[Vascular dementia: diagnostic challenge and treatment].
BACKGROUND
Treatment of vascular dementia depends on accurate diagnosis and criteria for evaluation of therapeutic responses that are not well standardized.


METHODS
Diagnostic criteria for vascular dementia, tools for the assessment of its clinical course and current treatment options are sequentially reviewed.


RESULTS
Strict diagnostic criteria with high specificity should be selected in clinical trials. Tools for sequential assessment are not standardized. Clinical endpoints of real value for patients and caregivers are usually excluded from analysis. Prevention of recurrent cerebrovascular events is the only known treatment for stabilization and eventually recovery of cognitive and behaviour disturbances. Benefit may be obtained by adapting hospital or home environment and introducing daily routines minimizing stress and fatigue. The use of non-specific cerebral stimulants and so-called neuroprotective drugs is controversial. Careful neuropsychological evaluation guiding management of specific deficits and the use of psychiatric drugs in selected situations may also be useful.


CONCLUSIONS
Strict criteria for the diagnosis of vascular dementia and for the evaluation of treatment responses should be used in drug trials. Aside the secondary prevention of stroke, no drug therapy influencing cognition or neuronal damage has been proved to be useful in patients with vascular dementia.
André
C
C
Setor de Estudos em Doenças Cerebrovasculares, Hospital das Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Brasil.
D015140:Dementia, Vascular / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D018450:Disease Progression; D006801:Humans