[Therapeutic strategies in vascular dementia. From polypragmatic to targeted intervention and research]

Cerebrovascular diseases are the second most common cause of dementia. The definitions of vascular dementia (VD) so far proposed in the literature provide little of no information on the etiology of the vascular lesions leading to dementia. An etiology-based classification (e.g. aided by computer tomography) is, however, a must for the development of successful therapeutic strategies. Three kinds of treatment can be differentiated: (1) prevention (before dementia degradation or a stroke occurs), (2) slowing the progress, or prevention, of new infarct, and (3) symptomatic treatment of cognitive and neurological deficits. The treatment strategies are based on three patho-etiological models: (1) recurrent ischemia (i.e. micromboli) which can be treated with aspirin or ticlopidine. (2) Reduce cerebral blood flow, whether so-called vasodilators have any therapeutic benefit remains an open question (3). Reduced perivascular metabolism-which cannot as yet be adequately treated. However, as in all VD-subtypes, rigorous treatment of all cerebrovascular risk factors, such as hypertension and diabetes mellitus is mandatory.