Contribuciones vasculares al deterioro cognitivo y la demencia

People with vascular contributions to cognitive impairment and dementia (VCID) almost always have abnormalities in the brain on magnetic resonance imaging (MRI) scans. These include evidence of prior strokes, often small and asymptomatic, as well as scattered changes in the brain’s “white matter," or the connecting “wires” of the brain that are critical for relaying messages between brain regions. Microscopic brain examination shows thickening of blood vessel walls called arteriosclerosis and thinning or loss of components of the white matter.

Las formas de contribuciones vasculares al deterioro cognitivo y la demencia son:

• Demencia vascular, que se refiere a la pérdida progresiva de la memoria y otras funciones cognitivas causada por una lesión vascular o una enfermedad dentro del cerebro. En ocasiones, los síntomas de la demencia vascular pueden ser difíciles de distinguir de los de la enfermedad de Alzheimer. Los problemas de organización, atención, pensamiento lento y resolución de problemas son más prominentes en las contribuciones vasculares, mientras que la pérdida de memoria es más prominente en el Alzheimer.
• Vascular cognitive impairment, which involves changes with language, attention and the ability to think, reason and remember that are noticeable but are not significant enough to greatly impact daily life. These changes, caused by vascular injury or disease within the brain, progress slowly over time.
• Demencia posterior a un accidente cerebrovascular, que puede desarrollarse meses después de un accidente cerebrovascular grave. No todas las personas que han sufrido un accidente cerebrovascular grave desarrollarán demencia vascular, pero el riesgo de tenerlo es significativamente mayor.
• Demencia multiinfarto, que es el resultado de muchos pequeños accidentes cerebrovasculares (infartos) y miniinfartos. El lenguaje u otras funciones pueden verse afectados, según la región del cerebro afectada. El riesgo de demencia es significativamente mayor en alguien que ha sufrido un accidente cerebrovascular. La demencia es más probable cuando los accidentes cerebrovasculares afectan a ambos lados del cerebro. Incluso los accidentes cerebrovasculares que no muestran ningún síntoma perceptible pueden aumentar el riesgo de demencia.
• La arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (ACADISL) es un trastorno hereditario extremadamente raro causado por un engrosamiento de las paredes de los vasos sanguíneos pequeños y medianos, lo que reduce el flujo de sangre al cerebro. La ACADISL se asocia con la demencia multiinfarto, el accidente cerebrovascular y otros trastornos. Los primeros síntomas pueden aparecer en personas de entre 20 y 40 años. La ACADISL puede presentar síntomas que pueden confundirse con esclerosis múltiple. Muchas personas con esta enfermedad no están diagnosticadas.
• La demencia vascular subcortical (anteriormente conocida como enfermedad de Binswanger) implica un daño microscópico extenso en los pequeños vasos sanguíneos y las fibras nerviosas que forman la materia blanca, el tejido que transmite señales entre diferentes áreas del cerebro, así como entre el cerebro y otras partes del cuerpo. Algunos la consideran una forma agresiva de demencia multiinfarto. Los cambios cognitivos que causa son problemas con la memoria a corto plazo, la organización, la atención, la toma de decisiones y el comportamiento. Los síntomas tienden a comenzar después de los 60 años y progresan de forma gradual. Las personas con enfermedad vascular subcortical a menudo tienen presión arterial alta, un historial de accidentes cerebrovasculares o evidencia de enfermedad de los grandes vasos sanguíneos del cuello o de las válvulas cardiacas.
• La angiopatía amiloide cerebral es una acumulación de placas amiloides en las paredes de los vasos sanguíneos del cerebro. Generalmente se diagnostica cuando se descubren varias hemorragias pequeñas en el cerebro mediante resonancia magnética.

Vascular cognitive impairments (VCID) arise as a result of risk factors that similarly increase the risk for cerebrovascular disease, such as a stroke, atrial fibrillation, hypertension, diabetes and high cholesterol. Symptoms of VCID can begin suddenly and progress or subside during one’s lifetime. VCID can occur along with Alzheimer’s disease. 

VCID can also be caused by small blood clots that block blood vessels in the brain as well as vessel wall disease. A series of mini strokes, known as “transient ischaemic attacks,” causing widespread brain damage. These conditions lead to damage in the brain cells because of lack of oxygen. 

The primary risk factors for developing vascular contributions to cognitive impairment and dementia (VCID) are age, genetics, lifestyle and preexisting health issues, including a history of stroke and high blood pressure. 

Additionally, the following health conditions may contribute to VCID: 

• Hyperglycemia
• Insulin resistance
• Síndrome metabólico
• Diabetes mellitus
• Hyperlipidemia
• Smoking, or a regular cigarette habit
• Obesity
• Lack of physical activity
• Poor diet
• Medical history of coronary artery disease, stroke, chronic renal disease, atrial fibrillation, peripheral arterial disease and heart failure 

Several studies have shown the Montreal Cognitive Assessment (MoCA) to be an effective tool in diagnosing vascular contributions to cognitive impairment and dementia (VCID). The MoCA is a short test of cognitive function that assesses short term memory, executive function, attention, working memory, visuospatial function, concentration, language, and orientation. 

Another test that may be effective in screening VCID is the Mini-Mental State Examination (MMSE). This is a simple pen‐and‐paper test of cognitive function based on a total possible score of 30 points; it includes tests of orientation, concentration, attention, verbal memory, naming and visuospatial skills.

People with vascular dementia may experience:

• Difficulty performing tasks that used to be easy, such as paying bills
• Trouble following instructions or learning new information and routines
• Forgetting current or past events
• Misplacing items
• Getting lost on familiar routes
• Problems with language, such as finding the right word or using the wrong word
• Changes in sleep patterns
• Difficulty reading and writing
• Loss of interest in things or people
• Changes in personality, behavior and mood, such as depression, agitation and anger
• Hallucinations or delusions (believing something is real that is not)
• Poor judgment and loss of ability to perceive danger

Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement. Vascular dementia can occur alone or be a part of a different diagnosis such as Alzheimer’s disease or other forms of dementia. When an individual is diagnosed with vascular dementia, their symptoms can be similar to the symptoms of Alzheimer’s.

Several studies have shown the Montreal Cognitive Assessment (MoCA) to be an effective tool in diagnosing vascular contributions to cognitive impairment and dementia (VCID). The MoCA is a short test of cognitive function that assesses short term memory, executive function, attention, working memory, visuospatial function, concentration, language and orientation. 

Another test that may be effective in screening VCID is the Mini-Mental State Examination (MMSE). This is a simple pen‐and‐paper test of cognitive function based on a total possible score of 30 points; it includes tests of orientation, concentration, attention, verbal memory, naming and visuospatial skills.

Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement. Vascular dementia can occur alone or be a part of a different diagnosis such as Alzheimer’s disease or other forms of dementia. When an individual is diagnosed with vascular dementia, their symptoms can be similar to the symptoms of Alzheimer’s.

Vascular dementia refers to changes to memory, thinking and behavior resulting from conditions that affect the blood vessels in the brain. Cognition and brain function can be significantly affected by the size, location and number of vascular changes.

Because many different disease processes can result in different forms of vascular dementia, there may not be one treatment for all. However, vascular dementia is often managed with medications to prevent strokes and reduce the risk of additional brain damage. Some studies suggest that medications that are used to treat Alzheimer’s might benefit some people with an early form of vascular dementia. Treating modifiable risk factors like high blood pressure, diabetes, high cholesterol and problems with the rhythm of the heartbeat can help prevent additional stroke. Living a healthy lifestyle is important to help reduce the risk factors of vascular dementia.

Following diagnosis, most people with vascular contributions to cognitive impairment and dementia (VCID) live for around five years after onset of symptoms. Lifestyle changes can improve health and living with VCID. A healthy diet, weight management, cessation of smoking, alcohol management, and blood pressure or cholesterol medication can all improve outlook. 

Volunteers are needed for clinical trials that are testing ways to prevent and treat vascular dementia. By joining one of these studies, you may help scientists learn about different conditions that affect blood flow to the brain and contribute useful information to help other older adults in the future.