Vascular Dementia

This article offers an in-depth analysis of vascular dementia, characterized as dementia primarily caused by cerebrovascular disease or impaired cerebral blood flow. It covers the causes, risk factors, cognitive profile, and management strategies for vascular dementia, including both non-pharmacological and pharmacological treatments. The article also discusses investigational agents with inconclusive results and is supported by references from various neurological and medical studies.

Defining Vascular Dementia

Vascular dementia is defined as any dementia which is primarily caused by cerebrovascular disease or impaired cerebral blood flow and leads to cognitive impairment. So, vascular dementia encompasses both dementia and milder forms of cognitive impairment.

Causative Factors of Vascular Dementia

Vascular dementia is caused by any cerebrovascular or cardiovascular disease including any of the causes of ischemic stroke or hemorrhagic stroke.

Risk Factors for Vascular Dementia

Risk factors for vascular dementia include pre-stroke risk factors, stroke-factors including intracerebral hemorrhage, aphasia, left hemisphere location and recurrent strokes, post-stroke factors.

Cognitive Profile of Vascular Dementia

The cognitive profile of vascular dementia is marked by prominent impairment of executive functions with relative sparing of episodic memory. It may be accompanied by other cortical signs of stroke including apraxia and aphasia.

Management Strategies for Vascular Dementia

For management; management of risk factor is important. These measures may be helpful to avoid recurrent stroke which is associated with a greater risk of cognitive decline and a higher mortality. These measures include antihypertensive therapy, diabetes control, statins, and antiplatelet therapy.

Non-pharmacological Therapy

Non-pharmacological therapy includes lifestyle interventions, such as, exercise and social interactions, post-stroke programs for cognitive and physical rehabilitation and behavioral therapy for neuropsychiatric symptoms.

Pharmacological Treatments

Pharmacological treatment with cholinesterase inhibitors including donepezil, galantamine-extended release, or rivastigmine. Also, memantine could be added in patients with severe dementia.

Investigational Agents in Vascular Dementia

Additionally, investigational agents include nimodipine, pentoxifylline, actovegin have been studied with inconclusive results.

References

1-Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006; 37:2220. 2-Ravaglia G, Forti P, Lucicesare A, et al. Physical activity and dementia risk in the elderly: findings from a prospective Italian study. Neurology. 2008;70:1786–1794. 3-Smith EE. Clinical presentations and epidemiology of vascular dementia. Clin Sci (Lond) 2017; 131:1059. 4- Verghese J, Wang C, Katz MJ, Sanders A, Lipton RB. Leisure activities and risk of vascular cognitive impairment in older adults. J Geriatr Psychiatry Neurol. 2009;22:110–118. 5-Hébert R, Lindsay J, Verreault R, et al. Vascular dementia : incidence and risk factors in the Canadian study of health and aging. Stroke 2000; 31:1487. 6-Sachdev PS, Brodaty H, Valenzuela MJ, et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology 2004; 62:912. 7- McGuinness B, Todd S, Passmore P, Bullock R: The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Cochrane Database Syst Rev. 2006 Apr 19; (2):CD004034. 8-Micieli G. Vascular dementia. Neurol Sci. 2006;27:S37–S39. 9-Roman GC. Vascular dementia revisited: Diagnosis, pathogenesis, treatment, and prevention. Med Clin N Am. 2002;86:477–99. 10-Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2011; 42:2672. 11-Malouf R, Birks J. Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev. 2004;1:CD004395 12-Moretti R, Torre P, Antonello RM, et al. Rivastigmine in subcortical vascular dementia: An open 22-month study. J Neurol Sci. 2002;203– 204(C):141–6. 13-Vincent S, Lane R. Rivastigmine in Vascular Dementia. Int Psycho-geriatr. 2003;15(s1):201–5. 14-Orgogozo JM, Rigaud AS, Stoffler A, et al. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300) Stroke. 2002;33:1834–9. 15-Demuth HU, Dijkhuizen RM, Farr TD, et al. Recent progress in translational research on neurovascular and neurodegenerative disorders. Restor Neurol Neurosci 2017; 35:87.