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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 2010 March;51(1):1-7

language: English

Definitions, criteria and mechanisms for vascular and mixed dementia

Ballard C. 1,2, Corbett A. 2

1 Wolfson Centre for Age-Related Diseases, Wolfson Wing, Guy’s Campus, King’s College, London, UK
2 Alzheimer’s Society, London, UK


Mixed vascular dementia/Alzheimer’s disease (AD) is a common condition, particularly in individuals over the age of 80. There are a number of potential explanations for this, including the likelihood that cerebrovacular disease triggers the development of AD pathology. In addition to the patients who separately meet operationalized diagnostic criteria for AD and VaD, a much larger number of patients have either AD with some VaD changes or VaD with modest Alzheimer type pathology. In these circumstances there is clearly an additive effect of the pathological substrates and a better classification is needed to reflect the overlap of pathologies and their contribution to the clinical dementia syndrome in a particular individual. It is also important that there are many different types of cerebrovascular and Alzheimer pathologies, including infarcts, small vessel disease, amyloid, tau pathology and cerebral amyloid angiopathy, leading to a complex potential typography of “mixed dementia”. There has been very little study of the biochemical characteristics of mixed VaD/AD, and further work will be important to identify the characteristic profile of biochemical alterations in different types of mixed VaD/AD to inform biomarker and treatment studies. There is evidence from several clinical trials that cholinesterase inhibitors may confer clinically significant benefit in patients with mixed VaD/AD, but further intervention studies also remain a priority.

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