Related Experiment Videos
Vascular Cognitive Impairment
1Penn State University/Geisenger Health System, Section of Neurology, Milton S. Hershey Medical Center, M.C. H037, P.O. Box 850, Hershey, PA 17033-0850, USA.
Insights
Vascular dementia is preventable through cerebrovascular disease management, yet current treatments are limited. Rethinking the term "vascular dementia" is crucial for effective intervention and patient care.
Area of Science:
- Neurology
- Gerontology
- Public Health
Background:
- Vascular dementia is the only preventable dementia.
- Current treatments focus on cerebrovascular disease prevention and stroke management.
- The efficacy of these measures for vascular dementia prevention is uncertain due to definitional issues.
Purpose of the Study:
- To highlight the need for a revised understanding of vascular dementia.
- To advocate for a shift away from the term "vascular dementia" in clinical practice.
- To emphasize the treatable nature of cerebrovascular disease underlying cognitive impairment.
Main Methods:
- Review of current literature on vascular dementia and cerebrovascular disease.
- Analysis of the limitations in defining and managing cognitive impairment.
- Conceptual re-evaluation of the term "vascular dementia".
Main Results:
- The term "vascular dementia" is considered obsolete as it implies untreatable, progressive, degenerative causes.
- Most cases involve treatable cerebrovascular disease, not an unknown degenerative process.
- Cognitive impairment spectrum ranges from asymptomatic "brain-at-risk" to dementia.
Conclusions:
- Successful management requires recognizing the term "vascular dementia" as obsolete.
- A rational therapeutic approach necessitates understanding the clinical spectrum and diverse, treatable causes.
- Focusing on treatable cerebrovascular disease offers a pathway to better patient outcomes.
Abstract:
Although vascular dementia remains the only form of dementia that is preventable, available treatment is limited to the primary and secondary prevention of cerebrovascular disease. Strokes are highly responsive to different forms of prevention and treatment. The effectiveness of the same measures in the prevention of vascular dementia remains unclear, however, owing mainly to the lack of agreement on the definition and management of cognitive impairment. The successful treatment of "vascular dementia" involves the recognition of this term as obsolete, for it falsely implies that the underlying cognitive impairment has an unknown degenerative cause, is progressive, and responds neither to currently available preventive measures nor to treatments. Although dementia resulting from multiple strokes can be a terminal manifestation of this form of cognitive impairment, most patients have treatable cerebrovascular disease. A rational therapeutic approach to the treatment of this cognitive syndrome necessitates an understanding of its broad clinical spectrum and the diverse causes that may be responsive to currently available treatments, from the clinical asymptomatic "brain-at-risk" stage to full-blown dementia.