Vascular dementia

Advances in medical practice have significantly increased the longevity of our population during the last 100 years. As the number of persons with dementia has grown, the significance of the contribution of cerebrovascular disease has become apparent, and it is now recognized to be the second most frequent cause of dementia in Western countries and perhaps the most frequent cause of dementia in Asian countries. Factors that increase the risk of vascular dementia include stroke, particularly more severe strokes involving the left hemisphere; vascular risk factors, such as diabetes mellitus; and host characteristics, such as older age and fewer years of education. Genetic factors are causative in familial disorders such as CADASIL, and the apolipoprotein E 4 allele may also make a contribution. Certain patients with vascular dementia may exhibit the stereotypic clinical features of executive dysfunction and a stepwise course of cognitive decline, particularly when subcortical disease is predominant, but the clinical distinctions between cerebrovascular disease and Alzheimer's disease may be subtle, in part because those two diseases frequently coexist. Two approaches to the treatment of patients with vascular dementia should be considered. First, treatment for stroke prophylaxis, including the careful management of vascular risk factors, could be worthwhile. Second, a variety of agents that have been investigated for the treatment of Alzheimer's disease might also prove to be beneficial for patients with vascular dementia, including cholinesterase inhibitors, neuroprotective agents, statins, calcium-channel blockers, anti-inflammatory medications, and antioxidants.