Treatment of vascular dementia Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Brucki, Sonia Maria Dozzi; Ferraz, Ana Cláudia; Freitas, Gabriel R. de; Massaro, Ayrton Roberto; Radanovic, Márcia; Schultz, Rodrigo Rizek

doi:10.1590/S1980-57642011DN05040005

Abstract

Scientific Department of Cognitive Neurology and Aging of ABN had a consensus meeting to write recommendations on treatment of vascular dementia, there was no previous issue. This disease has numerous particularities and can be considered a preventable dementia. Prevention treatment is primary care of vascular risk factors or a secondary prevention of factors that could cause recurrence of ischemic or hemorrhagic brain modifications. In these guidelines we suggested only symptomatic treatment, pharmacologic or non-pharmacologic. We have reviewed current publications on MEDLINE (PubMed), LILACS e Cochrane Library databases. Recommendations are concern to the following factors and their prevention evidences, association, or treatment of vascular dementia: physical activity, tobacco use, diet and food supplements, arterial hypertension, diabetes mellitus, obesity, statins, cardiac failure, atrial fibrillation, antithrombotics, sleep apnea, carotid revascularization, symptomatic pharmacological treatment.

Key words:
vascular dementia; pharmacological treatment; prevention; cholinesterase.

Resumo

O DC de Neurologia Cognitiva e do Envelhecimento da ABN reuniu-se para escrever recomendações para o tratamento da demência vascular, uma vez que não havia nenhuma recomendação neste sentido. Esta doença tem inúmeras particularidades e pode ser considerada uma das demências que pode ser prevenida. O tratamento para sua prevenção é o de cuidados primários para os fatores de risco vasculares, ou a prevenção secundária dos fatores que levam a recorrência de alterações isquêmicas ou hemorrágicas cerebrais. Nestas recomendações sugerimos apenas o tratamento sintomático, medicamentoso ou não. Baseamo-nos nas evidências disponíveis, através da revisão das publicações nas bases MEDLINE (PubMed), LILACS e Cochrane Library. As recomendações dizem respeito aos seguintes fatores e suas evidências na prevenção, associação ou tratamento da demência vascular: atividade física, álcool, tabagismo, dieta e suplementos, hipertensão arterial, diabetes mellitus, obesidade, estatinas, insuficiência cardíaca, fibrilação atrial, antiagregantes, apneia do sono, revascularização carotídea e tratamento farmacológico sintomático.

Palavras-chave:
demência vascular; tratamento farmacológico; prevenção; inibidores das colinesterases; memantina; diretrizes; consenso; Brasil.

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References

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Publication Dates

Publication in this collection
Oct-Dec 2011

History

Received
15 Sept 2011
Accepted
20 Nov 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Uda M, Ishido M, Kami K, Musuhara M. Effects of chronic treadmill running on neurogenesis in the dentate gyrus of the hippocampus of adult rat. Brain Res 2006;1104:64-72.

[2] Yaffe K, Fiocco AJ, Vittinghoff E, et al. Predictors of maintaining cognitive function in older adults. The Health ABC Study. Neurology 2009;72:2029-2035.

[3] Lautenschlager NT, Cox KL, Flicker L, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer's disease. A randomized trial. JAMA 2008; 300:1027-1037.

[4] Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F. Physical activity, including walking, and cognitive function in older women. JAMA 2004;292:1454-1461.

[5] Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incidente dementia among persons 65 years of age and older. Ann Intern Med 2006;144:73-81.

[6] Etgen T, Sander D, Huntgeburth U, et al. Physical activity and incident cognitive impairment in elderly persons: The INVADE study. Arch Intern Med 2010;170:186-193.

[7] Sofi F, Valecchi D, Bacci D, et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med 2011;269:107-117.

[8] Rockwood K, Middleton L. Physical activity and the maintenance of cognitive function. Alzh Dementia 2007;3:S38-S44.

[9] Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001;58:498-504.

[10] Abbott RD, White LR, Ross GW, et al. Walking and dementia in physically capable elderly men. JAMA 2004;292:1447-1453.

[11] Pahlman U, Savborg M, Tarkowski E. Cognitive dysfunction and physical activity after stroke: The Gothenburg Cognitive Stroke Study in the Elderly. J Stroke Cerebrovasc Dis 2011; epub ahead of print.

[12] Aarsland D, Sardahee FS, Anderssen S, Ballard C, the Alzheimer's Society Systematic Review Group. Aging Ment Health 2011;14: 386-395.

[13] Middleton L, Kirkland S, Rockwood K. Prevention of CIND by physical activity: different impact on VCI-ND compared with MCI. J Neurol Sci 2008;269:80-84.

[14] Ravaglia G, Forti P, Lucicesare A, et al. Physical activity and dementia risk in the elderly: findings from a prospective Italian study. Neurology 2008;70:1786-1794.

[15] Verghese J, Wang C, Katz MJ, Sanders A, Lipton RB. Leisure activities and risk of vascular cognitive impairment in older adults. J Geriatr Psychiatry Neurol 2009;22:110-118.

[16] Liu-Ambrose T, Eng JJ, Boyd LA, et al. Promotion of the mind through exercise (PROMoTE): a proof of concept randomized controlled trial of aerobic exercise training in older adults with vascular cognitive impairment. BMC Neurology 2010;10:14.

[17] Cyarto EV, Cox KL, Almeida OP, et al. The fitness for the ageing brain study II (FABS II): protocol for a randomized controlled clinical trial evaluating the effect of physical activity on cognitive function in patients with Alzheimer's disease. Trials 2010;11:120.

[18] Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 2006;63:739-747.

[19] Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol 2006;59:922-927.

[20] Scarmeas N, Sterm Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA. Mediterranean diet and Mild Cognitive Impairment. Arch Neurol 2009;66:216-225.

[21] Frisardi V, Panza F, Seripa D, et al. Nutraceutical properties of Mediterranean diet and cognitive decline: possible underlying mechanisms. J Alzheimers Dis 2010;22:715-740.

[22] Féart C, Samieri C, Rondeau V, et al. Adherence to a mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009; 302:638-648.

[23] Van de Rest O, Geleijnse JM, Kok FJ, et al. Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology 2008;71:430-438.

[24] Cole GM, Frautschy. DHA may prevent age-related dementia. J Nutrition 2010;140:869-874.

[25] Kang JH, Cook NR, Manson JE, et al. Vitamin E, Vitamin C, Beta Carotene, and cognitive function among women with or at risk of cardiovascular disease: the women antioxidant and cardiovascular study. Circulation 2009;119:2772-2780.

[26] Kang JH, Cook N, Manson J et al. A trial of B vitamins and cognitive function among women at high risk of cardiovascular disease. Am J Clin Nutr 2008;88:1602-1610.

[27] Anstey KJ, Holly MA, Cherbuin N. Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies. Am J Geriatr Psychiatr 2009; 17:542-555.

[28] Ruitenberg A, van Sweiten JC, Witteman JCM, et al. Alcohol consumption and risk of dementia: the Rotterdam study. Lancet 2002;359:281-286.

[29] Mukamal KJ, Kuller LH, Fitzpatrick AL, et al. Prospective study of alcohol consumption and risk of dementia in older adults. JAMA 2003;289:1405-1413.

[30] Espeland MA, Gu L, Masaki KH, et al. Association between reported alcohol intake and cognition: results from the Women's Health Initiative Memory Study. Am J Epidemiol 2005;161:228-238.

[31] Collins MA, Neafsey EJ, Mukamal KJ, et al. Alcohol in moderation, cardioprotection, and neuroprotection: epidemiological considerations and mechanistic studies. Alcohol Clin Exp Res 2009:33:206-219.

[32] Mehlig K, Skoog I, Guo X, et al. Alcoholic beverages and incidence of dementia: 34-year follow-up of the prospective population study of women in Göteborg. Am J Epidemiol 2008; 167:684-691.

[33] Marambaud P, Zhao H, Davies P. Resveratrol promotes clearance of Alzheimer's disease amyloid-b peptides. J Biol Chem 2005;280:37377-37382.

[34] Vingtdeux V, Dreses-Werringloer U, Zhao H, Davies P, Marambaud P. Therapeutic potential of resveratrol in Alzheimer's disease. BMC Neuroscience 2008;9(Suppl 2):S6.

[35] Brucki SMD. Does prevention for Alzheimer's disease exist? Dement Neuropsychol 2009;3:209-213.

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