Treatment of vascular dementia Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Abstract

Scientific Department of Cognitive Neurology and Aging of ABN had a consensus meeting to write recommendations on treatment of vascular dementia, there was no previous issue. This disease has numerous particularities and can be considered a preventable dementia. Prevention treatment is primary care of vascular risk factors or a secondary prevention of factors that could cause recurrence of ischemic or hemorrhagic brain modifications. In these guidelines we suggested only symptomatic treatment, pharmacologic or non-pharmacologic. We have reviewed current publications on MEDLINE (PubMed), LILACS e Cochrane Library databases. Recommendations are concern to the following factors and their prevention evidences, association, or treatment of vascular dementia: physical activity, tobacco use, diet and food supplements, arterial hypertension, diabetes mellitus, obesity, statins, cardiac failure, atrial fibrillation, antithrombotics, sleep apnea, carotid revascularization, symptomatic pharmacological treatment.

Estenose aórtica grave associada a demência vascular em paciente geriátrico, um relato de caso / Serious aortic stenosis associated with vascular dementia in a geriatric patient, a case report

“…A presença de hipertensão arterial ao longo da vida está associada ao risco aumentado de lesões cerebrais. A hipertrofia miocardica pode estar relacionada ao tempo de exposição e a gravidade da HAS e a outros fatores cardiovasculares, logo servindo como marcador da cronicidade e gravidade para a DV (10) . A hipercolesteromia é outro fator que contribui para a patogênese da sindrome demencial, a medida que aumenta os riscos de aterosclerose.…”

Vascular Brain Disease in Geriatric Neuropsychiatry

“…The use of donepezil showed good tolerability and may improve cognitive and functional status. Rivastigmine has shown to be effective on cognition, although with an effect size proportionally lower than donepezil [62].…”

“…Both hypertension and diabetes and have been related to the higher incidence of VCI. Blood glucose control should be moderate (glycated hemoglobin between 7 and 7.9%); however, scarce evidence for a specific class of antihypertensive drugs remains [6,62]. Patients with heart disease, e.g., atrial fibrillation, should be carefully monitored for appropriate anticoagulation levels.…”

“…Memantine, an NMDA antagonist, would act on the toxic action caused by glutamatergic overactivation, putatively exhibiting brain neuroprotective properties. There is also a need for further evidence demonstrating the benefits of this medication in VAD, but some specialists point to a possible improvement in subcortical conditions [62].…”

Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Assim, a prática de atividade física de intensidade leve a moderada deve ser fortemente recomendada a todos os indivíduos no nível de atenção primária como forma de prevenção primária e secundária de CCV. Por outro lado, as evidências de que a reabilitação física reduz a perda cognitiva pós-AVC ainda são insuficientes 58 Estudos randomizados e controlados por placebo demonstram pouca eficácia de ChEI na demência vascular pura 60,61 . Há um benefício cognitivo estatisticamente significativo, mas clinicamente leve, para funções cognitivas, principalmente velocidade de processamento e funções executivas 62 .…”