Emerging Concepts in Vascular Dementia: A Review

Abstract

Objective: Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. Materials and methods: A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. Results: VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. Conclusions: This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.

Effects of aspirin on dementia and cognitive function in diabetic patients: the ASCEND trial

“…However, these observational analyses do not take account of any effects of aspirin mediated via subclinical events such as unreported TIAs, silent brain infarcts, microinfarcts, microbleeds, or cumulative small vessel disease. 5 , 27 , 28 …”

Electroacupuncture ameliorates neuroinflammation in animal models

“…Vascular dementia (VaD) is a neurocognitive disorder in which the impairment of cognitive function is directly related to cerebrovascular lesions, and factors such as age, race and genetics are also involved in the pathogenesis. 39 VaD is characterized by progressive cognitive dysfunction and is generally considered to be the second most common type of dementia in the elderly after AD. A variety of vascular lesions can lead to VaD, such as chronic cerebral hypoperfusion (CCH), small vascular lesions (leukoaraiosis and lacunar infarcts), microinfarcts, microhemorrhages, cerebral amyloid angiopathy, and mixed vascular lesions.…”

Electroacupuncture of the Baihui and Shenting acupoints for vascular dementia in rats through the miR-81/IL-16/PSD-95 pathway

“…Among the various forms of dementia, VaD has an incidence rate that is widely considered to be second only to that of Alzheimer's disease (AD) (1). A study shows that the pathogenesis of VaD is complex, which is caused by the damage of localized larger vessels in brain or cumulative cerebral smaller vascular diseases (2). Therefore, vascular injury is the key of neuronal loss and synaptic disintegration.…”