Vascular dementia, a common aftereffect of stroke

Vascular dementia, a common aftereffect of stroke

Close to neurodegenerative diseases, and in particular Alzheimer’s disease, in the symptoms it causes, vascular dementia does not have the same cause nor exactly the same treatment. Kévin Rabiant, head of the Studies and Research department at Europe Alzheimer and related diseases, takes stock of this vascular neurocognitive disorder, the second cause of dementia in Europe.

What is vascular dementia?

Also called vascular neurocognitive disorder, vascular dementia causes a loss of autonomy of the same order as those caused by Alzheimer’s disease. But unlike the latter, this brain damage is not a neurodegenerative disease, it is the consequence of a cerebrovascular disorder, specifies Kévin Rabiant, head of the Studies and Research department at Europe Alzheimer and related diseases.

It is also much less common than Alzheimer’s disease: it represents 0.3% of forms of dementia at age 65 (vs. 1.2%) and 5.2% at age 90 (vs. 28.5%), indicates Kevin Rabiant. However, given the high prevalence of stroke, which is around 140,000 cases per year in Europe (“i.e. a stroke every 4 minutes”), and the risk of neurocognitive after-effects, vascular dementia represents the second cause of dementia. While the elderly are most at risk of developing vascular dementia, young adults are not immune if they have suffered a stroke. “Unlike neurodegenerative diseases responsible for dementia, age is not a major risk factor in stroke. Therefore, vascular dementia can appear in relatively young people, which also makes it possible to suspect vascular dementia rather than Alzheimer’s disease..

What causes vascular dementia?

The main disorder causing vascular dementia is ischemic or hemorrhagic stroke. Dementia can be caused by large strokes or, as is more common, by several small ones. Cognitive decline is not systematic, however, insists Kévin Rabiant; if applicable, its occurrence occurs either immediately after or within 6 months following the stroke.

Other causes can also cause vascular dementia such as hypertensive arteriopathy, hypotension leading to insufficient perfusion of the brain or Binswanger’s disease, a rare disease that affects people suffering from severe and poorly controlled high blood pressure and a disorder affecting all of their blood vessels. Certain hereditary forms also exist, they result from disorders due to genetic mutations. Among the most common, autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and autosomal recessive cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), two diseases which weaken small vessels and put people at risk. stroke and, consequently, vascular dementia.

It is not uncommon for vascular dementia to be associated with another form of dementia, often Alzheimer’s disease or Lewy body disease; we then speak of mixed dementia. “Vascular dementia actually increases the risk of developing Alzheimer’s disease with age.confirms Kévin Rabiant. In general, anything that weakens the brain constitutes a breeding ground for neurodegenerative diseases..

What are the symptoms of vascular dementia?

Vascular dementia manifests itself by different symptoms, common to all forms of dementia: memory problems, behavioral problems (apathy, lack of motivation, lack of desire), difficulties in planning and carrying out complex tasks, problems of language, attention problems, mood swings (irritability, aggressiveness and impatience are common), difficulty swallowing (watch out for blunders), difficulty speaking and walking. But unlike the symptoms induced by a neurodegenerative disease, “those which result from a lesion of the vessels of the brain are more or less marked depending on the brain structure affected. If it is the hippocampus for example, the memory problems will be more severe.shade Kévin Rabiant.

Another difference with Alzheimer’s disease and, more generally, neurodegenerative diseases: the suddenness of the symptoms. “If the symptoms are essentially the same, their onset can be sudden in cases of vascular dementia while it is very progressive in neurodegenerative diseases.. Furthermore, continues Kévin Rabiant, it is possible that certain cognitive functions remain unaffected, because the stroke destroys only a limited part of the brain parenchyma. Finally, the clinical picture of vascular dementia changes little, unless the affected person suffers a new stroke.

How to diagnose vascular dementia?

The diagnosis of vascular dementia is based on a clinical examination including a cognitive assessment looking for dementia. This assessment is carried out by a neurologist, a geriatrician or in a memory center. An imaging exam, an MRI or a positron emission tomography scan (PET-scan) can highlight brain lesions resulting from insufficient perfusion of the brain and rule out tumor damage. “If the imaging examination reveals atrophy in an area of ​​the brain but without trace of stroke, the diagnosis will tend towards a neurodegenerative disease; If the examination shows the presence of lesions typical of a stroke, the doctor will look for risk factors in his patient to confirm the diagnosis.. Excessive alcohol consumption, high cholesterol levels, diabetes, overweight or obesity, high blood pressure are the main risk factors for stroke. Identifying them makes it possible to adapt treatment to prevent recurrence of stroke and therefore vascular dementia.

How to prevent vascular dementia?

When vascular dementia results from a stroke, adopt a healthy lifestyle by eating a healthy diet, exercising regularly, abstaining from smoking, limiting alcohol consumption, and, if necessary. , by balancing your diabetes and following your antihypertensive treatment, helps limit the risks.

How to treat vascular dementia?

In the absence of specific treatment for vascular dementia, patient care is based on the treatment of diseases that increase the risk of stroke. “The mainstay of treatment consists of reducing the risk factors for stroke to prevent recurrences which cause worsening of the symptoms of vascular dementia linked to a first episode., indicates Kévin Rabiant. “If they are taken care of correctly, we can hope that the plateau (phase without evolution of symptoms, editor’s note), lasts longer.. In cases of mixed dementia, which combines vascular neurocognitive disorders and Alzheimer’s disease, medications against Alzheimer’s disease may be offered to improve certain symptoms and slow the progression. The prescription of antidepressants is common, but that of neuroleptics must be decided on a case-by-case basis due to the risk of worsening cognitive and motor disorders.

The treatment of vascular dementia is also based on a non-drug approach, including, if necessary, rehabilitation care by a physiotherapist and a speech therapist, stimulation activities aimed at preserving and maintaining the cognitive functions spared by the stroke, and psychological support.

What progress has been made in research into vascular dementia?

In 2022, only 6 phase III studies and 1 phase IV study (real-life study of a drug) have been published. A largely insufficient number given the prevalence of vascular dementia. And none of the work focuses on curative treatment. “And what’s more, the phase IV study focuses on paracetamol and its ability to relieve pain in patients with vascular dementia!, laments Kévin Rabiant. Hope rests on the advances that could be made in Alzheimer’s disease and from which vascular dementia could benefit, believes the head of the Studies and Research department at Europe Alzheimer and related diseases. “Anything that advances the management of dementia, regardless of its cause, will benefit patients with vascular dementia. Currently, around a hundred molecules are the subject of research in Alzheimer’s disease. Patients also benefit from advances in the prevention and treatment of strokes in the acute phase..