Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.1.1.8 (cholinesterase)
 12,691 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular dementia (VaD) is the second-most-common cause of dementia in the elderly, after Alzheimer's disease (AD). VaD is defined as loss of cognitive function resulting from ischemic, hypoperfusive, or hemorrhagic brain lesions due to cerebrovascular disease or cardiovascular pathology. Diagnosis requires the following criteria: cognitive loss, often predominantly subcortical; vascular brain lesions demonstrated by imaging; a temporal link between stroke and dementia; and exclusion of other causes of dementia. Poststroke VaD may be caused by large-vessel disease with multiple strokes (multiinfarct dementia) or by a single stroke (strategic stroke VaD). A common form is subcortical ischemic VaD caused by small-vessel occlusions with multiple lacunas and by hypoperfusive lesions resulting from stenosis of medullary arterioles, as in Binswanger's disease. Unlike with AD, in VaD, executive dysfunction is commonly seen, but memory impairment is mild or may not even be present. The cholinesterase inhibitors used for AD are also useful in VaD. Prevention strategies should focus on reduction of stroke and cardiovascular disease, with attention to control of risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, and hyperhomocysteinemia.
 ...
PMID:Vascular dementia: distinguishing characteristics, treatment, and prevention. 1280 86

The diagnosis and treatment of vascular dementia (VaD) are particularly challenging because of its multiple causal lesions and the variety of its clinical presentations. Even poststroke dementia cases may be due to preexisting Alzheimer's disease. Diagnostic criteria for clinical trials have been implemented quite recently. Of the vasodilator agents, only the ergoloid mesylates have shown mild benefit. The calcium channel blocker nimodipine appears to be useful in subcortical VaD. Of the nootropic agents, memantine appears to be promising. Pentoxifylline produced significant improvement in multi-infarct VaD. Aspirin, triflusal and Ginkgo biloba extract were associated with some stabilization of dementia progression, perhaps due to their antiplatelet effects. Acetyl-cholinesterase inhibitors appear to be useful in improving memory and activities of daily living in VaD. Results of a large trial of donepezil in VaD should be available soon. Hyperbaric oxygen has been reported to be effective in Binswanger's disease. From the public health perspective, stroke prevention, particularly in atrial fibrillation, and the early and adequate treatment of arterial hypertension clearly decrease the incidence of VaD.
 ...
PMID:Perspectives in the treatment of vascular dementia. 1284 69