Management of dementia with a cerebrovascular component

Background: Cerebrovascular disease (CVD) has been reconceptualized as an important factor in cognitive decline and dementia. The concept of vascular cognitive impairment (VCI) has been introduced to capture the whole spectrum of cognitive decline associated with CVD, and to emphasize the possibility of early intervention on vascular risk factors. Methods: Intervention studies in prevention and symptomatic therapy of dementia associated with CVD are reviewed. Results: We present recommendations based on the review of current literature. There is some evidence that treating hypertension can prevent cognitive decline. Galantamine has shown some benefit in the symptomatic treatment of possible Alzheimer's disease with CVD and donepezil has shown some benefits in vascular dementia. Other pharmacologic interventions lack sufficient empirical support. Conclusions: A more pro-active stance towards cognitive decline of vascular etiology is warranted, with some evidence supporting both prevention and symptomatic therapy. (c) 2007 The Alzheimer's Association. All rights reserved.