Vascular Neurocognitive Disorder

1 Vascular Neurocognitive Disorder Vascular neurocognitive disorders are a group of neurocognitive disorders that occurs when a stroke or any other form of vascular brain injury impairs blood supply to brain tissues resulting in impaired cognitive brain function. According to the latest DSM IV diagnostic criteria, the vascular neurocognitive disorder has to meet the diagnostic criteria for mild or major neurocognitive disorder and the symptoms explained by a vascular etiology or following a cerebrovascular event with cerebrovascular diseases evidenced through history, physical exam, or imaging. The patient has to decline attention and frontal executive function, and the symptoms are not explained by other brain or systemic conditions.

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2 Therapy in patients with vascular neurocognitive disorders aims to improve cognitive function while reducing or preventing further vascular brain damage. Most treatment approaches focus on mental stimulation, social integration, and lifestyle changes to lower blood cholesterol, control blood pressure, improve overall health and reduce stress (Albu et al., 2018). Supportive psychotherapy is often used in such patients and is highly recommended, especially in elderly patients. Other forms of psychotherapeutic approaches are less beneficial, especially among the older population and in later stages of progressed cognitive dysfunction where cognitive change is unlikely.

For psychopharmacological treatment, there is no approved drug used to treat vascular neurocognitive disorders. Acetylcholinesterase inhibitors and memantine can be used to improve cognitive symptoms in Alzheimer's. However, it is not recommended in non-Alzheimer vascular neurocognitive disorders as they are evidenced to increase the risk of adverse events and have minimal benefits when used in high doses, and have minimal therapeutic benefits in lower doses.

Using memantine produces no significant clinical improvement despite having a lower risk for adverse events (Kaminishi, 2020).

3 References Albu, C. V., Padureanu, V., Boldeanu, M. V., Bumbea, A. M., Enescu, A. S., Albulescu, D. M., ... & Enescu, A. (2018). Vascular neurocognitive disorders and the vascular risk factors. Journal of Mind and Medical Sciences, 5(1), 7-15. doi: 10.22543/7674.51.P715 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub. Kaminishi, K. S. (2020). Major neurocognitive disorders: Alzheimer disease, vascular dementia, and frontotemporal dementia. Psychiatry morning report: Beyond the pearls e-book (p.

85). Elsevier.

Kumral, E., & Özgören, O. (2017). Major vascular neurocognitive disorder: A reappraisal to vascular dementia. Turkish Journal of Neurology/Turk Noroloji Dergisi, 23(1). doi:10.4274/tnd.98250