The Vascular dementia (DV) Can be defined as an alteration of memory that is accompanied by a dysfunction in one or more of The following cognitive areas: language, praxis, executive function, orientation, etc. It is severe enough to affect activities Of the patient.
This type of disorder appears as a result of brain damage due to multiple vascular accidents or focal lesions in blood vessels Which supply the blood to brain (National Institute of Neurological Disorders and Stroke, 2015).
Vascular dementia is the second leading cause of dementia in Western countries, after Alzheimer disease . In addition, it is a type of dementia Potentially preventable (Álvarez-Daúco et al., 2005).
Normally, vascular dementia and vascular cognitive impairment arise as a result of different risk factors for both this pathology and For the suffering of Stroke , These include Articular fibrillation , hypertension , diabetes , High cholesterol and / or Angiopathy Amyloid , Among others (National Institute of Neurological Disorders and Stroke, 2015).
Statistics of vascular dementia
After Alzheimer's disease (AD), vascular dementia is the second cause of dementia .
Different statistical studies have shown that the incidence of vascular dementia (DV) in Europe was approximately 16/1000 at 65 Years and 54/1000 years old, accounting for about 20% of all cases of dementia (Bernal and Roman, 2011).
In the United States an estimated 4 million people have dementia symptoms and it has been predicted that this figure may reach The 16 million people due to population aging, of which between 20-25% of the cases (approximately 3.5 million People) will present dementia of vascular origin (Bernal and Roman, 2011).
The age of onset of this disorder is between 50-59 years in approximately 45% of cases, while 39% is between 60 and 69 Years old (Ramos-Estébanez et al., 2000).
This fact is mainly due to the increase in the prevalence in these age ranges of two or more chronic diseases such as hypertension, Diabetes, heart disease, or Osteoarthritis (Formiga et al., 2008).
As for gender, vascular dementia is more frequent in men, unlike Alzheimer's dementia, which is more frequent in women (Bernal and Roman, 2011).
Although the majority of cases of vascular dementia are usually pure, about 12% of the cases present a component of Alzheimer's disease in greater Or lower, increasing the prevalence of vascular dementia around 35-40% (Bernal and Roman, 2011).
Definition and concept of vascular dementia (DV)
The exponential growth of life expectancy in recent decades has led to an increase in aging. Currently, dementia is a major health problem in developed countries, since its incidence does not stop Increase (Bernal and Roman, 2011).
Under the term vascular dementia (VD), a poorly homogeneous group of disorders in which vascular factors play a Important role in the subsequent development of Cognitive impairment (DC) (Álvarez-Daúco et al., 2005).
In the scientific literature regarding the area of vascular dementia, we can find many terms associated with this clinical entity and that in Many cases some of them are misused like synonyms: among them we can find: multi-infarct dementia, dementia Atherosclerotic disease, leukoaraiosis dementia, Binswaswagner's disease, vascular cognitive impairment, etc. (Bernal and Roman, 2011).
The Vascular dementia Is defined as that resulting from cerebral, hemorrhagic, ischemic, or Hypo / hyperperfusion (Bernal and Roman, 2011).
The different etiological conditions will cause different brain vascular lesions that will vary in the number, extension and Localization affecting both cortical and subcortical regions, especially cholinergic ones (Bernal and Roman, 2011).
Vascular lesions may damage cortical or subcortical structures or may be restricted to White matter and the Basal ganglia , Causing damage in Specific circuits or interrupting connections between networks that may be essential to support different cognitive functions and / or Behavioral (Bernal and Roman, 2011).
Clinical features of vascular dementia
The symptoms and signs of this pathology along with the clinical course can be very variable from one patient to another, depending on the cause of the lesions and Especially for the location of these (Jodar Vicente, 2013).
In most cases, the onset of vascular dementia usually presents a steep and abrupt onset that follows a phased evolution. Many Families observe periods of stabilization, followed by"outbreaks"or more pronounced cognitive losses (Jodar Vicente, 2013).
Usually, the most common complaint from relatives and even the same patient, is"feeling that they are not the same". Can refer apathy , depression , abulia , Isolation and social inhibition or changes in personality (Bernal and Roman, 2011).
In addition, it is possible to observe focal type neurological alterations that will affect sensitivity and motor skills. A Shortness of gait, inability to perform basic activities of daily living (bathing, using the telephone, dressing, going to the bathroom, eating, etc.) Clumsiness in the production of language, etc. In addition, it is also possible to observe urinary incontinence or urgency.
Patients will also present alterations in the cognitive sphere. They may present a decrease in the attentional level, slowing the Processing speed, lack of ability to plan and execute actions and activities, confusion, disorientation, in addition to an alteration Important of immediate memory.
Types of Vascular Dementia
There is wide heterogeneity in the classification of types of vascular dementia. However, the review of the body of knowledge about Vascular dementias, allows to differentiate several types:
Cortical vascular dementia or multi-infarction
It occurs as a consequence of multiple focal lesions in the blood vessels Cortical. It is usually produced by the presence of emboli, thrombi, cerebral hypoperfusion, or strokes. In most cases, it is Multiple infarcts may be restricted to a cerebral hemisphere, therefore deficits will be associated with predominant cognitive functions In this (National Institute of Neurological Disorders and Stroke, 2015).
Subcortical vascular dementia or Binswanger's disease
It occurs as a consequence of lesions in the vessels Blood and nerve fibers that make up the White matter . The symptoms that are present are related to an alteration of the circuits Subcortical involved in short-term memory, organization, mood, attention, decision-making, or behavior (National Institute of Neurological Disorders and Stroke, 2015).
Different clinical studies, generally post-mortem, have shown cases in which a parallel occurrence occurs Both vascular etiologies and Alzheimer's disease (National Institute of Neurological Disorders and Stroke, 2015).
Diagnosis of vascular dementia
The presence of vascular dementia is determined by the presence of vascular lesions. In addition, it must fulfill the criterion of having no other cause explicable.
Thus, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke and the International Association for Recherche Et I'Enseignement en Neurosciences proposes that the diagnosis of vascular dementia must be supported under different criteria (Bernal and Roman, 2011):
Features for Probable DV Diagnosis
- Cerebrovascular disease.
- Abrupt or fluctuating progressive impairment of cognitive functions.
Clinical features consistent with DV diagnosis
- Early presence of alterations in memory.
- History of postural instability falls frequently.
- Early presence of urinary urgency or polyuria not explained by urologic injury.
- Pseudobulbar palsy.
- Behavioral and personality changes.
Features that make DV diagnosis uncertain
- Early start of alterations in the memory And progressive worsening of this and other cognitive functions in the absence of focal lesions Concordant in neuroimaging.
- Absence of neurological focal signs other than cognitive impairment.
- Absence of cerebrovascular disease in TAC or Cerebral MRI .
Causes and risk factors of vascular dementia
The main cause of vascular dementia is stroke. With the term Stroke (CVD) us We refer to any alteration that occurs transiently or permanently, in one or several areas of our brain as a consequence of a Disorder in the cerebral blood supply (Martínez-Vila et al., 2011).
In addition, a cerebrovascular accident may occur as a consequence of both Ischemic processes (Refers to the irruption of blood supply To the brain as a result of a blockage of a blood vessel) and of hemorrhagic processes (when the blood accesses the intra or extra cerebral tissue).
Regarding the risk factors, the vascular dementia condition is associated with all the factors concomitant with the accidents Cerebrovascular diseases. In this way, already in the first studies on DV was observed a marked influence of the hypertension, heart failure, Atrial fibrillation , Diabetes, smoking, sedentary, alcoholism, Sleep apnea-hypopnea syndromes , Hypercholesterolemia, age, low level Socioeconomic, etc. (Bernal and Roman, 2011).
On the other hand, it is also possible that patients who are submitted to surgeries of a high magnitude (cardiac, carotid, Hip), with states of cerebral hypoperfusion, chronic hypoxemia, exposure to pollen or chronic infections, autoimmune diseases Y Vasculitis , HE They treat patients with a high risk of presenting DV with cumulative vascular damage (Bernal and Roman, 2011).
Treatment of vascular dementia
There is currently no specific treatment to reverse the damage caused by a stroke. Usually, treatment tries to focus In the prevention of future stroke by controlling the medical conditions of risks.
On the other hand, in the therapeutic intervention of the cognitive deterioration will be useful programs of stimulation specific of dementia, like Programs aimed at developing and maintaining specific cognitive functions.
In addition, multidisciplinary rehabilitation programs that combine both medical intervention, Neuropsychological , occupational , Such as psychology.
The best approach to this type of pathology is to begin with the control of risk factors and therefore their prevention. It is essential to take a style Of healthy living , Eat a balanced diet, exercise , Avoid alcohol and / or tobacco consumption and also maintain a healthy weight.
- Álvarez-Saúco, M., Moltó-Jordá, J., Morera-Guitart, J., Frutos-Alegría, M., & Matías-Guíu Guía, J. (2005). Update on the diagnosis of vascular dementia. Rev Neurol, 41 (8), 484-492.
- Bernal Pacheco, O., & Roman Campos, G. (2011). An approach to vascular dementia.
- Formiga, F., Fort, I., Robles, M., Riu, S., Rodríguez, D., & Sabartes, O. (2008). Differential aspects of comorbidity in elderly patients with dementia type Alzheimer or with vascular dementia. Rev Neurol, 46 (2), 72-76.
- Jodar Vicente, M. (2013). Neuropsychology of dementia. In M. Jodar Vicente, D. Redolar Ripoll, J. Blázquez Alisente, B. González Rodríguez, E. Muñoz Marrón, J. Periañez, & R. Viejo Sobera, Neuropsychology (Pages 407-446). Barcelona: UOC.
- NHI. (2015). Binswanger's Disease . Retrieved from the National Institute of Neurological Disorders and Stroke: http://www.ninds.nih.gov/disorders/binswangers/binswangers.htm
- NHI. (2015). Multi-Infarct Dementia . Retrieved from the National Institute of Neurological Disorders and Stroke: http: //www.ninds.nih.gov/disorders/multi_infarct_dementia/multi_infarct_dementia.htm
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- Ramos-Estebánez, C., & Rebollo Álvarez-Amandi, M. (2000). Binswanger's disease. Rev Neurol, 31 (1), 53-58.
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