Neurological Manifestations of Vascular Dementia Treatment & Management

  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA   more...
 
Updated: Apr 10, 2012
 

Medical Care

The treatment of vascular dementia is symptomatic. Behavioral and psychiatric disturbances such as agitation, depression, and psychosis are common. Cerebrovascular disease should be treated by an internist and/or a neurologist familiar with the management of cerebrovascular disease.

  • Established protocols for the evaluation and treatment of stroke are available. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli.[13]
  • The presence of a rapidly progressive dementia and multiple strokes in a young patient may indicate uncommon causes of stroke such as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) or angiitis. If suspected on clinical grounds, these conditions should be excluded with the appropriate testing procedures (ie, skin biopsy, cerebral angiography). The decision to use anticoagulation in patients with vascular disease and dementia is particularly challenging because of the increased risk of falls and potential noncompliance in this group.
  • Patients with vascular dementia are prominently affected by depression and emotional incontinence. Both conditions respond well to treatment with serotonin reuptake inhibitors.
  • Patients with agitation may respond to environmental modification. Pharmacologic treatment can be useful in controlling agitation through sedation.
  • In a prospective study done by Ancelin et al (2012), no evidence was found that lipid-lowering agents given in late life reduced the risk of cognitive decline and dementia. However, it did raise the possibility that women with treatment-resistant high low-density lipoprotein (LDL) cholesterol may be at increased risk of decline in visual memory.[14]
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Surgical Care

No surgical intervention is established for treatment of vascular dementia.

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Contributor Information and Disclosures
Author

Jasvinder Chawla, MD, MBA  Chief of Neurology, Hines Veterans Affairs Hospital; Associate Professor and Director, Neurology Residency Training Program, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jaime Grutzendler, MD  Assistant Professor, Department of Neurology and Physiology, Northwestern University School of Medicine

Jaime Grutzendler, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience

Disclosure: Nothing to disclose.

Giovanni d'Avossa  MD, Lecturer, School of Psychology, Bangor University; NHS Honorary Consultant in Neurology

Disclosure: Nothing to disclose.

Fredy J Revilla, MD  Assistant Professor of Neurology, Head of Division of Movement Disorders, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati Veterans Affairs Medical Center

Fredy J Revilla, MD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Christopher Luzzio, MD  Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA  Professor of Neurology, University of Central Florida College of Medicine; Director of Cognitive Neurology, Director of Stroke Program, James A Haley Veterans Affairs Hospital

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Heart Association, and American Society of Neuroimaging

Disclosure: Nothing to disclose.

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