Vascular Cognitive Impairment and Vascular Dementia

Abstract

Vascular dementia (VaD) is the term applied to patients with an acquired dementia syndrome due to the effects of cerebrovascular disease. A variety of different vascular lesions can cause cognitive impairment, including clinical stroke, subclinical brain injury, global cerebral hypoperfusion, and cerebral hemorrhage. Cerebrovascular disease also frequently coexists with other pathologies in the aging brain commonly resulting in syndromes of cerebrovascular disease ``mixed'' with other neurodegenerative pathologies. Current diagnostic criteria for VaD require correlation of clinical features with neuroimaging findings. The prognosis and clinical course of VaD is more variable than other dementia syndromes and patients often stabilize (or even improve) after initial stroke. This process of decline and stabilization repeats itself with each additional vascular injury, resulting in a clinical course often described as ``stepwise''. When the cause of VaD is due to small vessel disease, the course is usually insidious, making it difficult to distinguish clinically from Alzheimer's disease (AD). Risk factor modification represents the primary treatment strategy for patients with VaD. Although there are no approved therapies to overcome cognitive impairment in VaD, several agents used in AD have demonstrated modest symptomatic benefits and may provide significant relief for patients and their caregivers.