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Vascular Neurocognitive Disorders and the Vascular Risk Factors Carmen V Journal of Mind and Medical Sciences Volume 5 | Issue 1 Article 3 Vascular neurocognitive disorders and the vascular risk factors Carmen V. Albu Craiova University of Medicine and Pharmacy, Department of Neurology, [email protected] Vlad Padureanu Craiova University of Medicine and Pharmacy, Department of Internal Medicine, [email protected] Mihail V. Boldeanu Craiova University of Medicine and Pharmacy, Department of Immunology, [email protected] Ana M. Bumbea Craiova University of Medicine and Pharmacy, Department of Physical Medicine and Balneology Anca S. Enescu Craiova University of Medicine and Pharmacy, Department of Internal Medicine, [email protected] See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Nervous System Diseases Commons, Neurology Commons, and the Neurosciences Commons Recommended Citation Albu, Carmen V.; Padureanu, Vlad; Boldeanu, Mihail V.; Bumbea, Ana M.; Enescu, Anca S.; Albulescu, Dana M.; Silosi, Cristian A.; and Enescu, Aurelia () "Vascular neurocognitive disorders and the vascular risk factors," Journal of Mind and Medical Sciences: Vol. 5 : Iss. 1 , Article 3. DOI: 10.22543/7674.51.P715 Available at: https://scholar.valpo.edu/jmms/vol5/iss1/3 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. Vascular neurocognitive disorders and the vascular risk factors Authors Carmen V. Albu, Vlad Padureanu, Mihail V. Boldeanu, Ana M. Bumbea, Anca S. Enescu, Dana M. Albulescu, Cristian A. Silosi, and Aurelia Enescu This review article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol5/iss1/3 J Mind Med Sci. 2018; 5(1): 7-15 doi: 10.22543/7674.51.P715 Review Vascular neurocognitive disorders and the vascular risk factors Carmen V. Albu1, Vlad Pădureanu2*, Mihail V. Boldeanu3, Ana M. Bumbea4, Anca Ş. Enescu2, Dana M. Albulescu5, Cristian A. Siloși6, Aurelia Enescu2 1Department of Neurology, 2Department of Internal Medicine, 3Department of Immunology, 4Department of Physical Medicine and Balneology, 5Department of Radiology/ Medical Imaging, 6 Department of Surgery, Craiova University of Medicine and Pharmacy, Craiova, Romania Abstract Dementias are clinical neurodegenerative diseases characterized by permanent and progressive transformation of cognitive functions such as memory, learning capacity, attention, thinking, language, passing judgments, calculation or orientation. Dementias represent a relatively frequent pathology, encountered at about 10% of the population of 65- year olds and 20% of the population of 80-year olds. This review presents the main etiological forms of dementia, which include Alzheimer form of dementia, vascular dementia, dementia associated with alpha-synucleionopathies, and mixed forms. Regarding vascular dementia, the risk factors are similar to those for an ischemic or hemorrhagic cerebrovascular accident: arterial hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, age, alcohol consumption, cerebral atherosclerosis/ arteriosclerosis. Several studies show that efficient management of the vascular risk factors can prevent the expression and/ or progression of dementia. Thus, lifestyle changes such as stress reduction, regular physical exercise, decreasing dietary fat, multivitamin supplementation, adequate control of blood pressure and serum cholesterol, and social integration and mental stimulation in the elderly population are important factors in preventing or limiting the symptoms of dementia, a disease with significant individual, social, and economic implications. Keywords: dementia, neurodegenerative disease, atherosclerosis, Alzheimer`s disease, cognitive decline Highlights: ✓ Dementia is a neurocognitive disorder with multiple and severe (individual, social, and economic) implications. ✓ Lifestyle changes implying stress reduction, regular physical exercise, decreasing dietary fat, social integration and mental stimulation in the elderly population are important factors in preventing or limiting the symptoms of dementia To cite this article: Albu CV, Pădureanu V, Boldeanu MV, Bumbea AM, Enescu AŞ, Albulescu DM, Siloși CA, Enescu A. Vascular neurocognitive disorders and the vascular risk factors. J Mind Med Sci. 2018; 5(1): 7-15. DOI: 10.22543/7674.51.P715 *Corresponding author: Vlad Pădureanu, Craiova University of Medicine and Pharmacy, Petru Rares Street No. 2, Craiova, Romania (200349), e-mail: [email protected] Carmen V. Albu et al. Introduction due to another medical condition, NCD due to multiple etiologies, and unspecified NCD (1, 2). Neuro-cognitive disorders (NCD) are Regarding their global prevalence, dementias, a term neurodegenerative diseases characterized clinically by almost super-imposable with major NCD, represent 1- persistent and progressive impairment of cognitive 2% of the population of 65 and older, and 30% by age 85 functions (1). These impairments are usually inherited, (3). Estimations of the prevalence of minor NCD for the with etiology and pathogeny currently documented, but older patients range between 2-10% at the age 65 and 5- they are not considered developmental disorders (2). 25% at the age 85 (2). The most common etiological According to the American Psychiatric Association factors are represented by: Alzheimer disease (60%– and The Diagnostic and Statistical Manual of Mental 80%), dementia with Lewy bodies, Parkinson disease Disorders, Fifth Edition (DSM5), the term dementia was with dementia (10%–20%), frontotemporal dementia replaced with the notion of major neurocognitive (5%–10%), cerebrovascular disease (10%– 20%) (4). disorder (NCD), defining thus a broad spectrum of Vascular neurocognitive disorder is the result of cognitive and functional disorders that form the basis for reduced cerebral blood flow that can either produce an diagnostic criteria. Nevertheless, for certain etiological ischemic stroke, with different strategic localizations at subtypes, the term of dementia is standard (2). Thus, the cerebral level (such as the angular gyrus, the according to the current international agreement, for the temporal lobe, the frontal lobe, the thalamus, the caudate confirmation of a major neurocognitive disorder, the nucleus, the hippocampus), or result in modifications cognitive deficiency and the main clinical SDR (source such as the hyaline and fibrosis of the small vessels with data review) must be characterized by a significant the appearance of infarcts at the level of the cerebral decline in performance compared to a previous level in white matter (clinically silent or accompanied by one or more cognitive fields such as: memory, learning, neurological non-specific signs). These injuries of the complex attention, executive function, perceptual-motor white matter generate interruptions of the cortical and skills related to language skills, or social knowledge. The subcortical circuits, with the deterioration of complex cognitive deficiency must interfere with daily activities, attention, information processing speed, and executive and the health care provider might request evidence of skills and abilities, resulting in a neurocognitive disorder minimum assistance for daily routines (e.g., invoices, (5-7). At the same time, there are also the so-called payment, testimonials from relatives, etc.). At the same cortical– subcortical border zone infarcts, the result of time, the cognitive deficiency must not be associated hypoperfusion from atherosclerosis, as well as extended with a psychological disorder, such as a major depression episodes of arterial hypotension that can be accompanied or schizophrenia. (3). by NCD. Consequently, neurocognitive disorders having This paper presents the main etiological forms of as etiology the cerebrovascular diseases actually dementia, focusing discussion especially on vascular represent a vast group of manifestations from the neurocognitive disorder and the vascular risk factors cognitive vascular sphere. They are characterized by two implicated (diabetes mellitus, age and arterial subcategories: medium or major NCD (7). hypertension, the metabolic syndrome, smoking and The major vascular NCD represents the second most alcohol consumption), as a premise to further understand frequent cause of NCD, second only to Alzheimer and develop therapeutic and prophylactic guidance disease. In the USA, the prevalence of vascular dementia is 0,2% for those between 65-70 years, and more than related to this severe disease. 16% for those over 80. In the first three months after a Discussion stroke, about 20-30% of the patients are diagnosed with DSM5 defines the incipient stage of dementia when dementia. Regarding patients with neurological pathology, the prevalence of vascular dementia increases the cognitive disorder is less severe as a minor from 13% at age 70 to 44,6% at age 90, compared to the neurocognitive disorder. Several diagnostic criteria are Alzheimer disease (23,6%-51%), and to vascular also formulated for this incipient stage. The subtypes of dementia associated with the Alzheimer disease (2% - minor or major NCD are: NCD due to Alzheimerʼs 46,4%). The prevalence is higher for men and Afro- disease, vascular NCD, NCD with Lewy bodies, NCD Americans, compared to Caucasians and East Asians (2, due to Parkinsonʼs
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