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1 30th June 22:23
dr. harman
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Posts: 1
Default Vascular dementia. Advances in nosology, diagnosis, treatment and prevention. (dementia diabetes apnea acetylcholinesterase cardiac)


Roman GC.

Department of Medicine/Neurology, University of Texas Health Science
Center at San Antonio and the Audie Murphy Veterans Administration
Hospital, San Antonio, TX 78229-3900, USA. romang@uthscsa.edu

Ischemic or hemorrhagic cerebrovascular disease (CVD) produces injury
of brain regions important for executive function, behavior, and memory
leading to decline in cognitive functions and vascular dementia (VaD).
Cardiovascular disease may cause VaD from hypoperfusion of susceptible
brain areas. CVD may worsen degenerative dementias such as Alzheimer
disease (AD). Currently, the global diagnostic category for cognitive
impairment of vascular origin is vascular cognitive disorder (VCD). VCD
ranges from vascular cognitive impairment (VCI) to VaD. The term VCI is
limited to cases of cognitive impairment of vascular etiology, without
dementia; VCI is equivalent to vascular mild cognitive impairment
(MCI). Risk factors for VaD include age, hypertension, diabetes,
smoking, cardiovascular disease (coronary heart disease, congestive
heart failure, peripheral vascular disease), atrial fibrillation, left
ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension,
cardiac arrhythmias, hyperfibrinogenemia, sleep apnea, infection, and
high C-reactive protein. Research on biomarkers revealed increased
CSF-NFL levels in VaD, whereas CSF-tau was normal. CSF-TNF-alpha, VEGF,
and TGF-beta were increased in both AD and VaD. VaD shows low CSF
acetylcholinesterase levels. This condition responds to
acetylcholinesterase inhibitors, confirming the central role of
cholinergic deficit in its pathogenesis. Evidence strongly suggests
that control of vascular risk factors, in particular hypertension,
could prevent VaD.
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