This review is based on a presentation given by Professor Black at the RCPE Care of the Elderly Symposium on 15 September 2010.
Dementia occurs after stroke in 25% of patients but also can arise from covert cerebrovascular disease (CVD). ‘Silent’ lacunes occur in 25% of the elderly, often associated with focal or confluent hyperintensities on T2-weighted magnetic resonance imaging, which are detected in 95% of seniors. These covert infarcts predict future stroke and faster cognitive decline. Best practice guidelines advocate screening for cognitive impairment in all phases of overt stroke, when covert CVD is uncovered, when vascular risk factors are present and if patients present with cognitive complaints. Standardised testing is recommended, emphasising executive unction and speed of processing. Cholinesterase inhibitors have cognitive enhancing effects in vascular dementia, but the major thrust is still aggressive management of vascular risk factors and healthy lifestyle choices. Given that mixed Alzheimer’s dementia and CVD is likely the most common substrate for dementia and that they share common vascular risk factors, a major goal for vascular medicine is cerebrovascular protection, not just to prevent heart attack and stroke, but also to maintain brain health and delay dementia.
Keywords Amyloid angiopathy, cholinesterase inhibitors, cognitive testing, overt and silent stroke, vascular dementia, white matter hyperintensities
Declaration of Interests The author has in the past 12 months received contract research funding from Novartis, Pfizer, Roche and GlaxoSmithKline, speaker’s honoraria from Janssen-Ortho, Lundbeck, Eisai and Pfizer and honoraria for ad-hoc consulting from Pfizer, Janssen-Ortho, Novartis, GlaxoSmithKline, Elan, Wyeth Pharmaceuticals and Bristol-Myers Squibb.
