nach oben

Current Treatment Options in Neurology

Erschienen in:

01.08.2015 | Dementia (E McDade, Section Editor)

Treatment of Vascular Cognitive Impairment

verfasst von: Aaron Ritter, MD, Jagan A. Pillai, MBBS, PhD

Erschienen in: Current Treatment Options in Neurology | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Opinion statement

Cerebrovascular disease (CVD) is an important cause of cognitive dysfunction and dementia. The term vascular cognitive impairment (VCI) is used to describe the entire spectrum of cognitive dysfunction—ranging from mild impairment to dementia—attributable to all forms of cerebrovascular disease. Accurate assessment and management of vascular risk factors are a top priority in the treatment of VCI, particularly early in the disease when prevention strategies may prove to be more effective. There are limited treatment options to improve cognition and function in VCI. Several acetylcholinesterase inhibitors and the NMDA receptor antagonist memantine have been studied in large, well-designed trials. These agents are safe and provide modest cognitive benefits in vascular dementia (VaD) but have demonstrated inconsistent efficacy on functional measures. Other therapies, such as aspirin, calcium channel blockers, and vitamin supplementation, have less evidence to support their use in improving cognition in VCI. Although primary prevention trials suggest that treatment of hypertension, adherence to a Mediterranean diet, physical activity, and smoking cessation may reduce the risk of cognitive decline, there is limited evidence regarding these interventions in helping improve cognition in VCI. The pathophysiology and treatment of cerebral autosomal dominant arteriopathy with subcortical infarcts (CADASIL), cerebral amyloid angiopathy (CAA), and subcortical white matter disease (SWMD) deserves special consideration.

Fratiglioni L et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S10–5.PubMed

Schneider JA. High blood pressure and microinfarcts: a link between vascular risk factors, dementia, and clinical Alzheimer’s disease. J Am Geriatr Soc. 2009;57(11):2146–7.PubMed

Schneider JA, Bennett DA. Where vascular meets neurodegenerative disease. Stroke. 2010;41(10 Suppl):S144–6.PubMedCentralPubMed

Babikian V, Ropper AH. Binswanger’s disease: a review. Stroke. 1987;18(1):2–12.PubMed

Hachinski VC. Multi-infarct dementia: a reappraisal. Alzheimer Dis Assoc Disord. 1991;5(2):64–8.PubMed

van Kooten F, Koudstaal PJ. Epidemiology of post-stroke dementia. Haemostasis. 1998;28(3-4):124–33.PubMed

Hachinski V. Vascular dementia: a radical redefinition. Dementia. 1994;5(3-4):130–2.PubMed

Bowler JV, Hachinski V. Vascular cognitive impairment: a new approach to vascular dementia. Baillieres Clin Neurol. 1995;4(2):357–76.PubMed

Roman GC et al. Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci. 2004;226(1-2):81–7.PubMed

10.

Erkinjuntti T, Gauthier S. The concept of vascular cognitive impairment. Front Neurol Neurosci. 2009;24:79–85.PubMed

11.

Chui H. Vascular dementia, a new beginning: shifting focus from clinical phenotype to ischemic brain injury. Neurol Clin. 2000;18(4):951–78.PubMed

12.

Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701.PubMed

13.

Bocti C, Black S, Frank C. Management of dementia with a cerebrovascular component. Alzheimers Dement. 2007;3(4):398–403.PubMed

14.

Launer LJ, Hughes TM, White LR. Microinfarcts, brain atrophy, and cognitive function: the Honolulu Asia Aging Study Autopsy Study. Ann Neurol. 2011;70(5):774–80.PubMedCentralPubMed

15.

Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). Lancet, 2001. 357(9251): p. 169-75.

16.

Schneider JA et al. Relation of cerebral infarctions to dementia and cognitive function in older persons. Neurology. 2003;60(7):1082–8.PubMed

17.

Sachdev PS et al. Progression of cognitive impairment in stroke patients. Neurology. 2004;63(9):1618–23.PubMed

18.

Desmond DW et al. Incidence of dementia after ischemic stroke: results of a longitudinal study. Stroke. 2002;33(9):2254–60.PubMed

19.•

Dichgans M, Zietemann V. Prevention of vascular cognitive impairment. Stroke. 2012;43(11):3137–46. Concise review of the evidence regarding strategies to prevent VCI.PubMed

20.

O'Donnell MJ et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23.PubMed

21.••

Douiri A et al. Long-term effects of secondary prevention on cognitive function in stroke patients. Circulation. 2013;128(12):1341–8. Large study on vascular risk management noting long-term effects (up to 16 years) on cognition.PubMed

22.•

Gorelick PB et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(9):2672–713. Comprehensive review of risk factors, pathophysiology, and treatment of VCI.

23.

Gupta M et al. The profile of behavioral and psychological symptoms in vascular cognitive impairment with and without dementia. Ann Indian Acad Neurol. 2013;16(4):599–602.PubMedCentralPubMed

24.

Staekenborg SS et al. Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease. J Neurol Neurosurg Psychiatry. 2010;81(5):547–51.PubMed

25.

Chiu PY, Liu CH, Tsai CH. Neuropsychiatric manifestations in vascular cognitive impairment patients with and without dementia. Acta Neurol Taiwan. 2007;16(2):86–91.PubMed

26.

Hsieh CJ, Chang CC, Lin CC. Neuropsychiatric profiles of patients with Alzheimer’s disease and vascular dementia in Taiwan. Int J Geriatr Psychiatry. 2009;24(6):570–7.PubMed

27.

Sink KM et al. Caregiver characteristics are associated with neuropsychiatric symptoms of dementia. J Am Geriatr Soc. 2006;54(5):796–803.PubMed

28.

Herrmann N et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry. 2006;21(10):972–6.PubMed

29.

Scarmeas N et al. Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol. 2005;62(10):1601–8.PubMedCentralPubMed

30.

Aarsland D, Sharp S, Ballard C. Psychiatric and behavioral symptoms in Alzheimer’s disease and other dementias: etiology and management. Curr Neurol Neurosci Rep. 2005;5(5):345–54.PubMed

31.

Perry E et al. Acetylcholine in mind: a neurotransmitter correlate of consciousness? Trends Neurosci. 1999;22(6):273–80.PubMed

32.

Craig LA, Hong NS, McDonald RJ. Revisiting the cholinergic hypothesis in the development of Alzheimer’s disease. Neurosci Biobehav Rev. 2011;35(6):1397–409.PubMed

33.

Selden NR et al. Trajectories of cholinergic pathways within the cerebral hemispheres of the human brain. Brain. 1998;121(Pt 12):2249–57.PubMed

34.

Mesulam M, Siddique T, Cohen B. Cholinergic denervation in a pure multi-infarct state: observations on CADASIL. Neurology. 2003;60(7):1183–5.PubMed

35.

Tohgi H et al. Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J Neural Transm. 1996;103(10):1211–20.PubMed

36.

Roman GC. Facts, myths, and controversies in vascular dementia. J Neurol Sci. 2004;226(1-2):49–52.PubMed

37.

Anand P, Singh B. A review on cholinesterase inhibitors for Alzheimer’s disease. Arch Pharm Res. 2013;36(4):375–99.PubMed

38.

Ceravolo R et al. Cerebral perfusional effects of cholinesterase inhibitors in Alzheimer disease. Clin Neuropharmacol. 2004;27(4):166–70.PubMed

39.

Roman GC et al. Donepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dement Geriatr Cogn Disord. 2005;20(6):338–44.PubMed

40.

Wilkinson D et al. Donepezil in vascular dementia: a randomized, placebo-controlled study. Neurology. 2003;61(4):479–86.PubMed

41.

Roman GC et al. Randomized, placebo-controlled, clinical trial of donepezil in vascular dementia: differential effects by hippocampal size. Stroke. 2010;41(6):1213–21.PubMedCentralPubMed

42.

Schilstrom B et al. Galantamine enhances dopaminergic neurotransmission in vivo via allosteric potentiation of nicotinic acetylcholine receptors. Neuropsychopharmacology. 2007;32(1):43–53.PubMed

43.

Auchus AP et al. Galantamine treatment of vascular dementia: a randomized trial. Neurology. 2007;69(5):448–58.PubMed

44.

Erkinjuntti T et al. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet. 2002;359(9314):1283–90.PubMed

45.

Erkinjuntti T, Roman G, Gauthier S. Treatment of vascular dementia—evidence from clinical trials with cholinesterase inhibitors. J Neurol Sci. 2004;226(1-2):63–6.PubMed

46.

Erkinjuntti T et al. An open-label extension trial of galantamine in patients with probable vascular dementia and mixed dementia. Clin Ther. 2003;25(6):1765–82.PubMed

47.

Bartorelli L et al. Effects of switching from an AChE inhibitor to a dual AChE-BuChE inhibitor in patients with Alzheimer’s disease. Curr Med Res Opin. 2005;21(11):1809–18.PubMed

48.

Ballard C et al. Efficacy, safety and tolerability of rivastigmine capsules in patients with probable vascular dementia: the VantagE study. Curr Med Res Opin. 2008;24(9):2561–74.PubMed

49.

Mok V et al. Rivastigmine in Chinese patients with subcortical vascular dementia. Neuropsychiatr Dis Treat. 2007;3(6):943–8.PubMedCentralPubMed

50.

Kumar V et al. An efficacy and safety analysis of Exelon in Alzheimer’s disease patients with concurrent vascular risk factors. Eur J Neurol. 2000;7(2):159–69.PubMed

51.

Jones RW. A review comparing the safety and tolerability of memantine with the acetylcholinesterase inhibitors. Int J Geriatr Psychiatry. 2010;25(6):547–53.PubMed

52.

Orgogozo JM et al. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke. 2002;33(7):1834–9.PubMed

53.

Wilcock G, Mobius HJ, Stoffler A. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500). Int Clin Psychopharmacol. 2002;17(6):297–305.PubMed

54.

Tomassoni D et al. Nimodipine and its use in cerebrovascular disease: evidence from recent preclinical and controlled clinical studies. Clin Exp Hypertens. 2008;30(8):744–66.PubMed

55.

Lopez-Arrieta JM, Birks J. Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database Syst Rev. 2002;(3):p. Cd000147.

56.

Wang P et al. Rationale and design of a double-blind, placebo-controlled, randomized trial to evaluate the safety and efficacy of nimodipine in preventing cognitive impairment in ischemic cerebrovascular events (NICE). BMC Neurol. 2012;12:88.PubMedCentralPubMed

57.

Amenta F et al. Nicardipine: a hypotensive dihydropyridine-type calcium antagonist with a peculiar cerebrovascular profile. Clin Exp Hypertens. 2008;30(8):808–26.PubMed

58.

An experimental, randomized, double-blind, placebo-controlled clinical trial to investigate the effect of nicardipine on cognitive function in patients with vascular dementia. Spanish group of nicardipine study in vascular dementia]. Rev Neurol, 1999. 28(9): p. 835-45.

59.

Gonzalez-Gonzalez JA, Lozano R. A study of the tolerability and effectiveness of nicardipine retard in cognitive deterioration of vascular origin. Rev Neurol. 2000;30(8):719–28.PubMed

60.

Price JF et al. Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial. BMJ. 2008;337:a1198.PubMedCentralPubMed

61.

Diener HC, Sacco R, Yusuf S. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes Trial (PRoFESS). Cerebrovasc Dis. 2007;23(5-6):368–80.PubMed

62.

McIlroy SP et al. Moderately elevated plasma homocysteine, methylenetetrahydrofolate reductase genotype, and risk for stroke, vascular dementia, and Alzheimer disease in Northern Ireland. Stroke. 2002;33(10):2351–6.PubMed

63.

Tanne D et al. Prospective study of serum homocysteine and risk of ischemic stroke among patients with preexisting coronary heart disease. Stroke. 2003;34(3):632–6.PubMed

64.

Selhub J et al. B vitamins, homocysteine, and neurocognitive function in the elderly. Am J Clin Nutr. 2000;71(2):p. 614s–20.

65.

Malouf R, Grimley Evans J. Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people. Cochrane Database Syst Rev. 2008;(4):p. Cd004514.

66.

Lewerin C et al. Significant correlations of plasma homocysteine and serum methylmalonic acid with movement and cognitive performance in elderly subjects but no improvement from short-term vitamin therapy: a placebo-controlled randomized study. Am J Clin Nutr. 2005;81(5):1155–62.PubMed

67.

Clarke R, Harrison G, Richards S. Effect of vitamins and aspirin on markers of platelet activation, oxidative stress and homocysteine in people at high risk of dementia. J Intern Med. 2003;254(1):67–75.PubMed

68.

McMahon JA et al. A controlled trial of homocysteine lowering and cognitive performance. N Engl J Med. 2006;354(26):2764–72.PubMed

69.

Durga J et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial. Lancet. 2007;369(9557):208–16.PubMed

70.

Solfrizzi V et al. Diet and Alzheimer’s disease risk factors or prevention: the current evidence. Expert Rev Neurother. 2011;11(5):677–708.PubMed

71.

Tangney CC et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011;93(3):601–7.PubMedCentralPubMed

72.

Feart C et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Jama. 2009;302(6):638–48.PubMedCentralPubMed

73.

Morris MC. Nutritional determinants of cognitive aging and dementia. Proc Nutr Soc. 2012;71(1):1–13.PubMed

74.

Kramer AF et al. Fitness, aging and neurocognitive function. Neurobiol Aging. 2005;26 Suppl 1:124–7.PubMed

75.

Vona M et al. Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction. Circulation. 2009;119(12):1601–8.PubMed

76.

Angevaren M et al. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev. 2008;(3):p. Cd005381.

77.

Lautenschlager NT et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. Jama. 2008;300(9):1027–37.PubMed

78.

Aarsland D et al. Is physical activity a potential preventive factor for vascular dementia? A systematic review. Aging Ment Health. 2010;14(4):386–95.PubMed

79.

Verdelho A et al. Physical activity prevents progression for cognitive impairment and vascular dementia: results from the LADIS (Leukoaraiosis and Disability) study. Stroke. 2012;43(12):3331–5.PubMed

80.

Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer’s disease: a meta-analysis of the literature. Acta Psychiatr Scand. 2006;114(2):75–90.PubMed

81.

Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review. Alzheimers Res Ther. 2013;5(4):35.PubMedCentralPubMed

82.

Horr T, Messinger-Rapport B, Pillai JA. Systematic review of strengths and limitations of randomized controlled trials for non-pharmacological interventions in mild cognitive impairment: focus on Alzheimer’s disease. J Nutr Health Aging. 2015;19(2):141–53.PubMed

83.

Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4(8):487–99.PubMed

84.

Nation DA et al. Pulse pressure in relation to tau-mediated neurodegeneration, cerebral amyloidosis, and progression to dementia in very old adults. JAMA Neurol. 2015;72(5):546–53.PubMedCentralPubMed

85.

Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and the risk for dementia: a double edged sword. Ageing Res Rev. 2009;8(2):61–70.PubMed

86.

In't Veld BA et al. Antihypertensive drugs and incidence of dementia: the Rotterdam Study. Neurobiol Aging. 2001;22(3):p. 407–12.PubMed

87.

Peila R et al. Reducing the risk of dementia: efficacy of long-term treatment of hypertension. Stroke. 2006;37(5):1165–70.PubMed

88.

Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. Jama, 1991. 265(24): p. 3255-64.

89.

Lithell H et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens. 2003;21(5):875–86.PubMed

90.

Peters R et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683–9.PubMed

91.

Forette F et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998;352(9137):1347–51.PubMed

92.

Forette F et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002;162(18):2046–52.PubMed

93.

Tzourio C et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163(9):1069–75.PubMed

94.

Dufouil C et al. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy. Circulation. 2005;112(11):1644–50.PubMed

95.

van Vliet P et al. The influence of age on the association between cholesterol and cognitive function. Exp Gerontol. 2009;44(1-2):112–22.PubMed

96.

Solomon A et al. Midlife serum cholesterol and increased risk of Alzheimer’s and vascular dementia three decades later. Dement Geriatr Cogn Disord. 2009;28(1):75–80.PubMedCentralPubMed

97.

Giannopoulos S et al. Statins and vascular dementia: a review. J Alzheimers Dis. 2014;42 Suppl 3:S315–20.PubMed

98.

Feldman HH et al. Randomized controlled trial of atorvastatin in mild to moderate Alzheimer disease: LEADe. Neurology. 2010;74(12):956–64.PubMed

99.

MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):7–22.

100.

Trompet S et al. Pravastatin and cognitive function in the elderly. Results of the PROSPER study. J Neurol. 2010;257(1):85–90.PubMed

101.

Lu FP, Lin KP, Kuo HK. Diabetes and the risk of multi-system aging phenotypes: a systematic review and meta-analysis. PLoS One. 2009;4(1), e4144.PubMedCentralPubMed

102.

Saczynski JS et al. Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility—Reykjavik study. Am J Epidemiol. 2008;168(10):1132–9.PubMedCentralPubMed

103.

Abbatecola AM et al. Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics. Neurology. 2006;67(2):235–40.PubMed

104.

Areosa SA, Grimley EV. Effect of the treatment of type II diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database Syst Rev. 2002;(4):p. Cd003804.

105.

Launer LJ et al. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol. 2011;10(11):969–77.PubMedCentralPubMed

106.

Patel A et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.PubMed

107.

Whitmer RA et al. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. Jama. 2009;301(15):1565–72.PubMedCentralPubMed

108.

Sabia S et al. Impact of smoking on cognitive decline in early old age: the Whitehall II cohort study. Arch Gen Psychiatry. 2012;69(6):627–35.PubMedCentralPubMed

109.

Galanis DJ et al. Smoking history in middle age and subsequent cognitive performance in elderly Japanese-American men. The Honolulu-Asia Aging Study. Am J Epidemiol. 1997;145(6):507–15.PubMed

110.

Ott A et al. Effect of smoking on global cognitive function in nondemented elderly. Neurology. 2004;62(6):920–4.PubMed

111.

Almeida OP et al. 24-month effect of smoking cessation on cognitive function and brain structure in later life. Neuroimage. 2011;55(4):1480–9.PubMed

112.

Auriel E, Greenberg SM. The pathophysiology and clinical presentation of cerebral amyloid angiopathy. Curr Atheroscler Rep. 2012;14(4):343–50.PubMed

113.

Aguilar MI, Freeman WD. Spontaneous intracerebral hemorrhage. Semin Neurol. 2010;30(5):555–64.PubMed

114.

Attems J, Jellinger KA. Only cerebral capillary amyloid angiopathy correlates with Alzheimer pathology—a pilot study. Acta Neuropathol. 2004;107(2):83–90.PubMed

115.

Greenberg SM. Cerebral amyloid angiopathy and vessel dysfunction. Cerebrovasc Dis. 2002;13 Suppl 2:42–7.PubMed

116.•

Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry. 2012;83(2):124–37. Excellent review of pathophysiology, diagnosis, and treatment of CAA.PubMed

117.

O'Donnell HC et al. Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med. 2000;342(4):240–5.PubMed

118.

Biffi A et al. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology. 2010;75(8):693–8.PubMedCentralPubMed

119.

Biffi A et al. Warfarin-related intraventricular hemorrhage: imaging and outcome. Neurology. 2011;77(20):1840–6.PubMedCentralPubMed

120.

Arima H et al. Effects of perindopril-based lowering of blood pressure on intracerebral hemorrhage related to amyloid angiopathy: the PROGRESS trial. Stroke. 2010;41(2):394–6.PubMed

121.

Goldstein LB et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008;70(24 Pt 2):2364–70.PubMed

122.

Chung KK et al. Cerebral amyloid angiopathy related inflammation: three case reports and a review. J Neurol Neurosurg Psychiatry. 2011;82(1):20–6.PubMed

123.

Kloppenborg RP et al. Steroid responsive encephalopathy in cerebral amyloid angiopathy: a case report and review of evidence for immunosuppressive treatment. J Neuroinflammation. 2010;7:18.PubMedCentralPubMed

124.

Jellinger KA. The pathology of “vascular dementia”: a critical update. J Alzheimers Dis. 2008;14(1):107–23.PubMed

125.

Roh JH, Lee JH. Recent updates on subcortical ischemic vascular dementia. J Stroke. 2014;16(1):18–26.PubMedCentralPubMed

126.

Yoshita M et al. Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD. Neurology. 2006;67(12):2192–8.PubMedCentralPubMed

127.•

Benzinger TL. Progressive white matter abnormalities in autosomal dominant Alzheimer’s disease: results of the DIAN study. Alzheimer Dement. 2012;8(4):68–69. Notes significant white matter changes in the DIAN study (AD subjects without significant vascular comorbidities).

128.

Maillard P et al. Coevolution of white matter hyperintensities and cognition in the elderly. Neurology. 2012;79(5):442–8.PubMedCentralPubMed

129.

Verdelho A et al. White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study. Neurology. 2010;75(2):160–7.PubMed

130.

Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. Bmj. 2010;341:c3666.PubMedCentralPubMed

131.

Inzitari D et al. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. Bmj. 2009;339:b2477.PubMedCentralPubMed

132.

Richard E et al. Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of white matter lesions on MRI: the evaluation of vascular care in Alzheimer’s disease (EVA) study. Stroke. 2010;41(3):554–6.PubMed

133.

Pantoni L et al. Efficacy and safety of nimodipine in subcortical vascular dementia: a randomized placebo-controlled trial. Stroke. 2005;36(3):619–24.PubMed

134.

Chabriat H et al. Cadasil. Lancet Neurol. 2009;8(7):643–53.PubMed

135.

Amberla K et al. Insidious cognitive decline in CADASIL. Stroke. 2004;35(7):1598–602.PubMed

136.

Dichgans M et al. The phenotypic spectrum of CADASIL: clinical findings in 102 cases. Ann Neurol. 1998;44(5):731–9.PubMed

137.

Andre C. CADASIL: pathogenesis, clinical and radiological findings and treatment. Arq Neuropsiquiatr. 2010;68(2):287–99.PubMed

138.

Mizuno T et al. Cognitive impairment and cerebral hypoperfusion in a CADASIL patient improved during administration of lomerizine. Clin Neuropharmacol. 2009;32(2):113–6.PubMed

139.

Dichgans M et al. Donepezil in patients with subcortical vascular cognitive impairment: a randomised double-blind trial in CADASIL. Lancet Neurol. 2008;7(4):310–8.PubMed

Titel: Treatment of Vascular Cognitive Impairment
verfasst von: Aaron Ritter, MD
Jagan A. Pillai, MBBS, PhD
Publikationsdatum: 01.08.2015
Verlag: Springer US
Erschienen in: Current Treatment Options in Neurology / Ausgabe 8/2015
Print ISSN: 1092-8480
Elektronische ISSN: 1534-3138
DOI: https://doi.org/10.1007/s11940-015-0367-0

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Opinion statement

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2015

Treatment of Primary Progressive Aphasia

Treatment of Sleep-Related Eating Disorder

Treatment and Management of Dementia Due to Alzheimer’s Disease