title: Alzheimer's disease with cerebrovascular disease: current status in the Asia-Pacific region.
abstract: There is growing awareness of the coexistence of Alzheimer's disease and cerebrovascular disease (AD+CVD), however, due to lack of well-defined criteria and treatment guidelines AD+CVD may be underdiagnosed in Asia.
  
  
  
  Sixteen dementia specialists from nine Asia Pacific countries completed a survey in September 2014 and met in November 2014 to review the epidemiology, diagnosis and treatment of AD+CVD in Asia. A consensus was reached by discussion, with evidence provided by published studies when available.
  
  
  
  AD accounts for up to 60% and AD+CVD accounts for 10-20% of all dementia cases in Asia. The reasons for underdiagnosis of AD+CVD include lack of awareness as a result of a lack of diagnostic criteria, misdiagnosis as vascular dementia or AD, lack of diagnostic facilities, resource constraints and cost of investigations. There is variability in the tools used to diagnose AD+CVD in clinical practice. Diagnosis of AD+CVD should be performed in a stepwise manner of clinical evaluation followed by neuroimaging. Dementia patients should be assessed for cognition, behavioural and psychological symptoms, functional staging and instrumental activities of daily living. Neuroimaging should be performed using computed tomography or magnetic resonance imaging. The treatment goals are to stabilize or slow progression as well as to reduce behavioural and psychological symptoms, improve quality of life and reduce disease burden. First-line therapy is usually an acetylcholinesterase inhibitor such as donepezil.
  
  
  
  AD+CVD is likely to be under-recognised in Asia. Further research is needed to establish the true prevalence of this treatable and potentially preventable disease.
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore. christopher_chen@nuhs.edu.sg.|Memory Aging and Cognition Center, National University Health System, Singapore, Singapore. christopher_chen@nuhs.edu.sg.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: Research Institute for Dementia Care, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Homma
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: V C T
authors.initials: VC
authors.lastname: Mok
authors.affiliation: Neurokrish Consulting Pvt Ltd, Chennai, India.
authors.forename: E
authors.initials: E
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: S
authors.initials: S
authors.lastname: Alladi
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Meguro
authors.affiliation: Department of Neurology, Okayama University, Okayama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Abe
authors.affiliation: Memory Center, St Luke's Medical Center, Quezon City, Philippines.
authors.forename: J
authors.initials: J
authors.lastname: Dominguez
authors.affiliation: Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines.
authors.forename: S
authors.initials: S
authors.lastname: Marasigan
authors.affiliation: Department of Neurology, National Neuroscience Institute and Duke-NUS Singapore, Singapore, Singapore.
authors.forename: N
authors.initials: N
authors.lastname: Kandiah
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.|Neurocognitive Behavior Center, Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea.
authors.forename: D Y
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. asita@sltnet.lk.
authors.forename: H A
authors.initials: HA
authors.lastname: De Silva
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.|Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Division of Behavioral Neurology, Department of Neurology, Alzheimer's Disease Research Center, Medical College and Hospital, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Pai
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: V
authors.initials: V
authors.lastname: Senanarong
authors.affiliation: Eisai Co. Ltd, Mumbai, India.
authors.forename: A
authors.initials: A
authors.lastname: Dash
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D001208:Asia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D015897:Comorbidity; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D010139:Pacific Islands / Q000453:epidemiology; D015995:Prevalence; D014057:Tomography, X-Ray Computed
chemical_list: D002800:Cholinesterase Inhibitors
keywords: Alzheimer's disease; Asia; cerebrovascular disorders; consensus; dementia