Definition
Vascular dementia is a disorder characterized by a progressive and irreversible deterioration of cognitive abilities, due to the death of brain cells.
Vascular dementia is a disorder that affects patients in old age and mainly affects men, although it is not excluded that it may also affect female patients.
Causes
The cognitive deficit that characterizes vascular dementia is caused by a decrease in blood circulation in the brain, which leads to the gradual death of brain cells.
With the reduction of blood circulation to the encephalic level, the adequate supply of oxygen and nutrients to the brain cells, which therefore undergo certain death, is lacking.
The causes of this reduction in blood flow can be different. These include the disease of small blood vessels (considered to be the main cause of vascular dementia), atherosclerosis, stroke, mixed dementia and multi-infarct dementia.
The risk factors that can favor the onset of vascular dementia, on the other hand, are genetic predisposition, poor diet, overweight, hypertension and smoking.
Symptoms
The symptoms induced by vascular dementia depend on the brain areas affected by this disorder and vary from patient to patient.
Among the various symptoms that can occur, we find slowness of thought, loss of memory, disorientation, confusion, difficulty concentrating, personality changes, mood swings, hallucinations, depression, apathy, movement difficulties, loss of balance and frequent urination.
Finally, it should be remembered that, in many cases, vascular dementia is preceded by another type of disorder: vascular cognitive impairment.
Information on Vascular Dementia - Drugs and Care is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Vascular Dementia - Drugs and Care.
drugs
Unfortunately, there are no real drugs to treat vascular dementia, but treatments can be carried out to reduce progression.
First of all, when the vascular cognitive deterioration appears, it is good to immediately take steps to change one's lifestyle. In fact, this type of cognitive impairment is often caused by the smoking habit, unbalanced diets, high blood pressure, overweight and low physical activity. Therefore, it is essential to adopt a healthy lifestyle associated with a balanced diet and regular physical activity.
The pharmacological treatment of vascular dementia, on the other hand, involves the use of acetylcholinesterase and memantine inhibitors.
Also very important is the treatment of those conditions that favor and / or are associated with vascular dementia. Therefore - if necessary - the doctor will resort to the use of drugs for the treatment of hypertension, drugs for the treatment of high cholesterol, drugs for the treatment of stroke, drugs for the treatment of venous thrombosis and possibly drugs for the treatment of depression.
Acetylcholinesterase inhibitors
Acetylcholinesterase inhibitors can be used to treat vascular dementia in patients who experience confusion, memory loss and drowsiness. These drugs act by inhibiting the acetylcholinesterases responsible for the degradation of acetylcholine, a neurotransmitter that is involved in many cognitive processes at central level.
Acetylcholinesterase inhibitors are also used in the treatment of Alzheimer's disease.
Among the active ingredients most used, we recall:
- Donepezil (Aricept ®, Memac ®, Yasnal ®): donepezil is available for oral administration in the form of tablets. The dose of drug used varies from 5 mg to 10 mg a day, to be taken every night before bedtime. The exact dosage of the drug must however be established by the doctor for each patient.
- Rivastigmine (Exelon ®, Rivastigmine Actavis ®, Rivastigmine Teva ®, Nimvastid ®): rivastigmine is available in different pharmaceutical formulations. When administered orally, the usual starting dose of medication is 1.5 mg, to be taken twice a day. Later, your doctor may increase the dose of rivastigmine given up to a maximum of 6 mg twice a day.
- Galantamine (Reminyl ®, Galnora ®): galantamine is available for oral administration. The usual starting dose is 4 mg of drug, to be taken twice a day. Subsequently, the doctor will gradually increase the dose of galantamine administered until the most appropriate maintenance dose is reached for each patient. The maximum dose that can be administered should not exceed 12 mg twice a day.
Memantine
Memantine (Ebixa ®, Memantine Accord ®, Memantine Merz ®, Memantine Mylan ®, Nemdatine ®, Marixino ®) is a non-competitive NMDA receptor antagonist (N-methyl-D-aspartate). The latter is a post-synaptic glutamate receptor, the most important excitatory neurotransmitter in the brain.
Excessive glutamatergic stimulation can cause neuronal damage and, consequently, cell death. Therefore, through the inhibition of the aforementioned NMDA receptor, memantine indirectly decreases the glutamate activity, thus slowing down the cognitive deterioration that characterizes vascular dementia.
For the same reasons, memantine has therapeutic indications for the treatment of dementia induced by Alzheimer's disease.
Memantine is available for oral administration. The initial dose of medication used is 5 mg a day. The doctor will then gradually increase the amount of drug administered up to a maximum of 20 mg a day.
