Vascular dementia is a form of dementia in which vascular diseases of the brain and mental disorders coexist. It often coexists with Alzheimer’s disease.
It seems that the combination of degenerative and vascular lesions significantly increases the risk of cognitive decline. It is characterized by the impairment of various brain functions and is mainly due to the reduced blood flow to the brain after a stroke, large or small, mainly due to a heart condition (heart failure, atrial fibrillation, etc.) or due to chronic ischemic lesions.
The severity of vascular dementia depends on the extent of the damage caused acutely or chronically to the brain and the location of the damage within the brain.
Diagnosis of Vascular Dementia
The diagnosis of a vascular dementia is made by studying an MRI or CT scan of the brain and through a neuropsychological examination.
On CT scans of the brain, hypo- or hyperdense areas are observed, which mean thrombosis or intra-cerebral hematomas, usually old, associated with cortical atrophy. The findings are more important when they are bilateral and are mainly found in cortical areas related to mental functions.
Similarly, on MRI, areas of high signal appear around the ventricles of the brain or in other areas that have suffered cerebral damage due to ischemia or hemorrhage.
CT/MRI of the brain is important because it clarifies certain causes of reversible dementias, such as chronic subdural hematomas, frontal meningiomas and normal pressure hydrocephalus.
Treatment of Vascular Dementia
The treatment of Vascular Dementia is limited to prevention by addressing the risk factors that cause it as well as to the administration of drugs used for Alzheimer’s disease, as these two entities often coexist.
Irreversible risk factors include old age (with a significant increase in its incidence after the age of 65), male sex, genetic predisposition, history of previous history of strokes, family history of dementia as well as low level of education.
Dementia can be reversible if the classic risk factors for vascular disease (arterial hypertension, diabetes mellitus, dyslipidemia, obesity) that cause endothelial dysfunction, reduced production of nitric oxide (the most powerful endogenous vasodilator substance), disruption of self-regulation of brain perfusion, oxidative stress as well as inflammation of the vascular wall resulting in cerebral perfusion are addressed.