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Vascular Dementia

Prevention And Treatment Of Vascular Dementia



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

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

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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.

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Additional topics

Medicine EncyclopediaAging Healthy - Part 4Vascular Dementia - Introduction, Historic And Conceptual Context, Epidemiology, Etiology And Pathophsyiology, Heterogeneity Of Vascular Dementias - Post-stroke dementia, Diagnostic criteria