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Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention
1Department of Medicine/Neurology, University of Texas Health Science Center, Audie L. Murphy Memorial Veterans Hospital, 7703 Floyd Curl Drive, San Antonio, TX 78284-7883, USA. romang@uthscsa.edu
Insights
Vascular dementia (VaD) is a common cognitive decline in the elderly caused by cerebrovascular disease. Managing cardiovascular risk factors is key to preventing and treating VaD.
Area of Science:
- Neurology
- Geriatrics
- Cardiovascular Medicine
Background:
- Vascular dementia (VaD) is the second leading cause of dementia in older adults, following Alzheimer's disease (AD).
- VaD results from cognitive impairment due to brain lesions caused by cerebrovascular disease (CVD).
- Diagnosis involves identifying cognitive loss, vascular brain lesions on imaging, and excluding other dementia causes like AD.
Purpose of the Study:
- To define Vascular Dementia (VaD) and its causes.
- To outline diagnostic criteria for VaD.
- To discuss prevention and treatment strategies for VaD.
Main Methods:
- Review of existing literature on VaD.
- Analysis of diagnostic criteria including neuroimaging.
- Examination of etiological factors and therapeutic approaches.
Main Results:
- VaD encompasses cognitive decline from various vascular brain lesions, including strokes and hypoperfusion.
- Imaging is crucial for diagnosing VaD by detecting vascular lesions and excluding other dementias.
- Prevention of stroke and CVD, alongside risk factor management, is vital for reducing VaD prevalence.
Conclusions:
- Effective management of hypertension, diabetes, and other cardiovascular risk factors is essential for VaD prevention.
- Certain medications, including anticholinergics, antipsychotics, and antidepressants, may be used in managing VaD symptoms.
- Genetic counseling is recommended for familial forms of VaD, such as CADASIL.
Abstract:
VaD is the second most common cause of dementia in the elderly after AD. VaD is defined as the loss of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions as a result of CVD and cardiovascular pathologic changes. Diagnosis requires (1) cognitive loss (often predominantly subcortical), (2) vascular brain lesions demonstrated by imaging, and (3) exclusion of other causes of dementia, such as AD. VaD is excluded by brain imaging showing no evidence of vascular lesions. VaD may be caused by multiple strokes (MID or poststroke dementia) but also by single strategic strokes, multiple lacunes, and hypoperfusive lesions such as border zone infarcts and ischemic periventricular leukoencephalopathy (Binswanger's disease). Primary and secondary prevention of stroke and cardiovascular disease decreases the burden of VaD. Genetic advice is needed in patients with familial forms, such as CADASIL. Treatment involves control of risk factors (i.e., hypertension, diabetes, smoking, hyperfibrinogenemia, hyperhomocystinemia, orthostatic hypotension, cardiac arrhythmias). Anticholinergic medications used for AD are also useful in VaD, and atypical antipsychotic agents and antidepressants (e.g., selective serotonin reuptake inhibitors) may be required in some patients.