Vascular Dementia

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Kim Jackson  

Introduction

Vascular dementia is a heterogeneous category of brain disorders that cause cognitive impairment, and are attributable to cerebrovascular pathologies. It is responsible for at least 20% of cases of dementia, second in occurrence following Alzheimer’s disease. It usually occurs in patients with atherosclerosis and chronic hypertension that over time cause multiple white matter lesions or cortical infarcts. Patients with vascular dementia have a shortened life expectancy.

Epidemiology

Incidence is hard to discover but is strongly matched with age, occurring in 1% of patients greater than 55 years and in greater than 4% of patients over 71 years. To add to this uncertainty Alzheimer disease often co-occurs with vascular dementia. Also accelerated vascular changes occur in some people due to specific underlying disease not shown on vascular dementia studies. Risk factors for the development of vascular dementia include hyperlipidemia, hypertension, diabetes mellitus, and tobacco use.

Pathophysiology

Vascular dementia is an integral part of Alzheimer's and other geriatric neurodegenerative conditions associated with dementia, All form of vascular dementia have a similar pathogenic origin, resulting from hypoperfusion, oxidative stress and inflammation, which contribute to hemispheric white matter alterations. Demyelination and axonal loss also play a part in the wide ranging functional brain changes that underly cognitive impairment and the associated atrophy of the cerebral hemispheres.

Management

Dementias have no single treatments, with the focus being on treating individual risk factors (e.g. hypertension, smoking, hypercoagulation, atherosclerosis).

Alongside drug interventions, non-pharmacological interventions are used to treat the symptoms of dementia.

• Non-pharmacological Management eg Cognitive stimulation therapy; reminiscence therapy for mild to moderate dementia; cognitive rehabilitation or occupational therapy (working on functional goals of the individual and/or their carers).
• Lifestyle Modifications: Regular exercise and an active lifestyle; stimulating, personalised daily activities.

Prevention

In the absence of successful therapies, promoting and maintaining vascular health is critical to prevent both the vascular and neurodegenerative components of the vascular dementia. Vascular health is addressed by treating the risk factors eg. diabetes, hypertension, smoking, and hyperlipidemia. Mant studies proving that using antihypertensive medications reduces the risk of vascular dementia.

Physiotherapy Management

See Dementia main page