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  • Print publication year: 2019
  • Online publication date: June 2019

Chapter 7 - Vascular Dementia

Summary

Historically, the presence of vascular risk factors with imaging evidence of cerebral ischaemic/small vessel changes pointed towards a diagnosis of vascular dementia (VaD). This certainty, however, has been challenged by more recent evidence linking cerebrovascular risk factors readily attributed to VaD with the pathogenesis of Alzheimer’s disease (AD). Further diagnostic complication relates to the fact that the presence of cerebrovascular disease can also be encountered in other dementias and in those with no cognitive impairment. In one UK naturalistic memory clinic study, for example, more than 80% of patients diagnosed with AD (mean Hachinski Ischemic score < 1) had some evidence of cerebrovascular disease reported on their magnetic resonance imaging (MRI) brain scans [1]. Notwithstanding the challenges faced in diagnosing VaD and the heterogenous nature of the disorder, it is universally recognised that VaD is probably the second most common type of dementia after AD and remains a major public health problem [2].

1Tabet, N., Quinn, R., Klugman, A. (2009) ‘Prevalence and cognitive impact of cerebrovascular findings in Alzheimer’s disease: A retrospective, naturalistic study’. Int J Clin Pract 63: 338–45.
2Gorelick, P. B., Scuteri, A., Black, S. E., et al. (2011) ‘Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association’. Stroke 42: 2672–713.
3Yang, T., Sun, Y., Lu, Z., et al. (2017) ‘The impact of cerebrovascular aging on vascular cognitive impairment and dementia’. Ageing Res Rev 34: 1529.
4Prins, N. D., Scheltens, P. (2015) ‘White matter hyperintensities, cognitive impairment and dementia: An update’. Nat Rev Neurol 11: 157–65.
5Popescu, B. O., Toescu, E. C., Popescu, L. M., et al. (2009) ‘Blood-brain barrier alterations in ageing and dementia’. J Neurol Sci 283: 99106.
6Harris, J. J., Attwell, D. (2012) ‘The energetics of CNS white matter’. J Neurosci 32: 356–71.
7Garcia, P. Y., Roussel, M., Bugnicourt, J. M., et al. (2013) ‘Cognitive impairment and dementia after intracerebral hemorrhage: A cross-sectional study of a hospital-based series’. J Stroke Cerebrovasc Dis 22: 80–6.
8Hachinski, V. C., Lassen, N. A., Marshall, J. (1974) ‘Multi-infarct dementia – Cause of mental deterioration in the elderly’. Lancet 2: 207–10.
9Roman, G. C., Ekrjuntii, T., Wallin, A., et al. (2002) ‘Subcortical ischaemic vascular dementia’. Lancet Neurology 1: 426–36.
10Roman, G. C., Tatemichi, T. K., Erkinjuntti, T., et al. (1993) ‘Vascular dementia: Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop’. Neurology 43: 250–60.
11O’Brien, J. T., Thomas, A. (2015) ‘Vascular dementia’. Lancet 386: 1698–706.
12Hachinski, V. C. (1994) ‘Vascular dementia – A radical redefinition’. Dementia 5: 130–2.
13Scrobot, O. A., Black, S. E., Chen, C., et al. (2017) ‘Progress towards standardised diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment in Cognition Classification Consensus Study’. Alzheimers Dement 14(3): 280–92.
14Jorm, A. F., Jolley, D. (1998) ‘The incidence of dementia: A meta-analysis’. Neurology 51: 728–33.
15Barbay, M., Taillia, H., Nedelec-Ciceri, C., et al. (2017) ‘Vascular cognitive impairment: Advances and trends’. Rev Neurol (Paris) 173: 473–80.
16Kalaria, R. N. (2010) ‘Vascular basis for brain degeneration: Faltering controls and risk factors for dementia’. Nutr Rev 68(Suppl 2): S74S87.
17Ikram, M. A., Bersano, A., Manso-Calderón, R., et al. (2017) ‘Genetics of vascular dementia – Review from the ICVD working group’. BMC Med 15: 48.
18Stefanova, E., Pavlovic, A., Jovanovic, Z., et al. (2012) ‘Vascular risk factors in Alzheimer’s disease – Preliminary report’. J Neurol Sci 322: 166–9.
19Hoffmann, M. (2013) ‘The human frontal lobes and frontal network systems: An evolutionary, clinical, and treatment perspective’. ISRN Neurol: 892459.
20Korczyn, A. D., Vakhapova, V., Grinberg, L. T. (2012) ‘Vascular dementia’. J Neurol Sci 322: 210.
21Matthews, F. E., Brayne, C., Lowe, J., et al. (2009) ‘Epidemiological pathology of dementia: Attributable-risks at death in the Medical Research Council Cognitive Function and Ageing Study’. PLoS Med 6: e1000180.
22Wahlund, L. O., Barkhof, F., Fazekas, F., et al. (2001) ‘A new rating scale for age-related white matter changes applicable to MRI and CT’. Stroke 32: 1318–22.
23Ashby-Mitchell, K., Burns, R., Shaw, J., Anstey, K. J. (2017) ‘Proportion of dementia in Australia explained by common modifiable risk factors’. Alzheimers Res Ther 9: 11.
24Rakesh, G., Szabo, S. T., Alexopoulos, G. S., Zannas, A. S. (2017) ‘Strategies for dementia prevention: Latest evidence and implications’. Ther Adv Chronic Dis 8: 121–36.
25Farina, N., Rusted, J., Tabet, N. (2014) ‘The effect of exercise interventions on cognitive outcome in Alzheimer’s disease: A systematic review’. Int Psychogeriatr 26: 918.
26Wilkinson, D., Róman, G., Salloway, S., et al. (2010) ‘The long-term efficacy and tolerability of donepezil in patients with vascular dementia’. Int J Geriatr Psychiatry 25: 305–13.
27Kandiah, N., Pai, M. C., Senanarong, V., et al. (2017) ‘Rivastigmine: The advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia’. Clin Interv Aging 12: 697707.
28Erkinjuntti, T., Kurz, A., Gauthier, S., et al. (2002) ‘Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: A randomised trial’. Lancet 359: 1283–90.
29Orgogozo, J. M., Rigaud, A. S., Stöffler, A., et al. (2002) ‘Efficacy and safety of memantine in patients with mild to moderate vascular dementia: A randomized, placebo-controlled trial (MMM 300)’. Stroke 33: 1834–9.
30Rouch, L., Cestac, P., Hanon, O., et al. (2015) ‘Antihypertensive drugs, prevention of cognitive decline and dementia: A systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms’. CNS Drugs 29: 113–30.