Alzheimer's disease (AD) is the most common dementing disorder. The understanding of this disorder has greatly advanced over the past few years, and new therapeutic options have been developed. The second most common disorder, vascular dementia (VD), is a syndrome with multiple etiologies operating through different mechanisms. The combination of AD and VD is extremely common, and risk factors for VD have been detected and are presently known to apply also to AD. Cholinergic deficits occur in both conditions.
The identification of several genetic factors which can contribute to vascular damage, as well as possible auto-immune damage to vascular components, are important. It is remarkable that amyloid precursor protein (APP) mutations can cause the typical pathological changes of AD as well as amyloid deposition around blood vessels. These may lead to deficient blood perfusion to the brain, changes of the blood-brain barrier, as well as cerebral hemorrhages. Interestingly, attention to risk factors, such as hypertension, coronary artery disease, hyperlipidemia and smoking could reduce or delay the incidence of dementia, both vascular and AD. There is good evidence that the efficacy of cholinesterase inhibitors in mixed type dementia is similar to that which has been reported in AD.
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