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Vascular Changes Contribute to Dementia in Older People

Cerebrovascular disease and Alzheimer's disease synergize to increase risk of cognitive impairment

WEDNESDAY, July 27 (HealthDay News) -- Vascular changes contribute to age-related vascular cognitive impairment (VCI) and dementia, according to a new American Heart Association/American Stroke Association scientific statement published online July 21 in Stroke.

Philip B. Gorelick, M.D., M.P.H., from the University of Illinois in Chicago, and colleagues reviewed available literature from 1990 to 2010 to provide an overall guideline for practitioners to understand VCI and dementia, and its prevention and treatment.

The authors reported that VCI includes the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury, from mild cognitive impairment to fully developed dementia. VCI may be due to mechanisms regulating cerebral blood flow, and neurovascular unit dysfunction. Cerebral amyloid angiopathy is an important marker for the risk of VCI, Alzheimer's disease, microinfarction, and micro and macro-hemorrhage of the brain. A mixture of microvascular brain damage and Alzheimer's disease may heighten cognitive impairment risk in later life. Magnetic resonance imaging and other neuroimaging techniques provide evidence that subcortical VCI forms with white matter hyperintensities and small deep infarcts are common. Risk markers for VCI and stroke are often the same, and may also be the same in Alzheimer's disease. Markers of arterial aging -- carotid intimal-medial thickness and arterial stiffness -- may also be risk markers for VCI. The U.S. Food and Drug Administration currently does not approve any treatment for VCI, but detecting and controlling risk factors for stroke and cardiovascular disease may prevent VCI, even in older people.

"Cerebrovascular disease and Alzheimer's disease may work together to cause cognitive impairment and the mixed disorder may be the most common type of dementia in older persons," Gorelick said in a statement.

Several of the study authors disclosed financial ties to the pharmaceutical industry.

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