Demenza vascolare: aspetti nosografici, diagnostici, terapeutici, correlazioni con la malattia di Alzheimer

This article summarizes various concepts on vascular dementia, the second commonest cause of cognitive deterioration after Alzheimer's disease (AD). It reviews clinical and diagnostic aspects as well as therapeutic approaches. Our understanding of vascular dementia has evolved over time, in part through our ability to neuroradiologically image changes in patients, and also through our increased understanding of the neuropsychologic organization of the brain. In recent years, interest in vascular causes of dementia has increased and it has been proposed that vascular dementia may be more common than previously supposed. There is increasing evidence of a complex relationship between vascular dementia and AD. Recent and accumulating epidemiological research suggests that cardiovascular risk factors play an important role as risk factors for AD in later life. The concept of AD and vascular dementia as clearly distinguishable disorders clinically or aetiologically is becoming increasingly tenous. Vascular dementia and AD can co-exist ("mixed forms"); the presence of cerebrovascular disease may worsen Alzheimer dementia and may also increase the possibility that individuals with Alzheimer lesions in their brains will express a dementia syndrome. It seems clear that there is a connection between Alzeimer's disease and vascular factors. The exact mechanism behind this association is not clear. Thereby a basis for further research and discussion in this exciting area should have been formed.