How are risk factors for vascular dementia managed?

Updated: Mar 26, 2018
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA; Chief Editor: Glen L Xiong, MD  more...
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Answer

Vascular cognitive impairment is modifiable and preventable. Modifying vascular risk factors (eg, hypertension, diabetes mellitus, smoking, hyperhomocystinemia) and dietary factors (eg, hypercholesterolemia) in midlife may help to prevent stroke and vascular dementia. The single most important risk factor is hypertension. Epidemiologic cohort studies and intervention trials with antihypertensive medications demonstrated the usefulness of antihypertensive drugs in the prevention of vascular dementia.

Appropriate treatment for atrial fibrillation, coronary artery disease, congestive heart failure, and stroke is also recommended.

Adequate management of vascular risk factors, stroke, and heart disease in middle age may be the most effective way to prevent vascular dementia later in life. The distinction between vascular dementia and Alzheimer dementia is becoming increasingly blurred because vascular risk factors play a role in both diseases.

In patients with early cognitive impairment or with neuroimaging findings that demonstrate leukoaraiosis or stroke, secondary prevention can be facilitated by applying standard stroke-preventive therapies such as antiplatelet agents, warfarin, or carotid endarterectomy according to accepted guidelines.

A study by Vercambre et al examined data from participants in the Women's Antioxidant Cardiovascular Study; the findings revealed a significant difference in the rate of cognitive decline over 5 years (p< .003) among elderly women who had physical activity equivalent to daily 30 minutes walk at a brisk pace. Exercise may improve brain vascular health and strengthen the mechanisms underlying brain plasticity. [29]


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