ABSTRACT
VaD 581
63.7 Public health aspects of VaD 583
References 583
From many viewpoints, the most important advance in the field of dementia in the last decade has been the discovery of the critical contribution of vascular factors affecting the brain to the pathogenesis of Alzheimer’s disease (AD) and other forms of dementia (see Chapter 60, Vascular factors and Alzheimer’s disease). Population-based autopsy studies show that pure AD and pure cases of vascular dementia (VaD) appear to be uncommon in older demented subjects. In this age group, the neuropathology rule is the presence at autopsy of mixed dementia with a predominant vascular component (Zekry et al., 2002a). According to Matthews et al. (2009), the main attributable-risks at death for dementia are age (18 per cent), small brain (12 per cent), neocortical neuritic plaques (8 per cent) and neurofibrillary tangles (11 per cent), small vessel disease (12 per cent), multiple vascular pathologies (9 per cent), hippocampal atrophy (10 per cent), cerebral amyloid angiopathy (7 per cent) and Lewy bodies (3 per cent). This discovery explains some of the difficulties with criteria for VaD and offers hope for the treatment and prevention of late-life dementia, given the large armamentarium available for the treatment of vascular disease.
