The American Heart Association and the American Stroke Association have issued a 42 page statement regarding the vascular contributions to cognitive impairment and dementia that was published in the July issue of Stroke. Although Alzheimer’s disease has received the most attention vascular changes make significant contributions to cognitive decline and should be routinely addressed in clinical practice.

The statement suggests a new term, “vascular cognitive impairment,” to incorporate the varied cognitive disorders associated with stroke ranging from mild cognitive disorders through dementia. Don’t be confused by the introduction of a new term as accumulating evidence indicates that vascular factors also play a role in neurodegenerative cognitive disorders such as Alzheimer’s disease that develops latter in life and the recommendations below apply to all of us. Two criteria are needed to diagnose vascular cognitive impairment: (1) neuropsychological evaluation to demonstrate cognitive decline and (2) presence of stroke by history or neuroimaging (e.g., MRI, CT scan).

Stroke and heart disease are risk factors for both vascular cognitive impairment and Alzheimer’s disease. Hypertension, high cholesterol, diet, tobacco use, and sedentary life style play a causal role in cognitive decline. Many have summarized the relationship as “what’s good for the heart is good for the brain.” The hope is that detection and managing these factors may reduce the cognitive impairment that some experience as they age.

The committee makes numerous recommendations based on current scientific evidence that may reduce cognitive decline with age:
 Stop smoking
 Be moderate in using alcohol
 Exercise and manage weight (being either too skinny or being greatly overweight may increase risk)
 Eat a “Mediterranean” type diet
 Fish oil may be helpful via either eating fish or using supplements
 Aricept (donepezil) is useful to treat vascular cognitive impairment as well as Alzheimer’s disease
 Razadyne (galantamine) is beneficial for those with mixed vascular and Alzheimer’s disease

There are also a number of factors that do not appear to be helpful in treating or managing risk of vascular cognitive impairment based on current scientific evidence:
 Use of antioxidants and B vitamins have not proven useful
 Vitamin supplementation does not appear to enhance cognitive function even when homocysteine is lowered and vitamins’ usefulness in those without vitamin deficiencies has not been established.
 The evidence for usefulness of vitamin D for vascular cognitive impairment is mixed and limited to date
 The effectiveness of antiaggregant therapy (blood thinners) for vascular cognitive impairment is not well established. This is not to be confused with the helpfulness of these medications for treating stroke.
 Rivastigmine (Exelon) and Namenda have not yet been shown to be useful in vascular cognitive impairment.

Dr. Beckwith will present a three hour workshop (fee $100 per person/$150 per couple with limited seating) in Naples on August 8 (call 591-6226 to register).