Vascular Neurocognitive Disorder Continued

The "Stepwise" Decline

People who have vascular neurocognitive disorders often will experience different problems depending on the area of the brain that is affected. Some people have problems with forgetfulness that can respond to the use of reminders such as lists. Others may have problems with movement in a specific area of the body, problems with attention, language, etc.

The problems that happen with vascular neurocognitive disorder typically happen in a stepwise fashion. What this means is that the person will experience a rather sudden decrease in one or more areas of functioning that will then level off for a period of time. This is followed by a later decrease in functioning that levels off for a period of time, etc. This pattern happens in a stepwise fashion. This pattern is different from Alzheimer's disease because Alzheimer's disease most often produces a slow steady decline in functioning.

How Vascular Neurocognitive Disorder is Diagnosed

The DSM-5 has two categories of vascular neurocognitive disorder:

• Minor Vascular Neurocognitive Disorder is diagnosed when a person has one or more problems with their thinking or movement that do not result in major impairment in their daily functioning.
• Major Vascular Neurocognitive Disorder is diagnosed when a person has one or more problems that do result in impairment in their daily functioning.

When vascular neurocognitive disorder is diagnosed there should be either evidence that:

• Cognitive deficits are related to a vascular condition such as a stroke.
• Or evidence for changes in complex aspects of attention or reasoning.

The DSM-5 has two different categories of minor or major vascular neurocognitive disorders:

• Possible Vascular Neurocognitive Disorder is diagnosed when the person demonstrates issues on memory testing or other types of testing that look like they are due to a vascular problem. However, there is not sufficient evidence of a stroke or of vascular disease.
• Probable Vascular Neurocognitive Disorder is diagnosed when there is evidence of neurovascular disease and issues on testing.

The best evidence for vascular disease comes from:

• brain scans such as a CT or an MRI
• a documented history of a stroke or vascular condition
• a documented history of genetic factors that can lead to neurovascular disease.

Treatment of Vascular Neurocognitive Disorder

There are no drugs approved by the FDA to treat vascular neurocognitive disorder. Drugs used to treat Alzheimer's disease may or may not be helpful. The general approaches to treating people with suspected vascular neurocognitive disorders are the same as those used to treat high blood pressure, heart attack, etc. Most often the use of medications for these conditions, dietary changes, and if possible, use of an exercise program are the standard forms of treatment. The treatment for vascular disease may also be helpful in reducing any further damage to the brain, but in many cases, may not reverse brain damage that already happened. People who have suffered a stroke often have very severe problems after the stroke. However, as they recover they may get back some of their functions. If the vascular condition can be controlled with medications and lifestyle changes, the outcome may be fair to good for the person depending on when the treatment began. If the vascular condition is not caught and is not controlled the chances are very good that it will continue to progress.