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Therapy of vascular dementia: perspectives and milestones

Rita Moretti, Paola Torre, Rodolfo M. Antonello and Giuseppe Cazzato

Cerebrovascular disease is common in the elderly and can cause a wide spectrum of impairments that range from mild to severe. Sensitive and specific definitions of cerebrovascular cognitive impairment are hampered by the fact that cerebrovascular disease is not easily linked to cognitive syndromes, either clinically or pathologically, and the presence of coincident Alzheimer’s disease is common. Importantly, however, it does appear that the dementia caused by brain vascular disease may share similar anatomical substrates with Alzheimer’s disease, supporting the notion of a common substrate to dementia. Treatment of vascular cognitive impairment may need to emphasize primary or secondary prevention of cerebrovascular risk factors such as hypertension, but some symptomatic treatments are beginning to show modest success. Raised awareness of cerebrovascular disease as a cause for cognitive impairment is likely to result in better detection and treatment, leading to improved cognitive health for our aging population. Patients with vascular dementia (VaD) show cholinergic deficits that may result in characteristic clinical syndromes for different subtypes of the condition. Subcortical VaD is characterized by executive dysfunction and behavioral problems, reflecting deterioration of the frontal lobe. It is still under consideration whether cholinesterase inhibitors may have any effects on the typical symptoms of VaD. The authors’ suggestion is that VaD is not a unique pathology: the etiopathogenesis of multi-infarct dementia and that of subcortical VaD are quite different. Future studies need to consider those entities separately to obtain good results, for a group of patients for whom, until now, there have been few therapeutic options.