Vascular dementia revised

Abstract

Vascular dementia is the second leading cause of dementia, right after Alzheimer's disease. It is a condition with great medical, social and economic burden. Although its concept has been recognized for over a century, disease mechanisms, diagnostic criteria and treatment modalities remain unclear and generate confusion and debate. Dementia and cerebrovascular disease share risk factors and neuropathology, and may contribute to VaD. Several mechanisms have been proposed, including vascular risk factors (hypertension, diabetes, hyperlipidemia) and behavioral factors (physical inactivity, obesity) as major substrate for both cerebrovascular disease and dementia. Also, macro and micro-embolic events and chronic brain hypoper fusion contribute to vascular dementia . Having in mind that disease mechanisms for vascular dementia and Alzheimer's disease are overlapping, and that clinical manifestations of cognitive impairment are often very similar, setting the diagnosis of vascular dementia is not an easy task. In clinical research, various diagnostic criteria are proposed. They are based on two major requirements: clinical diagnosis of dementia and its vascular origin. According to its multi causal nature, vascular dementia stands as a difficult condition to treat. Several therapeutic modalities have been offered; however, further investigation and trials with long-term follow-up are needed.