Cognitive Improvement in a 78-Year-Old Man with Vascular Dementia Through Medication Therapy
Vascular dementia is one of the most common forms of cognitive decline among elderly patients, especially those with a history of stroke or cerebrovascular disease. In this case, a 78-year-old male presented with progressive memory loss, slowed thinking, and impaired executive function. After undergoing a comprehensive treatment plan that included both intravenous and oral medications, the patient experienced noticeable cognitive improvement and stabilized neurological condition.
Case Overview
Patient: Male, 78 years oldDiagnosis: Vascular DementiaHospital: The Second Affiliated Hospital of Harbin Medical UniversityTreatment Period: February 2022 (7-day inpatient care)Treatment Approach: Intravenous therapy with Naoliting (Xingnaojing), Xuesaitong, and Shuxuening, combined with oral medications including Piracetam and Donepezil Hydrochloride.Outcome: Significant improvement in memory function, no disease progression, and stable clinical condition upon discharge.
Initial Presentation and Diagnosis
The patient's family reported that, about two weeks prior to admission, the man began showing signs of slowed response and memory impairment. He would forget what he had eaten for breakfast by evening and struggled to recall familiar phone numbers. Despite existing motor and speech impairments from prior strokes, these symptoms had not worsened recently. There were no signs of nausea or vomiting.
During the initial cognitive assessment, the patient struggled with basic arithmetic tasks. When asked to subtract 7 from 100, he took about 10 seconds to respond with 93. He was unable to continue with the calculation when asked to subtract another 7. A head CT scan revealed multiple lacunar infarcts, some with areas of softening. Based on these findings and the patient's history of hypertension, diabetes, and multiple strokes, hospitalization was recommended for further evaluation.
Treatment Plan and Progress
Upon admission, the patient was alert but exhibited mild dysarthria, impaired short-term memory, and reduced calculation and executive function. His vital signs were stable: temperature 36.3°C, blood pressure 160/90 mmHg, heart rate 85 bpm, respiratory rate 18 bpm. Left limb muscle strength was graded at level 3.
An MRI scan confirmed multiple lacunar infarcts in both hemispheres, with no diffusion restriction on DWI, ruling out acute infarction. However, multiple cerebral artery stenoses and occlusions were noted. The Mini-Mental State Examination (MMSE) score was 20 out of 30, indicating moderate cognitive impairment.
The medical team diagnosed vascular dementia secondary to recurrent strokes. The treatment plan included intravenous therapy to improve cerebral circulation and metabolism, along with oral medications to enhance cognitive function. The patient received Naoliting for neuroprotection, Xuesaitong and Shuxuening to support blood flow, and Piracetam and Donepezil to improve memory and cognition.
Positive Outcomes Following Treatment
By the seventh day of hospitalization, the patient showed measurable improvement in memory function. There was no progression of neurological deficits, and his condition remained stable. Follow-up MRI confirmed no new acute infarcts or hemorrhages.
Prior to discharge, the patient's family was counseled on the importance of continued oral medication, regular follow-ups, and engaging the patient in cognitive exercises such as mental math to support brain function. The family was highly cooperative throughout the hospital stay and committed to implementing these recommendations at home.
Post-Discharge Care and Lifestyle Adjustments
Following recovery, it is essential for patients with vascular dementia to manage underlying risk factors like hypertension, diabetes, and hyperlipidemia. Given the patient's history of multiple strokes and residual motor and speech impairments, the care plan included:
- Social engagement: Encouraging participation in social and mentally stimulating activities such as calligraphy, puzzles, and light creative projects.
- Supervised living: Avoiding solitary activities due to the risk of wandering or getting lost as cognitive decline progresses.
- Nutrition: Maintaining a balanced diet rich in protein, vitamins, and antioxidants while avoiding high-fat and high-salt foods.
Clinical Insights and Conclusion
This case highlights the importance of early diagnosis and tailored treatment in managing vascular dementia. Recurrent strokes can lead to global cognitive decline, affecting not only memory but also motor and language functions. As healthcare providers, it's crucial to differentiate vascular dementia from other types such as Alzheimer's disease, frontotemporal dementia, Lewy body dementia, and Parkinson's disease dementia. Each condition requires a unique therapeutic approach, and accurate diagnosis is key to effective management.
For patients and caregivers, understanding the progression of vascular dementia and adhering to treatment plans can significantly improve quality of life and delay further cognitive deterioration. With proper medical care and lifestyle modifications, many patients can maintain functional independence for extended periods.