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The vascular contribution to dementia: World Stroke Organization scientific statement
Geert Jan Biessels1, Stephanie Debette2, Fanny M Elahi3
1Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
Summary
Vascular disease significantly contributes to dementia risk, often co-occurring with Alzheimer's disease. Interventions targeting vascular factors may improve both vascular dementia and the vascular component of neurodegenerative dementias.
Area of Science:
- Neurology
- Vascular Biology
- Geriatrics
Background:
- Alzheimer's disease and cerebrovascular pathology are leading causes of dementia in older adults.
- Vascular disease accounts for a substantial portion of dementia risk, frequently co-occurring with Alzheimer's disease.
- Cerebral small vessel disease and post-stroke cognitive impairment are key vascular contributors to dementia.
Purpose of the Study:
- To review the vascular contribution to dementia, including both vascular and neurodegenerative types.
- To summarize epidemiological, neuropathological, and clinical aspects of vascular disease in dementia.
- To discuss diagnostic criteria, biomarkers, and therapeutic interventions for vascular dementia.
Main Methods:
- A multi-disciplinary international expert group convened for this World Stroke Organisation (WSO) scientific statement.
- Review of epidemiological data, neuropathological findings, and clinical impact of vascular disease in dementia.
- Appraisal of transcriptomic, proteomic, imaging, and biochemical markers, alongside clinical trial data.
Main Results:
- Vascular disease is a major risk factor for dementia, with high co-pathology rates alongside Alzheimer's disease.
- Novel molecular targets (e.g., COL4A1/4A2, HTRA1) and biomarkers (e.g., VEGF-A, IL-6) have been identified.
- Multiple therapeutic pathways, including blood pressure management and novel drug targets, are under investigation.
Conclusions:
- Vascular interventions hold potential for treating vascular dementia and the vascular component of neurodegenerative dementias.
- Understanding the overlap between vascular disease, stroke, and Alzheimer's disease is crucial for effective management.
- Future opportunities lie in addressing upcoming challenges in vascular disease and dementia research.
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