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15 - Treatment of cognitive changes

from Section 3 - Treatment

Published online by Cambridge University Press:  15 September 2009

By
Serge Gauthier  and
Timo Erkinjuntti
Edited by
Lars-Olof Wahlund ,
Timo Erkinjuntti  and
Serge Gauthier
Lars-Olof Wahlund
Affiliation:
Karolinska Institutet, Stockholm
Timo Erkinjuntti
Affiliation:
University of Helsinki
Serge Gauthier
Affiliation:
McGill University, Montréal
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Summary

This chapter reviews available evidence for a cognitive improvement associated with cholinesterase inhibitors (ChEI) and memantine in vascular dementia (VaD) and Alzheimer's disease (AD) with cerebrovascular disease (CVD). It discusses cognitive changes associated with the dementia stage of VaD. A cholinergic deficit has been demonstrated in VaD, independently of any concomitant AD pathology. Cholinergic structures are vulnerable to ischemic damage. Donepezil and rivastigmine have been studied using randomized clinical trials in VaD and galantamine in a mixed population of VaD and AD with CVD. Sub-group analyses by radiological findings at baseline showed that the cognitive treatment effect for memantine was more pronounced in the small-vessel type group without cortical infarctions by computed tomography (CT) or magnetic resonance imaging (MRI). Cognitive tests should be performed before treatment, preferable using those with an executive component, to be repeated at set intervals in the order of six months.

Keywords

Alzheimer's diseasebeta amyloid markersblood-brain barrier breakdowncerebrospinal fluidinflammation markersvascular dementiavascular diseaseglial activation markers
Type
Chapter
Information
Vascular Cognitive Impairment in Clinical Practice , pp. 195 - 199
Publisher: Cambridge University Press
Print publication year: 2009

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