Vascular Dementia

Pathophysiology: Many subtypes of vascular dementia have been described to date. The spectrum includes (1) mild vascular cognitive impairment, (2) multi-infarct dementia, (3) vascular dementia due to a strategic single infarct, (4) vascular dementia due to lacunar lesions, (5) vascular dementia due to hemorrhagic lesions, (6) Binswanger disease, (7) subcortical vascular dementia, and (8) mixed dementia (combination of AD and vascular dementia). Vascular dementia is sometimes further classified as cortical or subcortical dementia.

Disease statistics: In a general population aged 75 years and older, the prevalence of a disorder fulfilling the diagnostic criteria of DLB is half that of Alzheimer's disease and the same as for vascular dementia. Vascular dementia accounts for ∼22.7% of the prevalence.

Treatment: Drug treatment is primarily used to prevent further worsening of vascular dementia by treating the underlying disease such as hypertension, hyperlipidemia, and diabetes mellitus. Antiplatelet agents are indicated. Pentoxifylline and, to a more limited extent, ergoloid mesylates (Hydergine), may be useful for increasing cerebral blood flow.

Research: In 2012, the President announced the National Plan to Address Alzheimer’s Disease, a national effort to expand research in Alzheimer’s and related dementias prevention and treatment and to move the most promising drugs from discovery into clinical trials. The Plan aims to prevent and effectively treat Alzheimer’s and related dementias by 2025. Its foundation is the 2011 National Alzheimer’s Project Act (NAPA), which was developed to create and maintain a national strategy to overcome the disease.