ABSTRACT
The occurrence of brain neurotransmitter deficits in vascular dementia (VaD) is indicated by autopsy and cerebrospinal fluid (CSF) investigations, and invivo positron emission tomography (PET) studies. Changes in the cholinergic system have been the most frequently reported, although there are also indications of involvement of the serotonergic and dopaminergic systems and possibly changes in central nervous system glutamate and GABA and the hypothalamic-pituitary-adrenocortical axis in VaD. Deficits may in part be the result of mixed vascular and neurodegenerative pathology (e.g. vascular pathology in combination with Alzheimer’s disease), but investigations using animal models are consistent with vascular disruption being associated with reduced cholinergic innervation. Since neurotransmitters modulate cerebral blood flow it is possible that neurotransmitter deficits in VaD not only contribute to behavioral and cognitive symptoms, but also further compromise cerebral perfusion and blood-brain barrier control. Clinical trials indicate potential benefits of cholinergic therapy in VaD and mixed dementia with vascular pathology.
