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Treatment and prevention of vascular dementia

Clinton B Wright, MD, MS
Section Editors
Steven T DeKosky, MD, FAAN, FACP, FANA
Scott E Kasner, MD
Deputy Editor
Janet L Wilterdink, MD


The entity of vascular dementia (VaD) is best understood as a heterogeneous syndrome rather than a distinct disorder, in which the underlying cause is cerebrovascular disease in some form, and its ultimate manifestation is dementia. There is considerable overlap between AD and VaD with regard to comorbidity as well as shared risk factors and even pathogenesis. The combination of pathologies may be more common than either in isolation, and it is not generally easy to identify the primary etiologic entity.

Preventative agents and treatments for VaD have at least potential overlap. The same agent could both prevent the development of VaD in patients at risk and prevent cognitive decline in patients with VaD or in earlier stages of cognitive impairment.

This topic will review the treatment, prevention, and prognosis of VaD. Other aspects of this disorder are discussed separately. (See "Etiology, clinical manifestations, and diagnosis of vascular dementia".)


Patients with cognitive impairment and clinical or radiologic evidence of cerebrovascular pathology should be screened and treated for vascular risk factors, especially hypertension. Although these measures may be more helpful in preventing rather than ameliorating dementia, there is a strong rationale for aggressive secondary stroke prevention measures in these patients [1,2]. Recurrent stroke is associated with greater risk of cognitive decline, and poststroke dementia is associated with higher mortality [3,4].

Based on the observed prevalence of potentially modifiable risk factors (eg, hypertension, diabetes, inactivity) combined with their associated relative risk for dementia, it has been estimated that risk factor reductions of 10 to 25 percent could prevent up to half of dementia cases [5]. Although population-based data are not entirely consistent and do not establish causality, it does appear that the incidence of all-cause dementia, and especially vascular dementia, is declining in high-income countries over the past several decades [6-10].

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Literature review current through: Nov 2017. | This topic last updated: May 11, 2017.
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