Vascular Dementia

Vascular dementia vies with LBD as the second most common type of dementia in the United States. The rate is higher in areas with higher rates of hypertension. Conceptually, VaD refers to cases in which vascular disease produces cerebral injury severe enough to result in dementia. This fairly simple concept is made clinically challenging by the multiple types of vascular disease and the varying location and degree of the resulting cerebral injury. Cerebral damage may be hem-orrhagic, hypoxic, or anoxic. The vascular disease can occur in larger arteries, medium or small arterioles, or capillaries. VaD may be the result of a sentinel infarct, multiple infarcts, Binswager's disease, or vasculitis. Hypoxic damage related to systemic episodes of hypotension can also result in VaD.

Given the variety of causes and manifestations, it is not surprising that there are no uniformly accepted criteria for the diagnosis of VaD. It may be overdiagnosed, given the high prevalence of subclinical cerebrovascular disease seen in elderly persons, or underdiagnosed, given the lack of clear criteria for diagnosis. VaD is the most common second diagnosis in mixed dementia, a finding that has clinical significance: AD + VaD or LBD + VaD = more cognitive and functional deficits than AD or LBD alone (Schneider et al., 2007).

Treatment of the resulting dementia includes off-label use of cholinesterase inhibitors and memantine, as well as treatment directed at the control of vascular risk factors. Psychosocial approaches are similar to those used with dementia in general, as described earlier. Disclosure of the diagnosis of VaD to family members creates an opportune "teachable moment" to discuss familial risk and prevention.

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