[Vascular dementia: an update].

Area of Science:

• Neurology
• Gerontology
• Pathophysiology

Context:

• Vascular dementia (VaD) diagnosis and management are complex.
• Existing guidelines, such as NINDS-AIREN, have limitations, particularly in assessing memory impairment realistically.
• There is a need for updated diagnostic criteria and therapeutic strategies for VaD.

Purpose:

• To summarize the current understanding of vascular dementia (VaD).
• To review recent advancements in VaD pathophysiology, especially concerning subcortical vascular dementia (SVD).
• To critically evaluate the efficacy of cholinesterase inhibitors and memantine in treating VaD.

Summary:

• The NINDS-AIREN guideline for VaD is widely used but may not accurately reflect clinical presentations by overemphasizing memory deficits.
• Recent studies have shed light on the pathophysiology of VaD, with notable findings in subcortical vascular dementia (SVD).
• Cholinesterase inhibitors and memantine, while promising, have shown limited effectiveness in improving VaD symptoms to date.

Impact:

• This review provides a comprehensive overview of VaD, aiding clinicians in diagnosis and treatment.
• Understanding recent pathophysiological findings can lead to more targeted therapeutic approaches.
• The critical evaluation of current medications informs future drug development for VaD.