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 function 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.
