Heart & Brain 2003; Volume 10, Issue 1: pages HB 1 – HN 24

Vascular dementia (VaD) and Alzheimer"s disease (AD) are often described as distinct entities. Recent literature suggests that they may be part of a continuum, where pure VaD is quite rare, Alzheimer"s disease is only 40% of the total and AD with cerebrovascular disease makes up the majority of cases that present to memory clinics. This relationship between VaD and AD is highlighted by their common risk factors – especially cardiovascular. Pure VaD is a heterogeneous entity, now separated clinically and radiologically into cortical, subcortical and strategic infarct subtypes. The treatment of VaD includes the primary and secondary prevention of cardiovascular and cerebrovascular disease; and early signs of a dementia may not always involve memory loss. This can lead to late presentations of patients when the more obvious signs and symptoms occur. Consequently, dementia services should work more closely with cardiology and stroke services in order to detect early cases of VaD. This will be increasingly important as new treatments become available....

Stroke, cognitive impairment and dementia are well-established complications of long-standing hypertension. There is a considerable time lag, usually several decades, between the onset of hypertension and the occurrence of these complications. Although antihypertensive treatment has been shown to decrease the risk of a first stroke, little evidence is available on the effects of antihypertensive treatment on the incidence of recurrent cerebrovascular events, cognitive impairment and dementia. The results of recent studies addressing this issue are discussed, along with directions for future research....

Vascular disease is the most common treatable cause of dementia. Contemporary epidemiological models suggest that in developed Western societies, vascular disease alone accounts for about 15% of all dementia. In association with Alzheimer’s disease, however, it is suspected to be involved in at least 50% of all dementia. Recent research points to shared risk factors in vascular dementia and Alzheimer’s disease, and common pathogenetic processes are likely. The exact criteria required for a diagnosis of vascular dementia remain imprecise and poorly developed. Advances in brain structural and functional imaging provide the best prospects for improvement in vascular dementia diagnosis. Here we set out the major processes that impinge upon the health of neurones and may contribute to vascular dementia. Clinical trials of interventions that might slow progression of cognitive impairment to vascular dementia are fully justified and are likely to improve the care of many old people at particular risk of dementia....

Historically, the approach towards dementia associated with vascular disease has been to manage risk factors. Recent findings also suggest that symptomatic treatment is a realistic option, and cardiologists should be aware of treatments that are, or may soon be, available for their patients. Here, agents that have been evaluated for the symptomatic treatment of vascular dementia (VaD) are reviewed. In particular, the role of cholinesterase inhibitors is discussed. These agents are commonly used worldwide to treat the symptoms of Alzheimer’s disease (AD). Since most patients with VaD have concomitant AD, cholinesterase inhibitors may provide some benefits in these patients. In addition, these agents have demonstrated some efficacy in patients with possible or probable VaD....

Physicians aiming to prevent vascular disease, either when managing an individual patient or when designing a clinical trial, usually think about reducing the risk of stroke or ischaemic heart disease, or their combination. And, yet, an explosion in numbers of another vascular-related condition is looming, namely in dementia. This first edition of Heart & Brain focuses on dementia in general, and vascular dementia more specifically....