Therapeutic Issues in Vascular Dementia: Studies, Designs and Approaches

Abstract

Vascular dementia (VaD) is a heterogeneous disorder arising from different types of cerebrovascular disease (CVD) and resulting in cognitive impairments that reflect the severity, location and extent of underlying damage. It can be subclassified into multiple cortical infarct, single strategic infarct, hemorrhagic and subcortical ischemic VaD, recognizing that all lesion subtypes can co-occur. In most population studies, VaD is the second commonest cause of dementia after Alzheimer's disease (AD), in the order of 20%. 1 Population autopsy studies, however, suggest that pure VaD is less frequent (< 10% of cases), while combined CVD and AD is the commonest neuropathological finding. 2,3 ABSTRACT: Vascular dementia (VaD) is a heterogeneous disorder resulting from various cerebrovascular diseases (CVD) causing cognitive impairment that reflects severity and location of damage. Epidemiological studies suggest VaD is the second commonest cause of dementia, but autopsy series report that pure VaD is infrequent, while combined CVD and Alzheimer's Disease(AD) is likely the commonest pathological-dementia correlate. Both diseases share vascular risk factors and benefit from their treatment. The most widely used diagnostic criteria for VaD are highly specific but not sensitive. Vascular Cognitive Impairment (VCI) is a dynamic, evolving concept that embraces VaD, Vascular Cognitive Impairment No Dementia (VCIND) and mixed AD and CVD. Clinical trials to date have focused on probable and possible VaD with beneficial effects evident for different drug classes, including cholinergic agents and NMDA agonists. Limitations have included use of cognitive tools suitable for AD that are insensitive to executive dysfunction. Disease heterogeneity has not been adequately controlled and subtypes require further study. Diagnostic VaD criteria now 13 years old need updating. More homogeneous subgroups need to be defined and therapeutically targeted to improve cognitive-behavioural outcomes including optimal control of vascular risk factors. More sensitive testing of executive function outlined in recent VCI Harmonization criteria and longer trial duration are needed to discern meaningful effects. Imaging criteria must be well-defined, with centralized review and standardized protocols. Serial scanning with quantification of tissue atrophy and lesion burden is becoming feasible, and cognitive interventions, including rehabilitation pharmacotherapy, with drugs strategically coupled to cognitive -behavioural treatments, hold promise and need further development.RÉSUMÉ: Préoccupations thérapeutiques dans la démence vasculaire : études, plans, approches. La démence vasculaire (DVa) est une entité hétérogène résultant de différentes maladies cérébrovasculaires (MCV) qui causent une atteinte cognitive reflétant la sévérité et la localisation des dommages. Les études épidémiologiques suggèrent que la DVa est la deuxième cause de démence, mais des études anatomopathologiques de matériel prélevé à l'autopsie démontrent que la MCV pure est rare et q...

The Aging Mind: Vascular Health in Normal Cognitive Aging

“…The term “vascular cognitive disorders” has been proposed as a way of defining cognitive disorders with a vascular contribution and is intended to cover a spectrum of impairment from mild to dementia 7 . To be able to identify cognitive deficits early enough to intervene, it is useful to define a category called “vascular cognitive impairment no dementia” (vCIND) 8 . The prevalence of vCIND may be as much as 3 million in the United States—as high as that for vascular cognitive impairment with dementia—but the true public health effect remains unknown 9 .…”

Hydrogen Sulfide Prevents Synaptic Plasticity from VD-Induced Damage via Akt/GSK-3β Pathway and Notch Signaling Pathway in Rats

“…Epidemiological studies show that vascular dementia (VD) is the second commonest cause of dementia after Alzheimer’s disease (AD), and results from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions [ 1 – 4 ]. The feature of VD is histopathological damage and progressive intellectual decline [ 5 ].…”

Comparison of integrated traditional Chinese and western medicine therapy on vascular cognitive impairment with no dementia

“…Previous studies have shown that VCIND can develop into vascular dementia (VD) (Dong et al, 2010). When VCIND does fully develop into dementia, it can be reversely controlled with medicine intervention (Black, 2007). Therefore, VCIND is the appropriate time for the prevention and control of VD.…”