Vascular Dementia Clinical Trials
Memantine belongs to the aminoadamantane chemical class and is structurally similar to amantadine, an antiparkinson and antiviral drug. It was initially developed to treat Parkinsons disease and was first tested in Europe in the 1990s, and later in the US, as a neuroprotective compound. In addition to its propensity to release dopamine from dopaminergic terminals, memantine is a weak, noncompetitive, open channel antagonist of the glutamate NMDA receptor . Since NMDA receptor-mediated excitotoxic nerve cell death is considered of paramount importance in ischemic nerve cell damage, NMDA antagonist properties make memantine an attractive neuroprotective compound. On the other hand, NMDA receptor antagonists have been well known to cause hallucinations and impair cognition, attributes which have seriously hampered their clinical development.
Rivastigmine is a nonspecific inhibitor of two enzymes: acetylcholinesterase and butyrylcholinesterase . Rivastigmines efficacy in in vascular dementia has been studied insufficiently to draw any meaningful conclusions. One study conducted on 16 patients with vascular dementia showed some benefits of rivastigmine on executive function and behavior . More studies are needed to understand if rivastigmine could be used for treatment of vascular dementia.
Blood pressure-lowering therapies
Cognitive Impairment In Cerebrovascular Diseases
Cerebrovascular diseases include a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. These include conditions that may cause acute interruption of cerebral circulation and subsequent acute neuronal damage, such as ischaemic or haemorrhagic stroke, and disorders that may cause chronic pathological changes in small vessels and neurological dysfunction, such as cerebral small vessel diseases. Patients with cerebrovascular diseases, both acute and chronic, usually have multidimensional functional impairments to the brain and an increased risk of cognitive impairment and dementia.
The cognitive consequences of cerebrovascular disease may substantially affect patients quality of life and cause a considerable disease burden for patients and their families. Compared with other brain dysfunctions such as movement disorders, cognitive impairment and dementia due to cerebrovascular diseases are neglected by both patients and physicians in all countries, but especially in low income and developing countries such as China.
Research Into The Cause Of Vascular Dementia
Vascular dementia is the second most commonly diagnosed type of dementia, and may account for 15 – 20% of all cases. Vascular dementia is caused by chronic reduced blood flow to the brain, usually as a result of a stroke or series of strokes. It can often coexist with Alzheimer’s disease.
Stroke, small vessel disease, or a mixture of the two can cause vascular dementia. Most commonly there is a blockage of small blood vessels somewhere in the network of arteries that feeds the brain. Blockages may be caused by plaque build up on the inside of the artery wall, or by blood clots which have broken loose. Clots can form as a result of abnormal heart rhythms, or other heart abnormalities. Also, a weak patch on an artery wall can balloon outward and form an aneurysm, which can burst and deprive brain cells of oxygen.
It is estimated that about 50% of cases of vascular dementia result from high blood pressure, which can lead to a major stroke or a series of strokes and a build up of brain damage over time. Less common causes of vascular dementia are associated with autoimmune inflammatory diseases of the arteries such as lupus and temporal arteritis, which are treatable with drugs that suppress the immune system.
An inherited form of vascular dementia known as CADASIL is caused by a mutation on the Notch3 gene. This is a very rare form of dementia and only affects families carrying the Notch3 gene mutation.
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There Are Many Different Dementia Typesalzheimers Disease Lewy Body Dementia Vascular Dementia Its Easier To Keep Them Straight If You Think About Dementia Thats Reversible And Dementia That Isnt
There are many different dementia types, some that can be reversed.
Various dementia types can be caused by medical or psychiatric conditions, among them high fever, vitamin deficiency, head trauma, or depression. These are the so-called reversible dementias. Other dementia types are irreversible andif youre wondering, Is dementia hereditary?can be caused by family genes.
Lets look at reversible dementia first. Its important to see a doctor if youre experiencing sudden memory-loss symptoms, especially if your health has recently changed.
The following are among the more common causes of reversible dementia:
- Excess alcohol consumption
- Vitamin deficiency
Can Diet Prevent Or Slow Down Dementia
We hear so much from the media about what we should or should not eat. One day blueberries are the new so-called superfood that will reduce our risk of developing dementia, the next it is the humble plum.
But what information can we rely on to be accurate? Can the food we eat really reduce our risk of developing dementia? If a person has dementia, can their diet or use of supplements influence how they experience dementia or its progression?
Knowing what and what not to eat is so confusing, the messages seem to change daily!
Person with dementia
The brain requires a regular supply of nutrients in our diet to function and remain healthy. There is growing recognition that what we eat affects the way our brains work and our mental health, as well as our physical health.
Traditionally research undertaken to investigate the connection between diet, cognitive function and risk of dementia has primarily focused on the impact of individual nutrients on brain health. Those nutrients commonly researched include: vitamins B6, B12, C, E and folic acid, as well as omega 3 essential fatty acids. The outcome of such research has been inconclusive and thus guidelines to advise on specific nutrient intakes have not been developed. In this feature well explore some of the ongoing research on this topic.
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What Is Vascular Dementia
Compared to Alzheimer’s disease, which happens when the brain‘s nerve cells break down, vascular dementia happens when part of the brain doesn’t get enough blood carrying the oxygen and nutrients it needs.
Though they happen in different ways, it is possible to have both vascular dementia and Alzheimer’s disease. Discouraging as this sounds, there is ample reason to control the risk factors that contribute to vascular dementia. Allowing the condition to run its course without intervention can make Alzheimer’s disease worse.
Control Your Blood Pressure
Hypertension or high blood pressure is strongly associated with an increased risk of dementia. High blood pressure can damage tiny blood vessels in the parts of the brain responsible for cognition and memory. The latest American Heart Association guidelines class blood pressure readings of 130/80 mm Hg and above as the start of high blood pressure.
Check your blood pressure at home. A study in the Netherlands found that a large variation in blood pressure readings over a period of years was associated with an increased risk of dementia. Inexpensive monitors that wrap around your upper arm can help you keep track of your blood pressure throughout the day and pick up on any variations. Some devices even send the results to your phone so you can easily track your readings or share them with your doctor.
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Treatment Of Vascular Dementia
I did not characterize Ms. Wilsons condition as dementia because she remained independent for the most part. She was still successfully keeping house, managing her bills, and driving without noticeable difficulty although she felt more cautious on unfamiliar roads. She and her husband were right to be concerned, though, because her difficulties with planning, focusing her attention, remembering instructions, and an increasing need for work arounds such as a cheat sheet to use the computer are characteristic signs of mild cognitive impairment.
Her depressive symptoms and MRI findings, along with diseases known to affect the health of her arteries , suggested that the cause of her mental changes was vascular. That means that her brains function was suffering as a result of damaged blood supply and related consequences of vascular disease.
Support And Other Therapies
There are also several therapies and practical measures that can help make everyday living easier for someone with dementia.
- occupational therapy to identify problems in everyday life, such as getting dressed, and find practical solutions
- speech and language therapy to help improve communication problems
- physiotherapy to help with movement difficulties
- psychological therapies, such as cognitive stimulation
- relaxation techniques, such as massage, music or dance therapy
- social interaction, leisure activities and other dementia activities, such as memory cafes
- making changes to your home, such as removing loose carpet and potential trip hazards, making sure the home is well lit, and adding grab bars and handrails
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Treatment Of Major Depressive Disorder To Prevent Cognitive Decline
Antidepressant and mood-stabilizing strategies have also been examined in patients who already have some degree of cognitive impairment. In a group of healthy subjects, 60 mg of citalopram given in divided doses of 30 mg reduced production by 38% compared with placebo. In a group of 45 patients with MCI treated with lithium versus placebo, treatment with lithium titrated to a blood level of 0.250.5 mEq/l for a year slowed down cognitive deterioration compared with placebo, as measured with the Alzheimers Disease Assessment Scale-Cognitive subscale. Lithium also decreased the level of phosphorylated tau in patients with MCI. In a study examining the association between amyloid pathology and remission of depressive symptoms with electroconvulsive therapy , remitters showed significantly lower A40/A42 than nonremitters. In a group of patients with MDD receiving ECT, there were changes in levels of CSF A1-42, the isoform with highest amyloidogenic potential. RCTs examining dementia prevention as a result of ECT are lacking however, evidence points to an increase in hippocampal volume with ECT,, thus providing a pathophysiological basis for the potential role of severe MDD treatment in dementia prevention.,
The role of pharmacological and nonpharmacological antidepressant strategies in preventing dementia onset and progression warrants further examination by future studies.
Folic Acid Vitamin B6 And B12
Deficiencies in folic acid, vitamin B6 and vitamin B12 can cause an amino acid in our body, called homocysteine, to rise. Higher than normal levels are considered to be a risk factor for a number of disease states including cardiovascular disease and dementia, and are thought to contribute to poor cognition.
However, there are no guidelines to consuming supplements of B6, B12, or folic acid individually merely to reduce the risk of dementia . Again the advice is to ensure that foods rich in B6, B12, and folate are present in the diet.
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Vascular Dementia: Symptoms And Possible Treatments
Medically Reviewed By: Whitney White, MS. CMHC, NCC., LPC
Often considered the second most common form of dementia, vascular dementia or vascular cognitive impairment tends to be underdiagnosed in the same manner as Alzheimer’s disease. Second, to Alzheimer’s, they are both considered common, with vascular dementia making up roughly ten percent of dementia cases.
What Is Vascular Dementia?
Though there are several different types of dementia, vascular dementia has some specific details and symptoms. With the basic definition of dementia as a general loss of cognition, impairment of memory disturbed planning or organizing or abstract thinking abilities. Vascular dementia involves this same definition but is the result of specific medical problems. The symptoms of dementia in vascular dementia are caused by restricted blood flow to parts of the brain. This restriction in blood flow may be caused by any number of medical conditions.
Some disorders that are known to contribute to or cause vascular dementia include cerebrovascular disease, central nervous system infection, brain trauma or tumors, vitamin deficiencies, metabolic and endocrine conditions, immune disorders, multiple sclerosis, Parkinson’s disease and more. All of these can lead deterioration in intellectual functions, occurring throughout different parts of the brain.
Symptoms of Vascular Dementia
Seven Stages Of Vascular Dementia
The basic seven stages of vascular dementia include the following:
How To Prevent Dementia 10 Strategies To Reduce Your Risk
According to the Center for Disease Control and Prevention, there are ways to decrease your risk of dementia. Studies are showing us that healthy lifestyle choices can prevent many forms of cancer, diabetes and heart disease. A healthy lifestyle can also improve your cognitive function. While there is no definitive way to prevent dementia, these 10 healthy lifestyle strategies may help you reduce your risk.
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Vascular Dementia Is One Of The Most Wide
When these cognitive problems affect a persons daily life, it is a strong indication that they have vascular dementia.
Diagnosis of vascular dementia is sometimes difficult.
This is because there are no tests that show that an individual has the disease. Doctors will, however, study the symptoms that a person is displaying to confirm whether they have the condition or not.
Thyroid and vitamin deficiencies, side effects of medications, or an array of infections may also cause symptoms.
Types Of Vascular Dementia
Vascular dementia can be divided into two types: post-stroke dementia and multi-infarct dementia .
POST-STROKE DEMENTIASymptoms are most obvious when they arise suddenly following a stroke, resulting in the blood supply to the brain being suddenly interrupted due to a blocked artery. This disruption can lead to damage or death of brain tissue. Not all stroke victims develop dementia it is estimated that approximately 20% of stroke patients develop post-stroke dementia within six months. Post-stroke dementia can result in physical symptoms and/or problems with vision or speech. Symptoms depend on what area and how much of the brain is affected.
MULTI-INFARCT DEMENTIAThis type of dementia results from a series of mini-strokes in vessels located deep within the brain . These mini-strokes may not lead to any sudden obvious onset of symptoms however, even these âsilent brain infarctionsâ still increase the risk of dementia, a result of disease of the brainâs blood vessels. Over time, the effects of this damage can result in dementia. Progression is referred to as âstep-wiseâ because symptoms worsen after any additional mini-strokes and then remain the same for a time. Symptoms that may develop include changes in reasoning and other thinking skills such as memory, as well as mood and behavior problems, including depression and apathy.
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Cognitive Retraining And Dementia
Cognitive interventions for dementia syndromes encompass a wide range of modalities, including cognitive training that targets one domain and increasing task difficulty as expertise develops, cognitive stimulation targeting multiple domains with emphasis on social interaction, and cognitive rehabilitation tailored at improving activities of daily living. These interventions aim at enhancing cognitive reserve, that is, the structural and dynamic capacities of brain circuits that compensate when one or more brain regions do not function adequately, thus increasing resilience against the neuropathological changes of dementia., Several long-term follow-up studies have looked at trajectories of cognitive impairment and the effect of cognitive stimulation, including the German Interdisciplinary Longitudinal Study on Adult Development and Aging Study, the Minority Aging Research Study, the Memory and Ageing Project, the Chicago Health and Ageing Project, and the Betula prospective cohort study. The PACE study was an RCT designed to study the effect of cognitive interventions on the progression of MCI. The intervention group received supervised education on cognitive retraining strategies. Over a period of 2 years, there was no significant effect on progression to dementia however, a limitation of the trial was the lack of active supervised task engagement for the participants of the intervention group beyond the 5-week intervention period.
Clinical Definitions And Epidemiology
Vascular dementia represents a clinical syndrome that includes a wide spectrum of cognitive dysfunctions resulting from brain tissue death due to ischemia caused by vascular disease. A number of excellent reviews have been written on the topics of its diagnosis, pathogenesis, and epidemiology . It is believed that vascular dementia is a distinct clinical and pathological entity from Alzheimers dementia, Lewy body dementia, or fronto-temporal dementia, although elements of vascular disease may be present in all of these conditions. Treatment of vascular dementia has also received extensive coverage . The prevailing conclusion of these reports is that most vascular dementia trials have produced disappointing results. It is important to note that so far no drug has been approved by regulatory agencies to treat vascular dementia . Epidemiologically, vascular dementia is considered the second most prevalent type of dementia after Alzheimers disease although this point of view maybe brought to doubt by our increasing understanding of Lewy body disease . From a clinicians point of view, vascular dementia represents a major source of frustration because of its relatively high prevalence and lack of effective treatment options.
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What Are The Risk Factors For Vascular Dementia
- Risk factors for vascular dementia are the same as those of cardiovascular disease – smoking, high blood pressure, diabetes, high cholesterol, physical inactivity, high-carb high-fat diet and ethnic origin .
- Risks of developing vascular dementia can be reduced by keeping blood pressure, blood sugar, cholesterol and body weight in the recommended range and following healthy lifestyle choices including regular exercise, avoidance of smoking and limiting alcohol intake.
Vascular Dementia Is Hereditary But At The Same Time It Is Not
One of the disorders is cerebral autosomal dominant arteriopathy with leukoencephalopathy and subcortical infarcts. It is one of the most common heritable cause of vascular dementia.
Another example of a monogenic ailment is Fabry disease. This is as a result of the mutation of gene GLA. Symptoms that persons who have this disease showcase include renal disease, cardiomyopathy, and stroke.
Experts believe that the single gene ailments above only account for a small percentage of vascular dementia cases. There is a possibility that their occurrence is taken lightly. There is a need for systematic studies on these disorders. After all, they can play a vital role in understanding vascular dementia.
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