Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 3-4, Pages: 247-255
https://doi.org/10.2298/SARH1304247P
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Vascular dementia: Facts and controversies
Pavlović Aleksandra (Klinički centar Srbije, Klinika za neurologiju, Beograd + Medicinski fakultet, Beograd)
Pavlović Dragan (Fakultet za specijalnu edukaciju i rehabilitaciju, Beograd)
Aleksić Vuk (Medicinski fakultet, Beograd)
Šternić Nadežda (Klinički centar Srbije, Klinika za neurologiju, Beograd + Medicinski fakultet, Beograd)
Vascular dementia (VaD) is the second most frequent dementia after
Alzheimer’s disease, and is diagnosed during lifetime in 20% of demented
patients. Fiveyear survival rate in VaD is 39%, while it is estimated to be
75% in healthy persons of the same age. It is therefore important to make
correct diagnosis of VaD early in the course of the disease. Risk factors for
VaD are identical to stroke risk factors, and there are significant
possibilities for the prevention of vascular cognitive decline. Cognitive
decline develops acutely or stepbystep within three months after stroke,
but more gradual progression of intellectual decline is also possible.
Neurological examination can reveal pyramidal and extrapyramidal signs,
pseudobulbar palsy, gait disturbance and urinary incontinence.
Neuropsychological profile comprises the loss of cognitive set shifting,
decline in word fluency, verbal learning difficulties, perseverations,
difficulties in complex figure copying, and in patients with cortically
located lesions also problems with speech and praxia. The basis of the
diagnosis is, besides history, neurological examination and
neuropsychological assessment, computed tomography and/ or magnetic resonance
brain imaging. Vascular risk factors control is the most important measure in
VaD prevention. Modern guidelines for the treatment of cognitive decline in
VaD emphasize that donepezil can be useful in the improvement of cognitive
status at the level of Class IIa recommendation at the level of evidence A,
while memantine may be useful in patients with mixed VaD and Alzheimer’s
disease dementia.
Keywords: vascular dementia, risk factors, stroke
Projekat Ministarstva nauke Republike Srbije, br. 175022 i
br. 175033