Clinical features of multi-infarct dementia

One of the best ways to consider the features of multi-infarct dementia is by comparison with Alzheimer's disease:

• progress is stepwise rather than gradual
• there is other evidence of systemic cardiovascular disease - especially hypertension
• focal neurological signs e.g. pseudobulbar palsy may be a feature
• walking may be in small steps - "marche a petit pas"
• the severity of symptoms can vary throughout the day, typically being worst in the evening
• there is generally better preservation of personality, insight and social responsiveness

These features can be combined into a numerical score - the Hachinski score, which can be used to make a rough-and -ready distinction between cases of Alzheimer's disease and multi-infarct dementia, but the differentiation between these two on clinical grounds is far from perfect.