Definition
Vascular dementia is a disorder characterized by a progressive and irreversible worsening 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 can also affect female patients.
Causes
The cognitive impairment 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 the blood circulation in the brain, the adequate supply of oxygen and nutrients to the brain cells is lacking, which, therefore, undergo certain death.
The causes of this reduced blood flow can be different. These include small blood vessel disease (considered 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 may occur, we find slowness of thought, memory loss, disorientation, confusion, difficulty concentrating, personality changes, mood swings, hallucinations, depression, apathy, difficulty moving, 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.
The 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.
Medicines
Unfortunately, there are no real drugs to treat vascular dementia, but treatments can be carried out to reduce its progression.
First of all, when the vascular cognitive deterioration appears, it is good to immediately run for cover by changing your lifestyle. In fact, this type of cognitive impairment is often caused by smoking, unbalanced diets, hypertension, overweight and low physical activity. It is therefore 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 inhibitors and memantine.
The treatment of those conditions that favor and / or are associated with vascular dementia is also very important. 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.
The following are the classes of drugs most used in the therapy against vascular dementia and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and dosage most suitable for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment.
Acetylcholinesterase inhibitors
Acetylcholinesterase inhibitors can be used in the treatment of vascular dementia in patients who experience confusion, memory loss and somnolence. These drugs act by inhibiting the acetylcholinesterases in the brain responsible for the degradation of acetylcholine, a neurotransmitter that is centrally involved in many cognitive processes.
Acetylcholinesterase inhibitors are also used in the treatment of Alzheimer's disease.
Among the most used active ingredients, we remember:
- Donepezil (Aricept ®, Memac ®, Yasnal ®): donepezil is available for oral administration in tablet form. The dose of drug used varies from 5 mg to 10 mg per day, to be taken every night before going to bed. 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 various pharmaceutical formulations. When administered orally, the usual starting dose of the drug is 1.5 mg, to be taken twice daily. Thereafter, your doctor may increase the dose of rivastigmine given 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 the drug, to be taken twice a day. Thereafter, the doctor will gradually increase the galantamine dose given until the most appropriate maintenance dose for each patient is reached. The maximum administrable dose should not exceed 12 mg, twice a day.
Memantine
Memantine (Ebixa ®, Memantine Accord ®, Memantine Merz ®, Memantine Mylan ®, Nemdatine ®, Marixino ®) is a non-competitive antagonist of the NMDA receptor (N-methyl-D-aspartate). The latter is a postsynaptic receptor for glutamate, the most important excitatory neurotransmitter in the brain.
An excessive glutamate stimulation can cause neuronal damage and, consequently, cell death. Through the inhibition of the aforementioned NMDA receptor, therefore, memantine indirectly decreases the activity of glutamate, 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 the drug used is 5 mg per day. The doctor will then gradually increase the amount of drug administered to a maximum of 20 mg per day.
