Vascular dementia: prevention and treatment.
BACKGROUND
Vascular dementia (VaD) is the most common cause of dementia in the elderly, second only to Alzheimer's disease (AD). Between 1% and 4% of people of 65 years of age suffer from VaD and the prevalence appears to double every 5-10 years after the age of 65.


CONCLUSIONS
Prevention aims to reduce the disease by eliminating its cause or main risk factors, particularly hypertension as well as diabetes mellitus, atherosclerosis, coronary artery disease, smoking, lipid abnormalities, and hyperhomocystinemia. Initial studies of several agents for symptomatic treatment were disappointing. However, there is growing evidence for cholinergic involvement in VaD and recent studies with cholinesterase inhibitors have shown improvement in cognitive, global function, and activities of daily living as compared with placebo and have been well tolerated.


CONCLUSIONS
VaD is a common condition and its prevalence is likely to increase. As physicians we need to be diligent with regards to recognition of risk factors and vigorous intervention. Promising results have been seen in several clinical trials of cholinesterase inhibitors and no safety of tolerability issues have been noted.
McVeigh
Catherine
C
Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, Queen's University of Belfast, Belfast, Northern Ireland, UK. catmcveigh@hotmail.com
Passmore
Peter
P
D000368:Aged; D015140:Dementia, Vascular / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology