Vascular dementia: neurological assessment and cardiovascular manifestations

Resumo

Vascular dementia is a form of dementia caused by brain damage resulting from problems with blood flow to the brain. It is often associated with risk factors and cardiovascular manifestations, such as high blood pressure, diabetes mellitus, ischemic heart disease, stroke, atrial fibrillation, among others. These factors may contribute to the development and progression of vascular dementia, as well as increase the risk of complications and mortality. Objective: to evaluate the relationship between vascular dementia and neurological and cardiovascular changes, as well as to identify the main strategies for prevention, diagnosis and treatment of this condition. Methodology: followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, which consists of a set of recommendations to guarantee the quality and transparency of systematic reviews. Searches were carried out in the PubMed, Scielo and Web of Science databases, using the following descriptors: “vascular dementia”, “neurological assessment”, “cardiovascular manifestations”, “risk factors” and “treatment”. Only articles published in the last 10 years (from 2013 to 2023), in English or Portuguese, that addressed the topic of vascular dementia and its neurological and cardiovascular implications were included. Articles that were not original (reviews, editorials, letters to the editor, etc.), that did not present sufficient or reliable data, that had an inadequate methodology or that were not relevant to the objective of the review were excluded. Results: 17 studies were selected. The neurological evaluation of vascular dementia should include a detailed anamnesis, a complete physical examination, a cognitive and functional assessment, as well as complementary exams such as computed tomography or magnetic resonance imaging of the skull. The cardiovascular assessment of vascular dementia must consider modifiable and non-modifiable risk factors, clinical manifestations, and laboratory and imaging findings. Pharmacological interventions may include medications to improve cognitive function (such as cholinesterase inhibitors or NMDA receptor antagonists), to control cardiovascular risk factors (such as antihypertensives, hypoglycemic agents, or anticoagulants), or to prevent complications (such as anti-inflammatories). or antidepressants). Conclusion: Vascular dementia is a serious and prevalent disease that affects both the central nervous system and the cardiovascular system. Its prevention, diagnosis and treatment require an integrated and multidimensional approach, which considers the neurological and cardiovascular aspects involved. Carrying out more studies on this topic is essential to expand scientific knowledge and improve the quality of life of patients with vascular dementia.