Behavior in subcortical vascular dementia with sight pathologies: visual hallucinations as a consequence of precocious g
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ORIGINAL ARTICLE
Behavior in subcortical vascular dementia with sight pathologies: visual hallucinations as a consequence of precocious gait imbalance and institutionalization Rita Moretti 1 & Paola Caruso 1 & Benedetta Storti 1 & Riccardo Saro 1 & Benedetta Kassabian 1 & Alessia Sala 1 & Anna Giannini 1 & Silvia Gazzin 2 Received: 20 August 2019 / Accepted: 25 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Subcortical vascular dementia (sVAD) is considered the most frequent dementia in old population, and it is due to a small vessel disease. It has a very specific nosography, where the dominant factors are dysexecutive functions, depression, and apathy. Very few studies described visual hallucinations in sVAD, apart from in the final stages of it. Methods This study recruited 577 patients with a diagnosis of sVAD associated with major ocular pathologies and 1118 patients with sVAD without any significant ocular pathology: Patients were followed up for 24 months. We studied the influence of ocular pathologies in precocious visual hallucinations, on behavior disorder (aggressiveness), and gait disorders (instability, fells). We registered the necessity of neuropsychiatric therapies, incidence of hospitalization, and institutionalization. Results What emerges from our study is that the ocular comorbidities might change the behavior profile of dementia, provoking behavioral alterations, and the need for therapies with adverse effects. As far as old age is a complicated status of life, many factors can modify its development. The possible contribution of multiple biological events cannot be neglected, particularly the underlying influence of chronic diseases as well as the geriatric conditions, per se, might compromise the cognitive functions and the pathological conditions. Ocular pathology as a superimposing event in sVAD might worse the outcome. A correct and rapid identification of critical patients might be relevant for the dynamic life events in these patients and their caregivers. Keywords Subcortical vascular dementia . Ocular pathologies . Visual hallucinations . Behavior disorder . Gait disorders . Institutionalization
Introduction Low-vision caused by age-related diseases affects 1 in 28 persons over the age of 40 [1]. Changes to vision occur with normative aging, and due to increases in life expectancy, it is projected that the number of people living with low vision will more than double by 2020 [1, 2]. The Dementia and Sight Loss Interest Group, as part of the Vision 2020 UK [3], has recently been asked to develop and promote a better
* Paola Caruso [email protected] 1
Department of Medical Surgical and Health Sciences, Cattinara Hospital Trieste, University of Trieste, Strada di Fiume, 447 Trieste, Italy
2
Italian Liver Foundation, Science Park, Trieste, Italy
understanding of the issues in which people affected by dementia with concomitant visual loss have to face. Visual information is transmitted from the eyes to the brain, through optical radiation, t
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