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  • Print publication year: 2020
  • Online publication date: September 2020

Chapter 2 - Vascular Dementia

from Section 1 - Epidemiology and Types of Disorders

Summary

Over the course of the last hundred years our understanding of dementia has undergone considerable change. For much of that time ‘senility’ was seen as an almost inevitable concomitant of ageing and was usually attributed to atherosclerosis. In the post-war period, a concept of multi-infarct dementia emerged, but at the same time Alzheimer’s disease (AD) came to be seen not as a rare young-onset disorder but as the cause of most cases of dementia. Indeed, the concept of dementia itself was built around the impairments seen in AD, notably the impairment of memory. With greater understanding of dementia, particularly its pathological basis, it came to be realized that many different kinds of pathology can produce a dementia syndrome and that multiple types of pathology are the rule rather than the exception. This chapter aims to review our current understanding of how cerebrovascular disease contributes to cognitive impairment in order to assist those involved in the assessment and management of people with cognitive impairments to understand the strengths and limitations of our current concepts, and to inform diagnosis and management.

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1.Hachinski, VC, Lassen, NA, Marshall, J. Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 1974; 304: 207–9.
2.Erkinjuntti, T, Gauthier, S. Diagnosing vascular cognitive impairment and dementia: concepts and controversies. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, LO, Erkinjuntti, T, Gauthier, S): 310. Cambridge University Press, 2009.
3.Boyle, PA, Yu, L, Wilson, RS et al. Person-specific contribution of neuropathologies to cognitive loss in old age. Ann Neurol 2018; 83: 7483.
4.Power, MC, Mormino, E, Soldan, A et al. Combined neuropathological pathways account for age-related risk of dementia Ann Neurol 2018; 84: 1022.
5.De Reuck, J, Maurage, C-A, Deremacourt, V et al. Aging and cerebrovascular lesions in pure and in mixed neurodegenerative and vascular dementia brains: a neuropathological study. Folia Neuropathol 2018; 56: 8187.
6.Niemantsverdriet, E, Feyen, BFE, Le Bastard, N et al. Overdiagnosing vascular dementia using structural brain imaging in dementia work-up. J Alz Dis 2015; 45: 1039–43.
7.Nagy, ZS, Esiri, MM, Jobst, KA et al. Relative roles of plaques and tangles in the dementia of Alzheimer’s disease: correlations using three sets of neuropathological criteria. Dement Geriat Cogn Dis 1995; 6: 2131.
8.Skrobot, OA, Attems, J, Esiri, M et al. Vascular cognitive impairment neuropathology guidelines (VCING): the contribution of cerebrovascular pathology to cognitive impairment Brain 2016; 139: 2957–69.
9.Moorhouse, P, Rockwood, K. Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurology 2008; 7: 246–55.
10.Barkhof, F, Fox, NC, Bastos-Leite, AJ, Scheltens, P. Neuroimaging in Dementia. Springer, 2011.
11.Tatemichi, TK, Desmond, DW, Mayeux, R et al. Dementia after stroke. Neurology 1992; 42: 1185.
12.Pendlebury, ST, Rothwell, PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurology 2009; 8: 1006–18.
13.Pendlebury, ST, Rothwell, PM for the Oxford Vascular Study.Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurology 2019; 18:248–58.
14.Smallwood, A, Oulhaj, A, Joachim, C et al. (2012) Cerebral subcortical small vessel disease and its relation to cognition in elderly subjects: a pathological study in the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Neuropathol Appl Neurobiol 2012; 38: 337–43.
15.Dichgans, M and Leys, D. Vascular cognitive impairment. Circ Res 2017; 120: 573–91.
16.van der Flier, W, Staekenborg, SS, Barkhof, F et al. Structural neuroimaging: CT and MRI. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, L, Erkinjuntti, T, Gauthier, S): 5869. Cambridge University Press, 2009.
17.Erkinjuntti, T, Inzitari, D, Pantoni, L et al. Research criteria for subcortical vascular dementia in clinical trials. J Neural Transm. Supple 2000; 59: 2330.
18.Scheltens, P, Erkinjuntti, T, Leys, D et al. White matter changes on CT and MRI: an overview of visual rating scales. Eur Neurol 2000; 39: 80–9.
19.Linn, J, Halpin, A, Demacrel, P et al. Prevalence of superficial siderosis in patients with cerebral congophilic angiopathy. Neurology 2010; 74: 1346–50.
20.Charimidou, A, Gang, Q, Werring, DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol, Neurosurg Psychiatry 2012; 83: 124–37.
21.Ince, G, Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study–MRC CFAS. Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet 2001; 357: 169175.
22.Charlton, RA, Morris, RG, Nitkunan, A, Markus, HS. The cognitive profiles of CADASIL and sporadic small vessel disease. Neurology 2006; 66: 1523.
23.Wiederkehr, S, Simard, M, Fortin, C et al. Validity of the clinical diagnostic criteria for vascular dementia: a critical review. Part II. J Neuropsychiatry Clin Neurosci 2008; 20: 162–77.
24.Fischer, P, Jellinger, K, Gatterer, G et al. Prospective neuropathological validation of Hachinski’s Ischaemic Score in dementias. J Neurol, Neurosurg Psychiatry 1991; 54: 580.
25.Rockwood, K, Davis, H, MacKnight, C et al. The Consortium to Investigate Vascular Impairment of Cognition: methods and first findings. Can J Neurol Sci 2003; 30: 237–43.
26.Verhey, FRJ, Lodder, J, Rozendaal, N et al. Comparison of seven sets of criteria used for the diagnosis of vascular dementia. Neuroepidemiology 1996; 15: 166–72.
27.O’Brien, JT, Erkinjuntti, T, Reisberg, B et al. Vascular cognitive impairment. Lancet Neurology 2003; 2: 8998.
28.Sachdev, PS, Looi, JCL. Neuropsychological differentiation of Alzheimer’s Disease and vascular dementia. In Vascular Cognitive Impairment: Preventable Dementia (eds Bowler, JV, Hachinski, V): 152176. Oxford University Press, 2003.
29.Price, CC, Jefferson, AL, Merino, JG et al. Subcortical vascular dementia. Neurology 2005; 65: 376–82.
30.Hachinski, V, Iadecola, C, Petersen, RC et al. National institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards. Stroke 2006; 37: 2220–41.
31.Hebert, R, Brayne, C. Epidemiology of vascular dementia. Neuroepidemiology 1995; 14: 240–57.
32.Ueda, K, Kawano, H, Hasuo, Y et al. Prevalence and etiology of dementia in a Japanese community. Stroke 1992; 23: 798.
33.Ikeda, M, Hokoishi, K, Maki, N et al. Increased prevalence of vascular dementia in Japan. Neurology 2001; 57: 839.
34.Fratiglioni, L, Launer, LJ, Andersen, K et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology 2000; 54: S10–5.
35.Hebert, R, Lindsay, J, Verreault, R et al. Vascular dementia: incidence and risk factors in the Canadian study of health and aging. Stroke 2000; 31: 1487.
36.Lopez, OL, Wolk, DA. Clinical evaluation: a systematic but user-friendly approach. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, L, Erkinjuntti, T, Gauthier, S): 3245. Cambridge University Press, 2009.
37.Wilcock, GK, Bucks, RS, Rockwood, K. Diagnosis and Management of Dementia: A Manual for Memory Disorders Teams. Oxford University Press, 1999.
38.Hodges, JR. Cognitive Assessment for Clinicians. 3rd edn. Oxford University Press, 2018.
39.Smith, AD, Smith, SM, de Jager, CA et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PloS One 2010; 5: e12244.
40.Wald, DS, Kasturiratne, A, Simmonds, M. Serum homocysteine and dementia: meta-analysis of eight cohort studies including 8669 participants. Alz Dement 2011; 7: 412–17.
41.NICE. Dementia: supporting people with dementia and their carers in health and social care. Clinical Guideline 42 (amended March 2011). National Institute for Health and Clinical Excellence.
42.Alexopoulos, GS, Abrams, RC, Young, RC et al. Cornell scale for depression in dementia. Biol Psychiat 1988; 23: 271–84.
43.Black, S, Román, GC, Geldmacher, DS et al. Efficacy and tolerability of donepezil in vascular dementia: positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial. Stroke 2003; 34: 2323–32.
44.Wilkinson, D, Doody, R, Helme, R et al. Donepezil 308 Study Group. Donepezil in vascular dementia: a randomized, placebo-controlled study. Neurology 2003; 61: 479–86.
45.Wilkinson, DG, Doody, RS, Black, SE et al. Donepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dement Geriatr Cogn Disord 2005; 20: 338–44.
46.Erkinjuntti, T, Kurz, A, Gauthier, S et al. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet 2002; 359: 1283–90.
47.Mok, V, Wong, A, Ho, S et al. Rivastigmine in Chinese patients with subcortical vascular dementia. Neuropsychiatr Dis Treat 2007; 3(6): 943–8.
48.Ballard, C, Sauter, M, Scheltens, P et al. Efficacy, safety and tolerability of rivastigmine capsules in patients with probable vascular dementia: the VantagE study. Curr Med Res Opin 2008; 24(9):2561–74.
49.Orgogozo, J, Rigaud, A, Stoffler, A et al. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke 2002; 33: 1834–9.
50.Wilcock, G, Möbius, HJ, Stöffler, A. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500). Int Clin Psychopharmacol 2002; 17: 297305.
51.NICE. Alzheimer’s disease – donepezil, galantamine, rivastigmine and memantine. Technology Appraisal 217. National Institute for Health and Clinical Excellence, 2011.
52.Erkinjuntti, T, Román, G, Gauthier, S et al. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke 2004; 35: 1010.
53.Román, G. Therapeutic strategies for vascular dementia. In Dementia (eds Burns, A, O’Brien, J, Ames, D): 574600. Hodder Arnold, 2005.
54.Bahar-Fuchs, A, Clare, L, Woods, B. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003260.
55.Alexopoulos, GS, Meyers, BS, Young, RC et al. ‘Vascular depression’ hypothesis. Arch Gen Psychiat 1997; 54: 915–22.
56.Sheline, YI, Pieper, CF, Barch, DM et al. Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiat 2010; 67: 277–85.
57.Banerjee, S. The Use of Antipsychotic Medication for People with Dementia: Time for Action. Department of Health, London, 2009.
58.McGuinness, B, Todd, S, Passmore, P et al. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database. John Wiley & Sons, 2009.
59.Forette, F, Seux, ML, Staessen, JA et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Int Med 2002; 162: 2046–52.
60.Tzourio, C, Anderson, C, PROGRESS Collaborative Group et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Int Med 2003; 163: 1069–75.
61.Bowler, JV. Modern concept of vascular cognitive impairment. Br Med Bull 2007; 83: 291305.