title: Vascular cognitive impairment: disease mechanisms and therapeutic implications.
abstract: The prevalence of vascular cognitive impairment (VCI) is likely to increase as the population ages and cardiovascular disease survival improves. We provide an overview of the definition and disease mechanisms of VCI and present a systematic literature review of the current evidence for the pharmacologic and nonpharmacologic therapies used to treat the VCI symptoms of cognitive dysfunction or to modify VCI through primary and secondary prevention. The Cochrane Database of Systematic Reviews was searched from 2005 to October 2010 using the keywords "vascular dementia" or "vascular cognitive impairment and therapy." MEDLINE was searched for English-language articles published within the last 10 years using the combined Medical Subject Headings (MeSH) "therapeutics and dementia," "vascular" or "vascular cognitive impairment." Although cholinesterase inhibitors and memantine produce small cognitive improvements in patients with VCI, these drugs do not improve global clinical outcomes and have adverse effects and costs. Selective serotonin reuptake inhibitors and dihydropyridine calcium channel blockers may improve short-term cognitive function in patients with VCI. Anti-hypertensive therapy with an ACE inhibitor-based regimen and statins may prevent the major subtype of VCI known as poststroke cognitive decline. Clinical and effectiveness studies with long-term follow-up are needed to determine the benefits and risks of pharmacologic and nonpharmacologic therapies to prevent and treat VCI. Given its growing health, social, and economic burden, the prevention and treatment of VCI are critical priorities for clinical care and research.
authors.affiliation: Division of General Medicine, University of Michigan Health System, and Ann Arbor VA Healthcare System, Ann Arbor, MI 48109, USA. deblevin@umich.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003704:Dementia / Q000150:complications / Q000188:drug therapy; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014652:Vascular Diseases / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D002317:Cardiovascular Agents; D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D014815:Vitamins