Emerging therapies for vascular dementia and vascular cognitive impairment.
BACKGROUND
Cerebrovascular disease (CVD) and ischemic brain injury secondary to cardiovascular disease are common causes of dementia and cognitive decline in the elderly. CVD also contributes to cognitive loss in Alzheimer disease (AD).


CONCLUSIONS
Progress in understanding vascular cognitive impairment (VCI) and vascular dementia (VaD) has resulted in promising symptomatic and preventive treatments. Cholinergic deficits in VaD due to ischemia of basal forebrain nuclei and cholinergic pathways can be treated with cholinesterase inhibitors used in AD. Controlled clinical trials with donepezil and galantamine in patients with VaD, as well as in patients with AD plus CVD, have demonstrated improvement in cognition, behavior, and activities of daily living. The N-methyl-D-aspartate receptor antagonist memantine stabilized progression of VaD compared with placebo. Primary and secondary stroke prevention, in particular with control of hypertension and hyperlipidemia, can decrease VaD incidence.


CONCLUSIONS
From a public health viewpoint, recognition of VCI before the development of dementia and correction of vascular burden on the brain may lead to a global decrease of incident dementia.
Helsinki University Central Hospital, Helsinki, Finland.
Timo
T
Erkinjuntti
Gustavo
G
Román
Serge
S
Gauthier
Howard
H
Feldman
Kenneth
K
Rockwood
D002219:Carbamates / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy*; D018849:Controlled Clinical Trials as Topic; D015140:Dementia, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000077265:Donepezil; D005702:Galantamine / Q000627:therapeutic use; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D048448:Phenylcarbamates; D010880:Piperidines / Q000627:therapeutic use; D012307:Risk Factors; D000068836:Rivastigmine; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D009626:Terminology as Topic
D002219:Carbamates; D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine