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PREFACE
Over the past century, enormous progress has been achieved regarding our
understanding of the dementias. Cognitive decline in the elderly can of
course result from many causes, but the contribution of vascular factors
is becoming more and more widely appreciated.
Vascular dementia is a vague term, encompassing
cognitive impairment resulting from vascular changes. As such, it has
multiple etiologies (frequently co-existing in a given patient), which
operate through different mechanisms. Risk factors for vascular dementia
have been detected and repeatedly confirmed. Very interestingly, many of
the risk factors which were identified for Alzheimer’s disease are also
involved in vascular dementia. These include hypertension, coronary artery
disease and smoking, and possibly also hyperlipidemia and
hyperhomocystinemia.
Other analogies between vascular dementia and
Alzheimer’s disease are depicted in Table 1.
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Vascular dementia |
Alzheimer’s disease |
Risk factors Mechanisms
Pathology
Primary prevention Secondary prevention
Symptomatic treatment |
Well established
Multiple identified
Heterogeneous
Exists
Probable
In development |
Many identified
Poorly understood
Homogeneous
In development
Not available
Partially effective |
The fact that vascular dementia is a syndrome is
reflected by the multiplicity of causative processes, like hemorrhage or
vascular occlusions, and the site of the lesions, e.g. cortical vs
subcortical, as well as grey matter vs white matter disorders.
The identification of several genetic factors which can
contribute to vascular damage, as well as possible auto-immune damage to
vascular components (for example anticardiolipin antibodies), are
important. It is remarkable that amyloid precursor protein (APP) mutations
can cause the typical pathological changes of Alzheimer’s disease as well
as amyloid deposition around blood vessels. These may lead to deficient
blood perfusion to the brain, changes of the blood-brain barrier, as well
as cerebral hemorrhages.
An unfolding issue relates to the overlap between
Alzheimer’s disease and vascular dementia. The mechanisms underlying this
overlap are only partly understood (amyloid angiopathy, perivascular
amyloid deposits in Alzheimer’s disease), but are probably of even greater
importance as reflected by the Nun study, which demonstrated clearly that
Alzheimer changes alone may be insufficient to cause dementia, but the
addition of vascular brain lesions (usually small, subcortical, clinically
unrecognized) were required for the manifestation of dementia (which was
then diagnosed clinically as Alzheimer’s disease).
In primary prevention of diseases, it is required to
identify risk factors so as to direct attention to those people at higher
risk of developing dementia. Thus, it is not yet clear whether the "risk
factors" which have been identified in vascular dementia are causative or
contributing to the development of cognitive impairment, and which are
coexisting but not directly related (e.g. coronary artery disease). Also,
host factors such as age and education may have a role but this is yet
unproven. Other analogies between vascular dementia and Alzheimer’s
disease are depicted in Table 1.
For many years, treatment of vascular disease was
oriented towards prevention of heart and kidney failure. Later on, the
same classes of drugs were found to help in preventing strokes, and
recently their effect against vascular dementia is being described. It is
quite possible that their efficacy will extend even further. Epidemiologic
and pathological data show that Alzheimer’s disease is associated with
vascular risk factors, such as hypertension and coronary artery disease.
Thus, attention to these risk factors (as well as others such as
hyperlipidemia and smoking) could reduce or delay the incidence of several
types of dementia.
Amos D. Korczyn
The Sieratzki Chair in Neurology
Tel-Aviv University Medical School
Ramat-Aviv (Israel)
INDEX Clinical
Vascular Cognitive Impairment Towards Criteria The Concept of Vascular
Cognitive Impairment
J.V. Bowler
Subtypes of Sporadic Vascular Dementia
A. Wallin and M. Sjögren
Natural History of Dementia Associated with Lacunar Infarctions
J. Aharon-Peretz, E. Daskovski and T.
Mashiach
Embolic Mechanism as a Possible Cause of Simultaneous Small Infarcts in
Multiple Vascular Territories
M. Sato, K. Nagata, A. Suzuki and J. Hatazawa
Chronic Misery Perfusion Syndrome Accompanying with Impaired Vascular
Reserve
K. Nagata, M. Sato, K. Tsutsumi and J.
Hatazawa
Neuropsychological and Neuroimaging Findings in Vascular Dementia and
Alzheimer´s Disease
S. Santos, T. Casadevall, C. Tejero, C. Ríos,
E. López, P. Larrodé, C. Iñiguez, LF. Pascual, M. Garcés, O. Fabre and F.
Morales
Sneddon’s Syndrome and Dementia
C. Tejero, T. Casadevall, L.F. Pascual, S.
Santos, I. Navas and E. Mostacero
Amyloid Angiopathy Associated with Cerebral Hemorrhage, Extensive
Microhemorrhages and Severe White Matter Edema
S. Salloway, E. Stopa, F. Douglas, J.
Wilterdink, J. Rogg and S. Salloway
Genetic, Clinical and Pathological Studies of CADASIL in Japan: A
Partial Contribution of Notch3 Mutations and Implications of Smooth Muscle
Cell Degeneration for the Pathogenesis
Y. Santa, E. Uyama, D. Hua Chui, M. Arima, S.
Kotorii, K. Takahashi and T. Tabira
Imaging
Validation Study of a CT-based Weighted Rating Scale for Subcortical
Cerebrovascular Disease in Patients with Mild Cognitive Deterioration
C. Geroldi, S. Galluzzi, J. Miao, C. Testa
and G.B. Frisoni
Leukoaraiosis in Patients Referred to a Dementia Clinic
T.S. Olsen, J.W. Kufahl and P.W. Norup
MRI Subcortical Hyperintensities and Response to Sertraline in
Geriatric Depressed Outpatients
S. Salloway, P.A. Boyle, S. Correia, P.F.
Malloy, D.A. Cahn-Weiner, L. Schneider, K.R.R. Krishnan and R. Nakra
A NMR Spectroscopy Study on the Effect of Nicergoline Treatment on
Brain Metabolism of Aged Rats
F. Conti, A. Miccheli, C. Puccetti, M.E. Di
Cocco, A. Battaglia, N. Carfagna, G. Pizzolato and L. Battistin
Cerebral Perfusion Changes Measured with 99m-Technetium HMPAO SPECT
After Zolpidem and Flumazenil Intervention
D.W. Oliver, R.P. Clauss, I.C. Dormehl, H.W.
Nel, E. Kilian and W.K.A. Louw
Acetazolamide Vasoreactivity in Vascular Dementia
T. Casadevall, S. Santos, P. Razola, C.
Tejero, P. Larrodé, C. Iñiguez, LF. Pascual, E. Mostacero, J. Banzo and F.
Morales
Electroencephalographic Evaluation of Vascular Dementia
K. Nagata, M. Sato, E. Yokoyama and H. Yuya
Pre-clinical Diagnosis of Alzheimer’s Type Dementia: A Case for
Fluorodeoxyglucose Positron Emission Tomography (FDG PET)
A. K. Demetriades
Association Between Cortical Impairment and Subcortical Infarction
Assessed Using MRI and 1H MRSI
N. Schuff, A-T. Du, D.L. Amend, W.J. Jagust,
B.R. Reed, H.C. Chui and M.W. Weiner
Neuropsychology
Importance of Depressive Symptoms as Risk Factor for Vascular Dementia
J.S. Meyer and Y.S. Li
Depressive and Anxiety Symptoms in the Acute Stage of Stroke
B.C. Lee, K.H. Yu, H.I. Ma, S. Jung, S.C.
Jeong, S.J. Kim, Y.S. Kim and M.H. Lee
DemTect®: A New Screening Instrument with Very High Sensitivity for
Vascular and Alzheimer Dementia
E. Kalbe, J. Kessler, R. Smith, R. Bullock,
L. Fischer and P. Calabrese
Mini Mental State Examination (MMSE) in Acute Stroke and Seven Years
After. The Influence of Age, Stroke Severity, Stroke Recurrence and Stroke
Risk Factors. A Community-based Study
T.S. Olsen, L.P. Kammersgaard, H.S. Jørgensen,
U.J. Weber,
H. Nakayama, H.O. Raaschou and P.M. Pedersen
Prevalence and Predictors of Impaired Global Cognitive Function in
Patients with Minor Stroke and TIA. A Long-term Community-based Follow-up
Study
T. Skyhøj Olsen, L.P. Kammersgaard, H.S.
Jørgensen, U.J. Weber, H. Nakayama, H.O. Raaschou and P.M. Pedersen
Mechanisms
The Role of Cholesterol in the Processing of
b-secretase
ASP-2
C. Sidera, J. Frimpong Manso, C. Liu and B.M.
Austen
Hyperhomocysteinemia and Dementia: A Specific Risk Factor for
Subcortical Dementia?
G. Billo, E. Galloni, M. Alecci, T.M.
Sgaramella, F. Perini, P. Dudine and V. Toso
Differential Distribution of Smooth Muscle Actin and Agrin in the
Microvasculature of the Tg App670,671 Mouse and Alzheimer Brain
E.G. Stopa, J.R. Fallon, S. Salloway, P.
Butala, B. Zipser, X. Morales, V. Hovanesian, C. Hulette, J. Ervi, R.
Tavare, C. Johanson and M. Vitek
Effect of APOE Genotype on Basement Membrane Agrin and iC3b Levels in
Alzheimer’s Disease
T. Gur, T. Berzin, B. Zipser, V. Hovanesian,
S. Salloway, J. Fallon, V. Kuo-Leblanc, E. Stopa, D. Glass, C. Hulette, C.
Rosenberg and M. Vitek
The Effect of ApoE Genotype of Cells Engaged in b-Amyloidosis on the
Response to Oxidative Stress
B. Mazur-Kolecka, D. Kowal, T. Sukontasup, J.
Krzeslowska, D. Dickson and J. Frackowiak
Vascular Myocytes Cultured from APP-Swedish Transgenic Mouse Deposit Ab
in Lysosomes
J. Frackowiak, B. Mazur-Kolecka, A. Potempska,
T. Sukontasup and D. Kowal
Cerebrospinal Fluid Markers of Subcortical Vascular Dementia.
Pathophysiological Aspects
M. Sjögren, M. Jonsson and A. Wallin
A New Experimental Model for Sporadic Alzheimer Disease: I.
Histopathological Features
R. Sinigaglia-Coimbra, E. Cavalheiro and C.
Coimbra
A New Experimental Model for Sporadic Alzheimer Disease: II. Persistent
Cognitive Deficits
R. Sinigaglia-Coimbra, A. Carvalho, W.
Lacerda, E. Cavalheiro, C. Coimbra and G. Xavier
The Cerebellar Cortex in Vascular Dementia: A Golgi and Electron
Microscope Study
S.J. Baloyannis and V. Costa
The Efficacy of Chinese Calligraphic Handwriting (CCH) on Stroke
Patients: A Multiple Cases Study
M.L. Chiu, H.S.R. Kao and S.M.Y. Ho
Therapy
Treatment of Vascular Dementia with Daily 325 mg Oral Aspirin
J.S. Meyer, M.H. Chowdhury and Minh Quach
Feasibility of Vascular Dementia Treatment with Cholinesterase
Inhibitors
Y.S. Li, J.S. Meyer, Anwarul Haque, M.H.
Chowdhury, G. Xu and Minh Quach
Should We Be Studying Cholinergic Drugs for the Treatment of Vascular
Dementia?
H. Geerts and C. Grantham
Galantamine Provides Broad Therapeutic Benefits in Patients with
Probable Vascular Dementia or Alzheimer’s Disease with Cerebrovascular
Disease
T. Erkinjuntti
Effect of Bromitil on Behavior and Reproductive Function in Male Rats
T.V. Khamidova, N.V. Seredinceva and L.
Tchigirinsky Ju.
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