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Vascular Dementia - Prevention And Treatment Of Vascular Dementia

aging clinical disease hachinski journal erkinjuntti

Primary prevention aims to reduce the incidence of a disease by eliminating its causes or main risk factors. In VaD dementia the targets are CVD, including arterial hypertension, atrial fibrillation, myocardial infarction, coronary heart disease, diabetes, generalized atherosclerosis, lipid abnormalities and smoking. In addition, the use of estrogen, anti-inflammatory agents and antioxidants appear to reduce the risk of VaD.

Secondary prevention aims to prevent established disease from progressing. It emphasizes early detection and treatment. Treatment is aimed at treating the underlying cause, such as large artery disease (e.g., aspirin, dipyridamole, clopidragril, carotid endarterectomy), cardiac embolic events (e.g. anticoagulation, spirin), small-vessel disease (e.g. antiplatelet therapy as in large vessel disease), and hemodynamic mechanisms (e.g. control of hypotension and cardiac arrythmias).

How well all this works still is unclear. While a considerable degree of progress in our understanding of vascular dementia has been made, it is clear that much needs to be done before we will have effective treatment of this common and disabling problem.

TIMO ERKINJUNTTI KENNETH ROCKWOOD

BIBLIOGRAPHY

CHUI, H. C. ‘‘Rethinking Vascular Dementia: Moving from Myth to Mechanism.’’ In The Dementias. Edited by J. H. Growdon and M. N. Rossor. Boston: Butterworth-Heinemann, 1998. Pages 377–401.

Erkinjuntti, T., and Hachinski, V. C. ‘‘Rethinking Vascular Dementia.’’ Cerebrovascular Diseases 3 (1993): 3–23.

ERKINJUNTTI, T.; BOWLER, J. V.; DECARLI, C.; et al. ‘‘Imaging of Static Brain Lesions in Vascular Dementia: Implications for Clinical Trials.’’ Alzheimer’s Dis Assoc Disord 13 (1999): S81–90.

ERKINJUNTTI, T.; OSTBYE, T.; STEENHUIS, R.; and HACHINSKI, V. ‘‘The Effect of Different Diagnostic Criteria on the Prevalence of Dementia.’’ New England Journal of Medicine 337 (1997): 1667–1674.

FRATIGLIONI, L.; LAUNER, L. J.; ANDERSEN, K.; et al. ‘‘Incidence of Dementia and Major Subtypes in Europe: A Collaborative Study of Population-Based Cohorts.’’ Neurology 54 (2000): S10–S15.

Hachinski, V. ‘‘Preventable Senility: A Call for Action Against the Vascular Dementias’’ [see comments]. [Review]. Journal of the American Geriatrics Society 340 (1992): 645–648.

Hachinski, V. C.; Lassen, N. A.; and Marshall, J. ‘‘Multi-infarct Dementia. A Cause of Mental Deterioration in the Elderly.’’ Journal of the American Geriatrics Society ii (1974): 207–210.

HEBERT, R., and BRAYNE, C. ‘‘Epidemiology of Vascular Dementia.’’ Neuroepidemiology 14 (1995): 240–257.

KONNO, S.; MEYER, J. S.; TERAYAMA, Y.; MARGISHVILI, G. M.; and MORTEL, K. F. ‘‘Classification, Diagnosis, and Treatment of Vascular Dementia.’’ Drugs & Aging 11 (1997): 361–373.

LOBO, A.; LAUNER, L. J.; FRATIGLIONI L.; et al. ‘‘Prevalence of Dementia and Major Subtypes in Europe: A Collaborative Study of Population-Based Cohorts.’’ Neurology 54 (2000): S4–S9.

Moroney, J. T.; Bagiella, E.; and Desmond, D. W., et al. ‘‘Meta-analysis of the Hachinski Ischemic Score in Pathologically Verified Dementias.’’ Neurology 49 (1997): 1096–1105.

ROCKWOOD, K.; BOWLER, J.; ERKINJUNTI, T.; HACHINSKI, V.; and WALLIN, A. ‘‘Subtypes of Vascular Dementia.’’ Alzheimer Dis Assoc Disord 13 (1999): S59–S64.

Skoog, I. ‘‘Status of Risk Factors for Vascular Dementia.’’ [Review]. Neuroepidemiology 17 (1998): 2–9.

Tomlinson, B. E.; Blessed, G.; and Roth, M. ‘‘Observations on the Brains of Demented Old People.’’ Journal of the Neurological Sciences 11 (1970): 205–242.

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