Pharmacotherapeutic options in vascular dementia

The term vascular dementia (VaD) refers to dementia syndromes which are caused by hypoxic-ischaemic brain lesions. Lesions found in vascular dementia, such as complete and incomplete infarctions, selective necroses and others, lack any neuropathological specificity. There is a high comorbidity of Alzheimer’s disease (AD) and vascular dementia. It can be presumed that ischaemic lesions and Alzheimer-like pathological changes exert additive effects in the manifestation of the clinical dementia syndrome.

Present diagnostic criteria, such as ICD-10, DSM IV, NINDS-AIREN (Roman et al.1993), ADDTC (Chui et al. 1992) show little congruence. Estimates of the prevalence depend highly on the set of criteria used. Hence, they differ considerably. Among others, age and preexisting brain atrophy are risk factors for the development of VaD. Additionally disturbances of lipid metabolism and blood pressure may be important risk factors for VaD and even for AD. To influence these parameters is of prophylactic and therapeutic importance. Acetylcholinesteraseinhibitors and memantine remain the most convincing therapeutic options.