From the Guidelines
Treatment for vascular dementia should focus on managing underlying cardiovascular conditions, slowing disease progression, and improving quality of life, with a comprehensive approach that includes pharmacological and non-pharmacological interventions, as recommended by the Canadian Stroke Best Practice Recommendations: Vascular Cognitive Impairment, 7th edition practice guidelines update, 2024 1.
Key Components of Treatment
- Controlling risk factors such as high blood pressure, diabetes, high cholesterol, and smoking to reduce the risk of further strokes and cognitive decline 1
- Using antiplatelet medications such as aspirin (81mg daily) or clopidogrel (75mg daily) to prevent further strokes, guided by existing primary and secondary stroke or vascular prevention indications 1
- Considering cholinesterase inhibitors like donepezil (5-10mg daily) or memantine (5-20mg daily) for modest cognitive benefits in some patients, based on randomized trials showing small magnitude benefits in cognitive outcomes 1
- Engaging in regular physical activity, such as 30 minutes daily of moderate activity, to preserve cognitive function and reduce the risk of vascular-related cognitive decline 1
- Implementing cognitive stimulation, a Mediterranean diet rich in fruits, vegetables, whole grains, and olive oil, and addressing depression, sleep disorders, and behavioral symptoms to maintain brain function and improve quality of life
Monitoring and Support
- Regular monitoring of cardiovascular health and cognitive function is essential to adjust treatment plans as needed
- Support for caregivers is crucial in managing this progressive condition, including providing communication tools, memory aids, and participation in goal-setting and interventions 1
From the FDA Drug Label
Memantine hydrochloride was evaluated in eight double-blind placebo-controlled trials involving a total of 1862 dementia (Alzheimers disease, vascular dementia) patients
The memantine drug is used in the treatment of moderate to severe dementia of the Alzheimer’s type, and although it has been evaluated in patients with vascular dementia, the label does not explicitly state its indication for vascular dementia treatment. However, it has been studied in vascular dementia patients in clinical trials 2.
- The dosage for memantine is the same for all types of dementia, with a recommended starting dose of 5 mg once daily, increasing to a maximum of 20 mg/day.
- Adverse reactions were similar in patients with Alzheimer’s disease and vascular dementia.
- Memantine should be used with caution in patients with severe renal impairment or hepatic impairment.
It is essential to consult a healthcare professional for proper diagnosis and treatment of vascular dementia.
From the Research
Treatment Options for Vascular Dementia
- The treatment of vascular dementia focuses on preventing further cerebrovascular damage and managing related symptoms, such as depression 3.
- Treatment options include:
- Cholinesterase inhibitors (donepezil, galantamine, and rivastigmine) which have shown promise in improving cognitive function in patients with vascular dementia 4, 5, 6.
- N-methyl-d-aspartate (NMDA) receptor antagonists (memantine) which may be effective in managing symptoms, but the evidence is less robust 4, 7.
- Cardiovascular risk factor reduction, including treatment of hypertension, elevated cholesterol, and atrial fibrillation, as well as smoking cessation, exercise, and dietary changes 3, 5.
Pharmacological Interventions
- Donepezil has been shown to be effective in improving cognitive function in patients with vascular dementia, with a moderate to high level of certainty 4, 6.
- Galantamine has also been shown to be effective, although the evidence is less robust than for donepezil 4, 6.
- Rivastigmine may have a beneficial effect on cognition, but the evidence is less certain and further research is needed 6.
- Memantine may be effective in managing symptoms, but the evidence is limited 4, 7.
Non-Pharmacological Interventions
- Cardiovascular risk factor reduction is crucial in preventing further cerebrovascular damage and managing symptoms of vascular dementia 3, 5.
- Lifestyle modifications, such as smoking cessation, exercise, and dietary changes, may also be beneficial in managing symptoms and preventing further decline 3.