Vascular dementia

The term vascular dementia refers to the global cognitive deterioration caused by the existence of a cerebrovascular disease of the ischemic or hemorrhagic type, requiring a temporary link between both situations. It is a syndrome of multifactorial etiopathogenesis, a reflection of the great heterogeneity of cerebral vascular disease.

It is considered that 10% of deaths in developed countries are related to cerebrovascular accidents or stroke, which are also a very important reason for disability, especially in the elderly.

80% of cerebrovascular accidents are ischemic in nature with atherothrombotic or cardioembolic origin and about 20% are hemorrhagic in nature. In addition, it represents the second cause of dementia, with 20-30% of cases.

The main risk factors for the development of cerebrovascular disease are well known, such as advanced age, high blood pressure, diabetes mellitus, dyslipidemia, smoking, alcohol and joint fibrillation. Adequate control of these factors should lead to a reduction in the incidence and prevalence of vascular dementia.

In complementary imaging tests (brain scan, nuclear magnetic resonance) or neuroimaging, the characteristic images of this type of dementia are appreciated and correspond to the lesions in the brain. Depending on the affected areas, this will be the type of dementia developed.

Lesions in brain tissue that are classically related to vascular dementia are cerebral cortex infarcts, lacunar infarcts (small infarcts with a summative effect), and diffuse ischemic involvement of the cerebral white matter. These alterations affect the areas of integration of common acts (praxis), language management, calculation, memory storage, and visual and spatial coordination.

The main risk factors for the development of cerebrovascular disease are well known, such as advanced age, high blood pressure, diabetes mellitus, dyslipidemia, smoking, alcohol and joint fibrillation. Adequate control of these factors should lead to a reduction in the incidence and prevalence of vascular dementia.

Clinically, unlike dementia caused by Alzheimer's disease (gradual and insidious onset over time), vascular dementia generally has a sudden onset and usually progresses in leaps (clinical worsening with each cerebrovascular event that suffers the patient), with a relative preservation of personality and memory.

Patients with this disease also tend to have early impairment of the ability to walk, with other motor disturbances and symptoms of early urinary incontinence (both rare in Alzheimer's disease up to more advanced stages), as well as greater emotional lability and tendency to depression. In general, the fundamental characteristic is that its symptoms depend on the location of the damaged brain areas, which is usually irregular.

Treatment

The treatment of vascular dementia inevitably involves the prevention of new cerebrovascular accidents, the rehabilitation as far as possible of the neurological focal points and the supportive treatment of the patients.