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 Singapore, the prevalence of dementia and cognitive disorders is likely to increase rapidly over the coming years. We have the fastest ageing population in the Asia-Pacific region with15-20% of the total population above the age of 65 by the year 2030. At the present time it is estimated that we have about 25 000 patients with dementia and this number is set to increase to 53,000 by 2020.
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.