Decrease in acetylcholine transmitting neurons and their target nerve cells. Memory loss is an early symptom. Small and large cerebral infarct of varying ages are present. Hypertension is frequently associated but not essential. In early stages personality and insight tend to be better preserved than in Alzheimers dementia.
Depressive symptoms are common, and suicide is possible.
As the condition advances, neurologic features may develop, especially hemiplegias, pseudobulbar palsy, with pathologic laughing and crying. Treatment is similar to that of other forms of cerebral ischemic disease. Control of hypertension is important. Slowed motor movements, ataxia and weakness may be evident. Most of the reflexes are hyperactive with extensor plantar responses.