Vascular cognitive impairment and vascular dementia
Abstract
In the developed world, 5–10 percent of people older than 65 years have dementia. One fifth of dementia aetiologies are due to vascular brain lesions (VaD – vascular dementia). A milder form is called vascular cognitive impairment (VCI). The main clinical criteria for VaD are: 1. cognitive decline verified by standardized cognitive test/scale, 2. evidence of the associated vascular brain lesion, 3. excluded reversible causes of cognitive decline.
The main risk factors for VaD are age, atherosclerosis, diabetes, and hypertension. They play a key role in the pathogenesis of cognitive impairment. Depending on the brain region damaged different cognitive domains can be affected with or without other neurological signs. These diversities in the clinical picture challenge the correct diagnosis. The unique feature of VaD is its progression, which can be stopped, if the patient receives an appropriate treatment.
The treatment of VCI and VaD symptoms is similar to that of Alzheimer’s disease. More importantly, VCI may be slowed down or even stopped with proper secondary stroke prevention and good rehabilitation. The most efficient is primary stroke prevention with healthy lifestyle and the treatment of acquired risk factors.
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