1. Risk Factors and Therapies for Vascular Dementia:
An Integrative Review of the Literature
Lauren Davis
DePaul University School of Nursing
Purpose
Conceptual Framework
Methodology
Conclusion
Research Objectives
The purpose of this integrative literature review is to identify the risk factors and health behaviors that contribute to vascular dementia
A secondary objective is to review the proposed treatments for vascular dementia as described in the literature
Relevance
A rise in the aging population will increase the cost, burden and need for better understanding of those with dementia
There is research on Alzheimer dementia which has well-established diagnostic criteria, but this does not yet exist for vascular dementia
VaD is the most expensive form of dementia to care for costing approximately $18, annually
There is no cure for VaD
Brain Images: Healthy vs. VaD
Pender’s Model of Health Promotion
Cognitive-perceptual factors such as:
Perceived benefits of health promotion
Barriers to health promotion
Self-efficacy of health promotion
Considers how these factors influence individuals’ engagement in the promotion of their own health
Modifying factors also influence cognitive-perceptual processes like:
Demographic characteristics
Interpersonal influences
Behavioral factors
Helps to identify healthy and unhealthy behaviors
Modifiable risk factors that may contribute to VaD:
Smoking
Alcohol consumption
Obesity
Lack of physical activity
Hypertension
Hyperglycemia
Hyperlipidemia
Integrative Literature Review
Two searches in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and PsychINFO
Boolean phrase included:
“vascular dementia”
“cognitive impairment”
“risks”
Inclusion data:
Articles from published from 2015 until present
Peer-reviewed
Full-text
English language
Adult human subjects (if applicable)
14 articles included in review
There are several themes that are evident after reviewing the literature with regards to both risk factors and therapies used in vascular dementia and are outlined in the data matrix
Authors of these works also call for more studies to further evaluate both risk factors and therapies
Other potential areas of study include utilization of screening tools, protective effects against dementia, timing of lifestyle changes and its effects on dementia, and population-based studies
Nursing Implications
Assess all potential risk factors and their potential role in the development of VaD in all patients
Increase patient awareness of VaD
Provide additional resources and education on appropriate lifestyle and health behavior modifications
Obtain a detailed drug history
Utilize screening tools
Montreal Cognitive Assessment (MoCA)
Results
Themes in the Literature: Risk Factors for Vascular Dementia
Disease of the heart and vasculature
Peripheral vascular disease
Chronic heart disease
Atrial fibrillation
Hypertension
Hypoperfusion
Stroke
Health behaviors
Obesity (in those less than 65 years old)
Smoking
Alcohol consumption
Socioeconomic status
Low education
Themes in the Literature: Therapies for Vascular Dementia
Exercise
Pharmacologic intervention
Alternative therapies
Acupuncture
Herbal supplements
Combination therapy
Utilization of imaging technology
Background
Vascular dementia (VaD) is changes to the brain as result of diseases that affect the vasculature
VaD causes vascular cognitive impairment (VCI), a spectrum of cognitive disorders ranging from mild cognitive impairment through fully developed dementia
VaD may also cause aphasia, apraxia, agnosia, confusion, agitation, anterograde amnesia, gait disturbance, unprovoked falls, personality and mood changes, depression, mild memory deficit, psychomotor retardation, and abnormal executive function