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Feature Article

Diagnosis and management of vascular dementia

Jeffrey C L Looi, Perminder Sachdev
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Abstract

Vascular dementia is one of the most common causes of dementia in the elderly population. Intervention in the early stages may help to prevent progression towards more severe cognitive impairment.

Key Points

  • Stroke is a major cause of vascular dementia; therefore, risk factors for stroke are risk factors for vascular dementia.
  • Vascular disease and Alzheimer’s disease co-occur in a significant proportion of patients. Cerebrovascular disease is known to promote clinical expression of Alzheimer’s disease.
  • In general, cognitive impairments secondary to vascular dementia are more varied than those seen in Alzheimer’s disease. Memory deficit may not be as marked in patients with vascular dementia.
  • Impairment of frontal lobe executive function is more prominent in vascular dementia than in Alzheimer’s disease, and is characterised by impaired organisation or judgement, and by behavioural changes. These frontal lobe deficits may significantly impair independent living before memory deficits are manifest.
  • Control of hypertension is one of the most established interventions for reducing the risk of vascular dementia. However, it is crucial to also make lifestyle changes that lower blood pressure. Modification of other cardiovascular risk factors and antiplatelet therapy may also reduce the risk of progression.
  • Management of psychiatric complications can greatly improve quality of life for patients and carers.
  • Liaison with specialists and aged care assessment teams can augment the care provided by the GP.

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