Dementia vascular

Vascular dementia (VD) accounts for 20-30% of dementia cases, with clinical and pathological overlap with AD. Reductions in cholinergic markers suggest cholinergic deficits in VD, and ChEIs increase ACh availability and improve their cerebral blood flow. 

Tohgi, H, Abe, T, Kimura, M, Saheki, M and Takahashi, S (1996) Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J. Neural Trans. 103 1211-1220. 

With or without behavioral symptoms Vascular dementia... 

Psychotic symptoms in late life (greater than 65 years of age) are generally a result of an ongoing chronic illness carried over from younger life however, a small percentage of patients develop psychotic symptoms de novo, defined as late-life schizophrenia. The 6-month prevalence rate of schizophrenia in the elderly is around 1%. However, other illnesses presenting with psychotic symptoms are common in this population, as approximately one-third of patients with Alzheimer s disease, Parkinson s disease, and vascular dementia experience psychotic symptoms. The majority of data for antipsychotic use in the elderly comes from experience treating these other disease states. 

Lopez-Arrieta JM and Birks J (2002). Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database of Systematic Reviews, 3, CD000147. 

Tohgi H, Sasaki K, Chiba K and Nozaki Y (1990). Effect of vinpocetine on oxygen release of hemoglobin and erythrocyte organic polyphosphate concentrations in patients with vascular dementia of the Binswanger type. Arzneimittelforschung, 40, 640-643. 

McCusker SM, Curran MD, Dynan KB, McCullagh CD, Urquhart DD, Middleton D et al. Association between polymorphism in regulatory region of gene encoding tumour necrosis factor a and risk of Alzheimer s disease and vascular dementia a case-control study. Lancet 2001 357 436 139. 

Herminghaus, S., Frolich, L., Gorriz, C. et al. Brain metabolism in Alzheimer disease and vascular dementia assessed by in vivo proton magnetic resonance spectroscopy. Psychiat. Res. 123 183-190, 2003. 

Alzheimer s disease, Parkinson disease, prion diseases (Creutzfeld-Jacob in humans, scrapie in sheep), Huntington disease, dementia with Levy s bodies, sclerosis multiplex and amyotrophic lateral sclerosis, frontotemporal lobar degeneration, and vascular dementia are the most commonly occurring neurodegenerative diseases, with different (and often unknown) pathophysiology, creating serious health care problems and... 

Dementia is characterised by a progressive decline in cognitive function. The prevalence of dementia increases with age. With the demographical changes, the number of patients with dementia will increase. There are three major forms of dementia Alzheimer s disease, vascular dementia and a mixed dementia. Beside these, there are several less common subtypes of dementia. 

Two neurodegenerative diseases will be considered in greater detail here, Alzheimer s disease and Parkinson s disease, due to the pertinence of herbal medications to their treatment. Also discussed in some detail are vascular dementia and normal aging. Other degenerative conditions may benefit from herbal medications, but have not received the amount of attention in research that the above conditions have. Of particular interest to many degenerative conditions are herbal medications with demonstrated antioxidant and neuroprotective effects. 

Frontal and subcortical lacunar infarcts typically affect attention, language, visuospatial function, and motor programming (Babikian et al. 1990). Compared to patients with Alzheimer s disease, those with vascular dementia show better orientation, recall, and language ability. On... 

Cognitive effects Humans with dementia Several studies have looked at the effects of ginkgo extracts on cognitive function in people with dementia. German health authorities approved a ginkgo extract in 1994 for treatment of primary degenerative and vascular dementias (Itil et al. 1998). 

Ginkgo has been examined in a number of clinical populations, including Alzheimer s disease, vascular dementia, and age-associated cognitive decline. Most studies employed the extracts EGb 761 or LI 1370. Many have methodological flaws including limited sample size or insufficient description of randomization, patient characteristics, measurement techniques, or result presentation, but there are a number of well-controlled studies available for drawing preliminary conclusions (Field and Vadnal 1998). 

Although the meta-analysis by Oken and colleagues examined efficacy in Alzheimer s disease only, improvements have been seen in other conditions such as age-related memory decline and vascular dementia (Kanowski et al. 1996 Haase et al. 1996 Allain et al. 1993). More research is needed to establish the quantitative clinical significance of ginkgo extract. 

Bowler JV, Hachinski V. (1997). Vascular Dementia. In Behavioral Neurology and Neuropsychology. Feinberg T, Farah MJ, eds. New York McGraw-Hill. 

Konno S, Meyer JS, Terayama Y, Margishvili GM, Mortel KF. (1997). Classification, diagnosis, and treatment of vascular dementia. Drugs Aging. 11(5) 361-73. 

Skoog I. (1979). Status of risk factors for vascular dementia. Neuroepidemiology. 17(1) 2-9. 

Alzheimer s disease (AD) is the most frequent cause of dementia (50-70%), followed by vascular dementia (30 0%) and mixed dementia (15-20%). These prevalent forms of age-related neurodegeneration represent a major problem of health in developed countries, with more than 25 million people affected and probably more than 75 million people at risk during the next 20-25 years worldwide. The prevalence of dementia increases exponentially, from approx. 1% at 60-65 yr to more than 30-35% in people older than 80yr. It is very likely that in those patients older than 75-80 yr most cases of dementia are mixed in nature (degenerative plus vascular), whereas pure AD cases are very rare after 80yr (1-3). 

Fig. 10.8 Absolute genetic variation (AGV) and relative genetic variation (RGV) between Alzheimer s disease and vascular dementia associated with bigenic, trigenic, and tetragenic clusters of Alzheimer s disease (AD)-related genes. APOE, apolipoprotein E PS, presenilin. (Adapted from refs. 12,19,20, and 59.)...

White matter hyperintesities in magnetic resonance imaging (MRI) scans reflecting cerebrovascnlar damage and brain hypoperfusion are more severe in ACE-D/D subjects (638). Association of ACE-D/D with vascular dementia has also been reported (615,639), although in some stndies no association of ACE-I/D indel variant with vascnlar dementia was fonnd (640). 

Engelborghs, S., Dermaut, B., Goeman, J., et al. (2003) Prospective Belgian study of neuro-degenerative and vascular dementia APOE genotype effects. J. Neurol. Neurosurg. Psychiatry, 74, 1148-1151. 

Scacchi, R., De Bernardini, L., Mantuano, E., et al. (1998) DNA polymorphisms of apoUpo-protein B and angiotensin I-converting enzyme genes and relationships with Upid levels in Italian patients with vascular dementia or Alzheimer s disease. Dement. Geriatr. Cogn. Disord., 9, 186-190. 

Wang, H.K., Fung, H.C., Hsu, W.C., et al. (2006) Apolipoprotein E, angiotensin-converting enzyme and kaUikrein gene polymorphisms and the risk of Alzheimer s disease and vascular dementia. J. Neural Transm., 113, 1499-1509. 

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