Therapeutic strategies for vascular cognitive disorders

A recent development is the recognition of the importance of vascular lesions in the pathogenesis and clinical presentation of most cases of late-onset Alzheimer’s disease (AD) (Roman, 2002a), supporting the concept that vigorous treatment of vascular risk factors in patients with early cognitive decline could delay the onset or prevent dementia (Román et al., 2012; Willis and Hakim, 2013; Román and Boller, 2014). It has been estimated that one-third of AD cases worldwide might be attributable to potentially modiable vascular risk factors (Norton et al., 2014). According to Barnes and Yae (2011) ‘A 10%-25% reduction in all seven risk factors (diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment and physical inactivity) could potentially prevent as many as 1.1-3.0 million AD cases worldwide’. A recent, population-based double-blind randomized controlled trial (RCT) in Finland (Ngandu et al., 2015), on 1260 subjects ages 60-77 years, demonstrated that aer 2 years of a multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), cognition improved or remained better in the intervention group compared with the control group that received only general health advice.