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• W1965432827 abstract "Apart from vascular prevention strategies, cognitive enhancing therapeutics in Vascular Cognitive Disorders (VCD) has been complicated due to heterogeneity reflecting different vascular etiologies, severity and location of brain damage. Epidemiologically, vascular dementia (VaD) is the second cause of dementia, but autopsy series suggest that the commonest neuropathological substrate is combined Alzheimer's (AD) and cerebrovascular lesions. Previous diagnostic criteria for VaD are highly specific but insensitive, making clinical trial recruitment challenging and generalizability doubtful. More homogenous subgroups need to be targeted for both pharmacotherapy and non-pharmacological interventions. Standardized cognitive batteries that capture the executive dysfunction so prevalent in VCD should be implemented. New diagnostic criteria de-emphasize memory, but still classify by the degree to which cognitive deficits impair daily function. Previous clinical trials focused on probable and possible VaD using the NINDS-AIREN criteria and reported beneficial effects on cognition with the cholinergic agents and memantine, but efficacy in global function and daily activities was not consistent, though in mixed Alzheimer/VaD cases, global and functional benefits were found. Replication studies with both donepezil and galantamine on new VaD samples reproduced modest cognitive, but not global or functional, benefits. In the donepezil study, hippocampal atrophy modulated cognitive responsiveness. Given the limited cognitive efficacy, without functional benefit, a separate label for cholinergic agents for VaD has not been granted. Non- pharmacological interventions, including goal management training to compensate for executive dysfunction, have been tried in small samples. This approach is labour-intensive, but web-based group interventions may hold some promise. Validation studies are still underway for the new harmonized batteries and newer imaging protocols, and these will need to be tested in appropriate clinical populations, possibly with longer duration trials to discern meaningful effects, including brain outcomes such as atrophy and subcortical ischemic vascular disease burden, if disease-modifying therapies emerge. New emerging criteria for VCD attempt to address previous limitations. Standardized protocols that more sensitively test salient cognitive features and quantify brain changes, now available, should be incorporated into clinical trial designs. However, until new targeted treatments emerge, vascular protection, both pharmacological and lifestyle-modification, remain the mainstay of treatment." @default.
• W1965432827 created "2016-06-24" @default.
• W1965432827 creator A5040635626 @default.
• W1965432827 date "2012-07-01" @default.
• W1965432827 modified "2023-09-27" @default.
• W1965432827 title "F5-02-04: The treatment of vascular cognitive disorders: Current practice and future promise" @default.
• W1965432827 doi "https://doi.org/10.1016/j.jalz.2012.05.1959" @default.
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