Vascular Cognitive Disorder. A Biological and Clinical Overview

Abstract

Although vascular dementia (VaD) represents the second most common cause of dementia after Alzheimer's disease (AD) in the elderly, and is referred as the "silent epidemic of the twenty-first century", there is still a controversy on terminology, classification and diagnostic criteria of VaD. The diagnosis of VaD resides in clinical criteria determining a cognitive impairment, the presence of cerebrovascular disease and, only in the case of post-stroke dementia or multi-infarct dementia, a temporal relationship between these. The search for a reliable biochemical tests helping in the diagnosis of VaD is so far not available. Several vascular risk factors have a role in the development of VaD and their identification and treatment are among the major aspects of management of VaD. A new line of research in this field is the study of genetic factors underlying vascular cognitive impairment which are: (1) genes predisposing to cerebrovascular disease, and (2) genes that influence brain tissue responses to cerebrovascular lesions. Evidence in favour of a coexistence of vascular and degenerative components in the pathogenesis of dementia in an elderly population comes from neuropathological and epidemiological studies. There is now a great debate whether VaD and AD are more than common coexisting unrelated pathologies and, instead, represent different results of synergistic pathological mechanisms. Preventive approaches aiming at reducing incident VaD by targeting patients at risk of cerebrovascular disease (primary prevention), or acting on patients after a stroke (secondary prevention) to prevent stroke recurrence and the progression of brain changes associated with cognitive impairment are mandatory therapeutic strategies.

Resveratrol Reverses the Synaptic Plasticity Deficits in a Chronic Cerebral Hypoperfusion Rat Model

“…1 It is reported that about 20% of dementia cases are diagnosed as VaD around the world. 2 Permanent occlusion of bilateral carotid arteries had been wildly used for the VaD model because of chronic cerebral hypoperfusion (CCH).…”

Biomarkers in vascular dementia: A recent update

“…potential biomarkers to correlate with the pathogenesis of VaD. However, further studies are needed to establish their clinical significance 47,60. The proposed biomarker genes predisposing to cerebrovascular disease are ACE, AGT, eNOS, PON, MTHFR, MEF2A, ALOX5, LTA, APOM, and PDE4D.…”

Stroke and Dementia in Atrial Fibrillation

“…Unfortunately, up to date there are no resolute clinical criteria for VCI, still the common clinical finding is progressive gait alteration and incontinence. (Battistin & Cagnin, 2010) And recently, there is a growing interest in the clinical and scientific area involving the elderly community in investigation of elderly fallers. Interestingly, recurrent fallers had lower MMSE scores than single fallers or non-fallers.…”