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Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer's disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from "severe dementia". Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. A pilot study has demonstrated the feasibility of the trial. The main study is in progress.
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PMID:Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project. 184 9

Vascular dementia is the second most common type of dementia in the elderly after the dementia of Alzheimer's disease. Six forms of vascular dementia have been described: multi-infarct dementia, lacunar dementia, Binswanger's subcortical encephalopathy, cerebral amyloid angiopathy, white-matter lesions associated with dementias, and single-infarct dementia. Each is described. Severe dementia is found in 5% of persons over age 65 and in 15% to 20% of persons over age 80 years. Alzheimer's disease accounts for 50% to 60% of cases of severe dementia and vascular dementia for 10% to 20%; 20% of the patients have both disorders. The incidence of vascular dementia, which seems to be declining, is about 7/1,000 persons/year. Hypertension is the most powerful risk factor for all vascular dementias. Vascular dementias can be accurately diagnosed by using clinical and mental state examinations, Diagnostic and Statistical Manual of Mental Disorders criteria, ischemic scores, and computed tomography or magnetic resonance imaging. The most successful treatment of vascular dementia is the prevention of cerebral infarcts. Study of the incidence of vascular dementias and their treatment will be included in the European Trial on Systolic Hypertension in the Elderly (SYST-EUR) of 3,000 elderly hypertensive patients.
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PMID:Hypertension and the risk of dementia in the elderly. 200 54

Vascular dementia (VaD) is the second commonest dementia after Alzheimer's disease (AD). Epidemiological studies of this condition suffer from many shortcomings related to definition of the disease, diagnostic criteria and assessment of subjects. The prevalence of VaD increases linearly with age and varies greatly from country to country, ranging from 1.2 to 4.2% of people over 65 years old, even after adjustment for age and sex. The incidence of VaD is more homogeneous than prevalence and is estimated at 6-12 cases per 1,000 persons over 70 years per year. The mean duration of the disease is around 5 years and survival is less than for the general population and for AD. The major risk factors for VaD appear to be hypertension, diabetes, heart disease and stroke. Although some of these risk factors are modifiable, there is no study on efficacy of prevention of VaD.
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PMID:Epidemiology of vascular dementia. 747 66

Vascular dementia and its most common subtype, multi-infarct dementia, are pathologically proven clinical entities. Their prevalence is not as high as previously thought, but they do represent a significant percentage of the population of demented patients. The diagnosis is more difficult to make than is the diagnosis of Alzheimer's disease; however, there are excellent criteria to guide the physician in making the diagnosis. At present the only treatment available is to control the risk factors responsible for the basic disease process; in the majority of cases this requires controlling hypertension.
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PMID:Multi-infarct dementia. 802 33

Vascular dementia is a clinical syndrome of acquired intellectual impairment resulting from brain injury due to a cerebrovascular disorder. It is a complex diagnosis, and diagnostic criteria vary. In community practice, the physician can probably make the diagnosis based on the history and medical examination. CT demonstration of one or more infarcts increases the likelihood of this diagnosis. Hypertension is a major risk factor for vascular dementia. Others include smoking, hyperlipidemia, atrial fibrillation, diabetes, and a sedentary lifestyle. Cerebrovascular disease is an important cause of cognitive decline in older patients. Therefore, it is important to recognize risk factors for stroke and institute measures for prevention.
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PMID:Vascular dementia: stroke prevention takes on new urgency. 822 23

Vascular dementia is seen much more often in people at age 85 than in those between the ages of 55 and 75. The differential diagnosis includes Alzheimer's disease and mixed dementia. The classic criteria for vascular dementia--stepwise deterioration and focal neurologic signs--are important, as focal neurologic signs usually don't occur in Alzheimer's disease. Identifying a significant number of points on the Hachinski scale, including hypertension, can help make a diagnosis of vascular disease. For more effective differential diagnosis, CT or MRI can be useful. However, not all clinicians are convinced of the necessity of imaging, as long as stroke risk factors such as hypertension and hyperlipidemia are managed for all older patients.
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PMID:Vascular dementia: how to make the diagnosis in office practice. 825 93

Vascular dementia is the most common cause of dementia in the elderly after Alzheimer's disease. Many forms of vascular dementia have been described: multi-infarct dementia, lacunar dementia, Binswanger's subcortical encephalopathy, cerebral amyloid angiopathy, white matter lesions associated with dementias, single infarct dementia, dementia linked to hypoperfusion and haemorrhagic dementia. The difficulty of diagnosing vascular dementia must not be underestimated and an international consensus is needed for epidemiological studies. The NINCDS-AIREN group has recently published diagnostic criteria. The State of California Alzheimer's Disease Diagnostic and Treatment Centers also proposed some which differ from the NINCDS-AIREN criteria in considering only ischaemic vascular dementia and not other mechanisms such as haemorrhagic or hypoxic lesions. Most studies stress hypertension as the most powerful risk factor for all forms of vascular dementia. The incidence rate ranges from 7 per 1000 person-years in normal volunteers to 16 per 1000 person-years in hypertensive patients. No therapeutic attempt has influenced the course of the disease once the dementing condition is established. The only effective approach is preventive treatment. The objective of the SYST-EUR Vascular Dementia project is to confirm that the treatment of isolated systolic hypertension is able to reduce its incidence.
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PMID:Assessing vascular dementia. 853 23

Vascular dementia (VD) and Alzheimer's type dementia are two main causes of dementia in the aged. Considering historical backgrounds and ethnic differences, a simplified classification of VD is suggested. First, poststroke dementia of acute onset associated with an infarct that is large enough to impair general cognitive functions, or strategically located. Second, multi-infarct dementia that develops incrementally with increasing numbers of infarcts, and which should be classified as multiple cortical infarct dementia and multiple small infarctor lacunar dementia. Third, vascular dementia of the Binswanger type (VDBT). We compared two types of white matter lesions, periventricular hyperintensity (PVH) and confluent centrum semiovale hyperintensity (CCSH) in lacunar stroke patients with regard to the cerebral blood flow (CBF). In patients with PVH, there was a significant positive correlation between the dementia scores and the CBF in the parietal and temporal areas but not in the frontal area. In CCSH patients, there was a significant positive correlation in the frontal area but not in the parieto-temporal areas. Therefore, dementia in most patients with PVH may not be primarily related to the PVH, but may possibly be due to coexisting Alzheimer's type dementia, and dementia in most CCSH patients may be related to cerebrovascular disease. VDBT is unique clinically in its slowly progressive intellectual deterioration and pathologically in diffuse, confluent, and almost symmetrical white matter lesions. For the pathogenesis of VDBT, our studies suggest that hypertension, short-term variations in blood pressure, and a sustained nighttime elevation of blood pressure promote small vessel disease and cause ischemia of the cerebral white matter that is located in the end-fields of penetrating arteries; this leads to an imparied integrity of the blood-brain barrier and free radical generation, both of which may have important roles in producing diffuse white matter degeneration.
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PMID:[Problems in vascular dementia]. 864 89

Differential diagnosis of dementing diseases is very important to rule in the so-called treatable dementia. The new DSM-IV criteria for dementia include memory disturbances and one or more of aphasia, apraxia, or frontal lobe dysfunctions as essentials. Alzheimer disease requires, in addition, slowly progressive course and ruling out other brain or systemic diseases. Vascular dementia requires focal neurological or neuroimaging signs. Other diseases which cause dementia include chronic subdural hematoma, infection and brain tumor. CT or MRI can readily diagnose them if suspected and they may be treated. Systemic diseases associated with treatable dementia include electrolyte disturbances, hypothyroidism, vitamin deficiency, alcohol or drug intoxication, syphilis and HIV infection. Prevention of dementia seems to be the future problem as we could prevent cerebrovascular diseases by treating hypertension.
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PMID:[Clinical aspects of dementia]. 875 26

The aetiology of the common dementias of old age remains incompletely understood. Here we describe some of the biological, neurophysiological and psychological changes associated with ageing of the human brain, in terms of those that occur throughout life and those that are characteristic of senescence. Age-dependent diseases, such as Alzheimer's disease (AD), idiopathic Parkinson's disease (IPD) and dementia with Lewy bodies (DLB), are considered from these viewpoints, and risk factors described. Vascular dementia (VaD) is related to hypertension and atherosclerosis and detailed description of its pathogenesis is outside the scope of this review. The importance of age as the main risk factor raises basic questions about the relationship of these diseases to the ageing process itself. Similarities and differences between ageing and disease may be important for a rational approach to prevention and treatment of cognitive decline and dementia in later life.
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PMID:Some developments in brain ageing and dementia. 949 98


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