Treatment

Progression of cerebrovascular disease can be arrested or slowed via various approaches. Primary prevention focuses on control of risk factors for cerebrovascular disease such as hypertension, hyperlipidemia, diabetes mellitus, and smoking. Secondary prevention of cerebrovascular disease mainly focuses on the use of anticoagulant medications such as warfarin and antiplatelet agents to prevent cerebral infarction (Kaplan and Sacco, 2002). Limited evidence suggests that these preventive approaches can improve or stabilize patients with VaD. Elevated homocysteine levels are usually treated with folate supplementation.

Limited research has suggested a role for cholinesterase inhibitors in the treatment of VaD. In a small case series, Mendez and colleagues (1999) found that donepezil seemed to improve processing speed, arousal, and behavioral initiation in patients with VaD.

Psychopathology is a frequent accompaniment of VaD as outlined above and can be approached in much the same way that it is approached in other conditions. In using psychotropic medications in VaD patients, the fact that the patients may be susceptible to parkinsonism should be kept in mind.

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