Possibilities for prevention

For primary prevention the target is the brain at risk of cerebrovascular disease and cognitive impairment. The methods relate to the treatment of putative risk factors of vascular dementia, and the promotion of potential protective factors. Risk factors include those related to cerebrovascular disorders and stroke, to vascular dementia, to post-stroke dementia, to white-matter lesions, and to cognitive impairment or dementia, and also those related to Alzheimer's disease. (8) The vascular risk factors include arterial hypertension, atrial fibrillation, myocardial infarction, coronary heart disease, diabetes, generalized atherosclerosis, lipid abnormalities, and smoking. The demographic factors include age and education. One putative protective factor is oestrogen. (83>

Knowledge of effects of primary prevention on these risk factors in populations free of cognitive impairment is still scant. (884) In a European study, treatment of mild systolic hypertension decreased the incidence of dementia.(85) Positive effects in primary prevention of stroke support the idea that action on vascular risk factors could reduce the numbers of patients with vascular dementia.

For secondary prevention the target is the brain already affected by cerebrovascular disease and at risk of vascular dementia. Actions include diagnosis and treatment of acute stroke in order to limit the extent of ischaemic brain changes, prevention of recurrence of stroke, and treatment of risk factors. Treatment is guided by the aetiology of cerebrovascular disorder such as large artery disease (e.g. aspirin, dipyridamole, carotid endarterectomy), cardiac embolic events (e.g. anticoagulation, aspirin), small-vessel disease (e.g. antiplatelet therapy), and haemodynamic mechanisms (e.g. control of hypotension and cardiac arrhythmias)/!5,29,44) Hypoxic ischaemic events (cardiac arrhythmias, congestive heart failure, myocardial infarction, seizures, pneumonia) are an important risk factor for incident dementia in patients with stroke and should be taken into account in the secondary prevention of vascular dementia.

Detailed knowledge of the effects of secondary prevention of vascular dementia is lacking. In a small series of patients with established vascular dementia, control of high arterial blood pressure,(86,) cessation of smoking/86) and use of aspirin(87» improved or stabilized cognition. It has been suggested that lowering of plasma viscosity could also have an effect in vascular dementia.(88» The absence of progressive cognitive decline in patients receiving placebo in treatment trials of vascular dementia may also reflect an effect of intensified risk factor control.(8!)

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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