbness or weakness in your face, arms or legs, especially on one side.
• Severe headache.
• Difficulty walking.
• Dizziness.
• Loss of coordination and balance.
• Difficulty speaking or understanding words.

If stroke or TIA symptoms appear, it’s very important to go to the ER to get immediate medical help, even if symptoms resolve!

What causes multi-infarct dementia?

A series of small strokes that damage brain tissue causes multi-infarct dementia. A stroke happens when blood can’t get to a part of your brain. A blood clot or fatty deposits (called plaques) can block the vessels that supply blood to your brain, causing a stroke.

Many people who have MID don’t realize they’ve had strokes. In cases of smaller strokes, the blocked blood vessel can clear after a few minutes. So, the symptoms of the stroke (such as weakness on one side of your body) may be temporary.

However, these strokes can still damage your brain tissue. Several small strokes can cause enough brain damage to lead to dementia.

What are the risk factors for multi-infarct dementia?

The risk factors for multi-infarct dementia are the same as the risk factors for stroke. They include:

• High blood pressure (hypertension). This is the most significant risk factor for multi-infarct dementia. It’s rare for people who don’t have high blood pressure to have MID.
• Diabetes.
• Conditions that can cause blood clots or other blockages, like atherosclerosis, coronary heart disease, heart valve disease and carotid artery disease.
• High LDL cholesterol levels (hyperlipidemia).
• Smoking.

How is multi-infarct dementia diagnosed?

There’s no single test to diagnose multi-infarct dementia, so the diagnosis can be challenging. The symptoms are sometimes very similar to Alzheimer’s disease. In addition, you can have both MID and Alzheimer’s.

If you have symptoms of MID, your provider will ask about your health history and perform physical and neurological exams. They’ll also assess your risk for stroke, which may point to a diagnosis of MID.

Imaging tests of your brain, such as MRI or CT scans, can help diagnose MID if they show areas of brain damage. Your provider may also refer you to a specialist for neuropsychological testing so they can assess your cognitive symptoms, like issues with memory.

How is multi-infarct dementia treated?

There isn’t a cure for MID, as brain damage from strokes is permanent. Instead, treatment focuses on preventing future strokes by managing or preventing the medical conditions that increase your risk for stroke.

Your healthcare provider will prescribe medications (as needed) to:

• Manage your blood pressure.
• Reduce high cholesterol levels.
• Regulate blood sugar levels (diabetes).
• Thin your blood to prevent blood clots.

They’ll also recommend lifestyle changes, such as exercising, eating a healthy diet and avoiding smoking and drinking alcohol.

Depression commonly occurs with MID and may worsen brain function. Your provider may prescribe antidepressant medications if you have depression.

Your provider might also recommend additional therapy to help develop new pathways for the person with MID to cope and compensate following brain changes. These could include speech therapy, cognitive therapy and physical therapy.

Can I prevent multi-infarct dementia?

The best treatment for multi-infarct dementia is prevention early in life. Ways to reduce your risk factors and try to prevent MID include:

• Maintaining healthy blood pressure, cholesterol levels and blood sugar levels.
• Maintaining a healthy weight for you.
• Exercising regularly.
• Eating a healthy, well-balanced diet (like the Mediterranean or Dash diets).
• Quitting smoking. Ask your healthcare provider if you need help.
• Cutting back on alcohol consumption.
• Managing your stress. Try relaxation exercises, meditation, yoga and other methods.
• Taking all of your medications as prescribed by your healthcare provider. If your symptoms change or worsen, call your healthcare provider. Never stop or change your dose without talking with your provider first.

What can I expect if I or my loved one have multi-infarct dementia?

Multi-infarct dementia often gets worse over time. MID’s course is usually more like a staircase with sudden periods of decline (sometimes followed by some improvement) and then by more sudden periods of decline, as additional strokes happen. Each person has their own unique journey. Your healthcare team will be able to give you the best idea of what to expect based on your situation.

Generally, people with MID and other types of vascular dementia have a shorter life expectancy due to an increased risk for additional stroke or heart attack.

How do I take care of myself or someone with multi-infarct dementia?

A person with MID will need help with at least some aspects of daily function, such as managing medications, paying bills or preparing food. People with MID may be able to do many things for themselves. But it may not be safe for them to live alone, depending on the severity of their symptoms. For some with MID, more specialized care may be required from facilities that care specifically for people with dementia.

When should I see my healthcare provider?

You or your caregiver should call your healthcare provider when:

• Your symptoms are worsening.
• New symptoms appear.
• You have bothersome side effects from medications.

Is multi-infarct dementia the same as Alzheimer’s?

No. Both these conditions can lead to dementia, but they have different underlying causes. Dementia is the state of decline of cognitive functioning to such an extent that it interferes with a person's daily life and activities.

Dementia from MID results from brain damage due to a lack of blood flow from a series of strokes. Alzheimer’s disease causes dementia from an abnormal build-up of proteins in your brain. The build-up of these proteins in Alzheimer’s disease — amyloid protein and tau protein — causes brain cells to die.

In addition, Alzheimer’s symptoms usually develop at a slow, steady pace. With MID, the changes can happen suddenly or gradually in steps.

Is multi-infarct dementia the same as vascular dementia?

Multi-infarct dementia is a type of vascular dementia. Other types of vascular dementia include:

• Subcortical vascular dementia (Binswanger’s disease): When widespread, microscopic brain damage results from the thickening and narrowing of arteries in the subcortical areas of your brain.
• Stroke-related dementia: When a single stroke causes dementia.
• Mixed dementia: When dementia is the result of more than one condition. It’s often a combination of Alzheimer’s disease and vascular dementia.

A note from Cleveland Clinic

It can be overwhelming to learn that a loved one has multi-infarct dementia. Know that their healthcare team will help them and you through the process and provide individualized options for care. It’s important to take care of yourself as well. Consider joining support groups or creating your own support network to help you.