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(Stroke. 2004;35:1010.)
© 2004 American Heart Association, Inc.

Emerging Therapies

Emerging Therapies for Vascular Dementia and Vascular Cognitive Impairment

Timo Erkinjuntti, MD; Gustavo Román, MD; Serge Gauthier, MD; Howard Feldman, MD Kenneth Rockwood, MD

From Helsinki University Central Hospital, Helsinki, Finland (T.E.); University of Texas Health Science Center at San Antonio and A. Murphy Veterans Administration Hospital, San Antonio, Tex (G.R.); Alzheimer’s Disease Research Unit, McGill Centre for Studies on Aging, Montreal, Quebec, Canada (S.G.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (H.F.); and Queen Elizabeth II Health Science Centre, Geriatric Medicine Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada (K.R.).

Reprint requests to Dr Gustavo Román, University of Texas Health Science Center at San Antonio, Medicine/Neurology, Mail Code 7883, 7703 Floyd Curl Dr, San Antonio, TX 78229-3900. E-mail romang{at}uthscsa.edu

Abstract

Background— Cerebrovascular disease (CVD) and ischemic brain injury secondary to cardiovascular disease are common causes of dementia and cognitive decline in the elderly. CVD also contributes to cognitive loss in Alzheimer disease (AD).

Summary— Progress in understanding vascular cognitive impairment (VCI) and vascular dementia (VaD) has resulted in promising symptomatic and preventive treatments. Cholinergic deficits in VaD due to ischemia of basal forebrain nuclei and cholinergic pathways can be treated with cholinesterase inhibitors used in AD. Controlled clinical trials with donepezil and galantamine in patients with VaD, as well as in patients with AD plus CVD, have demonstrated improvement in cognition, behavior, and activities of daily living. The N-methyl-D-aspartate receptor antagonist memantine stabilized progression of VaD compared with placebo. Primary and secondary stroke prevention, in particular with control of hypertension and hyperlipidemia, can decrease VaD incidence.

Conclusions— From a public health viewpoint, recognition of VCI before the development of dementia and correction of vascular burden on the brain may lead to a global decrease of incident dementia.

Key Words: carbamates • cognitive disorders • dementia • galantamine • memantine • nimodipine • piperidines • vascular diseases • donepezil • rivastigmine

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