Vascular Dementia and a new Treatment Plan

It is estimated that, universally, the number of dementia suffering patients will increase from the current (2004) 19 million patients to 34 million patients in end of 2005, a result of the increasingly aging population. The most common type of dementia is Alzheimeraes disease accounting for about 2/3 of cases. Vascular dementia is the second in frequency cause of dementia. It represents the 15%-30% of dementias in the form of multiple cortical infarcts, subcortical arteriosclerotic encephaloparthy and lacunar infarct. Of decisive importance for the development of dementia is the presence of lesions in areas affecting the memory and the cognitive function such as the frontal white matter, the mesencephalon the thalamus, the hippocampus, the pons, the basal ganglion, the mammilary bodies and the genu of the internal capsule. The optimal treatment of hypertension (systolic, diastolic and pulse pressure) is significant for the prevention of clinical manifestation and for the progression of vascular dementia. Concerning the primary and secondary prevention of the stroke, the optimal treatment of hypertension in patients with stroke and in patients with high risk for developing a stroke or another cerebrovascular complication (such as the vascular dementia), demands the use of antihypertensive drugs. These drugs not only decrease the blood pressure but also have pleotropic effects concerning the pathogenesis, progression and prognosis of the ischemic brain lesions. According to the results of large scale randomized studies (Scandinavian Multi- Infract Dementia, Progress) the latest antihypertensive drugs such as: slow release calcium channel blockers, ACE inhibitors and angiotensin Π receptor blocking agents, seem to outclass the conventional antihypertensive treatment (beta- blockers, diuretics) concerning the prevention of brain tissue damage (probably due to additional actions), even though their antihypertensive effects remain the same. Furthermore, a number of other medications have been proposed for the treatment of cognitive decline, including NSAIDaeS, estrogen supplementation, melatonin and botanical agents, such as ginkgo biloba.
There are a number of psychoactive medications that are used for the purposes of restoring cognitive abilities, preventing further decline, and increasing functional status in patients with vascular dementia. These include cholinesterase inhibitors donepezil (ARICEPT). However, accumulated data horn clinical practice with typical Alzheimerdes disease patients, along with the outcome of additional clinical trials, will be critical in developing a more complete picture of donepezilaes efficacy. Thus, donepezil may prove preferable as a first-line treatment of vascular dementia.

Keywords: Vascular dementia, cognitive function, treatment