From: deputyfife23x@gmail.com   
      
   How does the treatment for vascular dementia differ from that of other   
   dementias?   
      
      
   Response from David B. Reuben, MD    
   Professor and Archstone Foundation Endowed Chair, Department of Medicine,   
   University of California, Los Angeles; Chief, Division of Geriatrics, UCLA   
   Medical Center, Santa Monica, California   
   Although there are considerable similarities between vascular dementia and   
   Alzheimer disease and signs and symptoms commonly overlap, the approach to   
   these different causes of dementia varies. For vascular dementia, there has   
   been an emphasis on the    
   reduction of vascular risk factors to prevent secondary progression of   
   cognitive decline due to subsequent strokes. Hence, standard lifestyle   
   interventions (ie, exercise, smoking cessation, weight loss if obese) are   
   recommended as well as aspirin,    
   antihypertensive therapy, and statins. These treatments have a strong evidence   
   base in prevention of cardiovascular events, including stroke, but the   
   evidence that they specifically reduce the risk for vascular dementia or   
   progression of dementia in    
   those with the disease is less clear.   
      
   The benefit of lowering blood pressure and the blood pressure target are   
   controversial. Although lowing blood pressure may prevent further strokes,   
   those who have existing cerebrovascular disease may need higher blood pressure   
   to maintain adequate    
   cerebral perfusion. Recently, the large Systolic Blood Pressure Intervention   
   Trial (SPRINT),[1] which aimed at a target systolic blood pressure <120 mm Hg,   
   was terminated early because of a reduction in overall cardiovascular events.   
   But the effect on    
   incident dementia has not yet been determined. Moreover, the benefit (and   
   potential risk) of aggressive blood pressure management may vary by age and   
   comorbidity. For example, among patients with diabetes, intensive lowering of   
   systolic blood pressure (   
   target <120 mm Hg) was associated with a greater decline in total brain volume   
   (a precursor to cognitive decline) compared with those having a less   
   aggressive target.[2]   
      
   Similarly, the benefit of diabetes control is uncertain, with some studies   
   demonstrating worse cognitive function associated with poorer blood sugar   
   control and some showing worse cognition with tighter control. With respect to   
   statins, a recent meta-   
   analysis found inconsistent evidence for an effect of statins on cognition   
   among persons who were cognitively intact.[3] A 2009 Cochrane review   
   identified two large randomized clinical trials that indicated no benefit of   
   statins on cognitive measures    
   despite reductions in serum cholesterol.[4] Nor was low-dose aspirin found to   
   preserve cognition in middle aged or elderly patients at increased   
   cardiovascular risk.[5]   
      
   Medications used to treat Alzheimer disease (acetylcholinesterase inhibitors   
   and memantine) are frequently used in the treatment of vascular dementia.   
   Cholinesterase inhibitors may have an effect on cognition in vascular   
   dementia.[6] They may also be    
   beneficial because Alzheimer disease often coexists with vascular dementia.   
   Overall, the effect of these drugs is small, of uncertain clinical   
   significance, and often without effects on functional status.[7] Data on   
   memantine are similar.   
      
   In summary, the current approach to treating vascular dementia differs from   
   that of treating Alzheimer disease in that it additionally focuses on treating   
   risk factors for vascular disease. The strength of evidence for effectiveness   
   of risk factor    
   reduction is still not robust, although it may be more convincing for primary   
   prevention of strokes and vascular dementia than for prevention of progression   
   of existing vascular dementia. Medications to treat Alzheimer disease are also   
   used both because    
   of possible effectiveness in treating vascular dementia and for treatment of   
   possible coexisting Alzheimer disease.   
      
   Developed in association with the UCLA Alzheimer's and Dementia Care Program   
      
      
      
   http://www.medscape.com/viewarticle/854503   
      
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