Vascular dementia is one of the few remediable causes of dementia among the eldery. Prevention of the disease can be best achieved by primary or secondary prevention of controllable risk factors for strokes. Therefore, early and accurate diagnosis of vascular cognitive impairment prior to the dementia stage is essential to the prevention and treatment of vascular dementia. Pharmacological and non-pharmacological methods for prevention of vascular dementia are listed in this article. Recent epidemiologic data, suggesting a direct correlation between vascular risk factors and Alzheimer type dementia, emphasized the importance of controlling vascular risk factors in the prevention of dementia. Treatment strategies for patients diagnosed as vascular dementia are also discussed. Several clinical trials for symptomatic improvement of vascular dementia are ongoing and their success can be a hope to patients with vascular dementia.
Alzheimer Disease ; Cognition Disorders ; Dementia ; Dementia, Vascular* ; Diagnosis ; Hope ; Humans ; Risk Factors ; Secondary Prevention ; Stroke

Aged ; Cognition Disorders ; diagnosis ; prevention & control ; Dementia ; diagnosis ; prevention & control ; Diagnosis, Differential ; Humans ; Middle Aged

Korea is becoming an aged society at an alarmingly fast rate, which suggests that dementia care may become a major public health problem in Korea. At this point in time, the new policy of national responsibility for dementia care is a well-timed strategy, but it should be assessed based on a careful consideration of several aspects. We must promote a model of dementia care in which all members of society jointly participate. We need to improve the volunteer system in dementia care, and to make various cultural spaces for patients suffering from dementia and their family members. We need to balance financial resources and benefits in cost-reduction plans for dementia treatment. We should implement a careful quality control system for dementia care and educational programs for public dementia care hospitals and nationwide regional dementia centers. These care systems should also incorporate a health policy aiming at primary prevention to reduce the prevalence of dementia in the future. Improving the new policy of national responsibility for dementia care using detailed analyses and systematic approaches will lead to a successful dementia welfare policy.
Dementia ; Health Policy ; Humans ; Korea ; Prevalence ; Primary Prevention ; Public Health ; Quality Control ; Volunteers

The Ministry of Science and ICT and the Ministry of Health and Welfare of the Republic of Korea have organized the first National Committee for Dementia Research, to which all domestic experts in the field have been invited as they endeavor to achieve ‘national dementia liability’, which is one of the core national agenda items of the current Korean government. To make this initiative sustainable and bring dementia under control, we should not focus only on providing care and economic support to the family of patients with dementia. Instead, a large-scale, long-term research and development (R&D) strategy for dementia prevention, diagnosis, and therapy is warranted. This R&D project comprises several parts: 1) elucidation of the etiology and prevention of dementia, 2) innovative diagnostics for dementia, 3) tailored therapies for dementia, and 4) tangible and effective care for dementia. Given the fact that dementia is a very heterogeneous condition involving multiple pathogenic factors and typically having a chronic disease course, comprehensive and integrated approaches across various disciplines should be explored for primary, secondary, and tertiary prevention of this disease. With the success of this R&D project, the national dementia liability system will gain momentum and come into its own. Integrated efforts in terms of both policyrelated and scientific initiatives would allow us to take a step closer to realizing our shared goal of living in a world of dementia carefree.
Alzheimer Disease ; Chronic Disease ; Dementia ; Diagnosis ; Humans ; Republic of Korea ; Tertiary Prevention

Alzheimer's disease (AD) is characterized by decreased neuronal activity and atrophy, while hyperactivity of neurons seems to make them resistant to aging and neurodegeneration, a phenomenon which we have paraphrased as 'use it or lose it'. Our hypothesis proposes that (1) during their functioning, neurons are damaged; (2) accumulation of damage that is not repaired is the basis of aging; (3) the vulnerability to AD is determined by the genetic background and the balance between the amount of damage and the efficiency of repair, and (4) by stimulating the brain, repair mechanisms are stimulated and cognitive reserve is increased, resulting in a decreased rate of aging and risk for AD. Environmental stimulating factors such as bilingualism/multilingualism, education, occupation, musical experience, physical exercise, and leisure activities have been reported to reduce the risk of dementia and decrease the rate of cognitive decline, although methodological problems are present.
Animals ; Brain ; pathology ; physiopathology ; Dementia ; genetics ; pathology ; physiopathology ; prevention & control ; Humans ; Models, Neurological

Vascular dementia (VaD) is the second most common cause of dementia in the elderly after Alzheimer's disease. At present, there are only very limited data that might support either the prevention or the treatment of vascular dementia, despite a long history of attempts. Heterogeneity of vascular dementia complicated the study of treatment and its diagnostic paradigm based on Alzheimer's disease made it impossible to identify cases early enough to prevent the development of dementia. A new concept, vascular cognitive impairment (VCI), has been proposed to underscore the impotance of early identification and treatment of vascular dementia. Prevention involves the control of putative vascular risk factors (i.e. hypertension, diabetes, cardiac arrhythmias, smoking, hyperlipidemia) and the promotion of potential protective factors. Primary and secondary prevention of stroke and cardiovascular disease decreases the burden of vascular dementia. Targets for the treatment of vascular dementia include 1) improvement of core symptoms (cognition, executive function, and behavior), 2) improvement of secondary factors affecting cognition (depression, anxiety, agitation), 3) slowing the progression of vascular dementia. Cholinesterase inhibitors used for Alzheimer's disease are also useful in vascular dementia, awaiting to be accepted as the first-line treatment for vascular dementia.
Aged ; Alzheimer Disease ; Anxiety ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Cholinesterase Inhibitors ; Cognition ; Dementia ; Dementia, Vascular* ; Executive Function ; Humans ; Hypertension ; Population Characteristics ; Risk Factors ; Secondary Prevention ; Smoke ; Smoking ; Stroke

PURPOSE: This study was done to examine actor and partner effect of dementia knowledge, self-efficacy and depression on dementia preventive behavior in elderly couples. METHODS: Participants were 115 couples aged 60 years or over who met eligibility criteria. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. RESULTS: Dementia knowledge in elderly couples showed actor and partner effect on dementia preventive behavior. Self-efficacy in the wife did not have direct effects on dementia preventive behavior, but showed indirect effects through dementia knowledge. Self-efficacy in the husband showed direct effects on dementia preventive behavior and indirect effects through dementia knowledge. Wife's depression had direct actor effect on dementia preventive behavior and indirect effect through self-efficacy and dementia knowledge. Husband's depression did not have direct actor effect on dementia preventive behavior, but indirect effect through self-efficacy and dementia knowledge. Effect size of wives' dementia knowledge, self-efficacy and depression on dementia preventive behavior was larger than that of husbands'. Dementia preventive behavior, dementia knowledge and depression had a mutual effect. CONCLUSION: Results indicate that to promote dementia preventive activity in elderly couples, programs should be conducted for both of the couple, but focused differently for wife and husband.
Aged ; Aged, 80 and over ; Dementia/*prevention & control ; *Depression ; Female ; Humans ; Knowledge ; Male ; Middle Aged ; Questionnaires ; *Self Efficacy ; Spouses/*psychology

Dementia is one of the biggest global public health challenges facing our generation today. By 2030, Korea is projected to have the highest life expectancy in the world. The government's new plans regarding national responsibility for dementia care are well-timed strategies for patients and family members suffering from dementia and should be welcomed. The newly designed national dementia strategy of Korea may set new standards for dementia welfare policies. However, these plans should be modified after careful consideration of following aspects: financial sustainability, issues related with long-term care systems for other critical diseases, and instantaneous nationwide implementation without a period of trial-and-error learning. More gradual and steady policy initiatives is preferred. Through consensus we should strategically develop the optimal quality control system for dementia care and education program for training physicians, dementia-care professionals, and workers to be deployed in both specialized 72 public dementia care hospitals and nationwide 252 regional dementia centers. In addition, these care plans should also include health policy aiming the primary prevention to reduce future dementia prevalence while creating dementia-friendly communities and emphasizing clinical and basic research for dementia. Modifying the current plans for the Korean national dementia strategy using stepwise, well-integrated, and systematic approaches will lead to successful dementia welfare policy.
Consensus ; Dementia* ; Education ; Health Policy ; Humans ; Korea ; Learning ; Life Expectancy ; Long-Term Care ; Prevalence ; Primary Prevention ; Public Health ; Quality Control

This article reviewed the beneficial effects of moderate voluntary physical exercise on brain health according to the studies on humans and animals, which includes improving psychological status and cognitive function, enhancing psychological well-being, decreasing the risks of Alzheimer's disease (AD) and dementia, and promoting the effects of antidepressant and anxiolytic. The possible underlying neurobiological mechanisms are involved up-active and down-active pathways. The up-active pathway is associated with enhancements of several neurotransmitters systems afferent to hippocampus, including norepinephrine (NE), serotonin (5-Hydroxytryptamine, 5-HT), acetylcholine (ACh) and gamma-aminobutyric acid (GABA). The down-active pathway is mainly concerned with up-regulation of the brain-derived neurotrophic factor (BDNF) and neurogenesis. It is suggested that NE activation via beta-adrenergic receptors may be essential for exercise-induced BDNF up-regulation. The possible intracellular signaling pathways of NE-mediated BDNF up-expression may be involved in GPCR-MAPK-PI-3K crosstalk and positive feedback.
Alzheimer Disease ; prevention & control ; Animals ; Brain ; physiology ; Dementia ; prevention & control ; Exercise ; physiology ; Humans ; Neurotransmitter Agents ; metabolism ; Physical Conditioning, Animal ; physiology ; Signal Transduction ; physiology

Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.
Anxiety Disorders/prevention & control/therapy ; Databases, Factual ; Dementia/prevention & control/therapy ; Eating Disorders/prevention & control/therapy ; *Exercise ; Humans ; Mental Disorders/prevention & control/*therapy ; Mood Disorders/prevention & control/therapy ; Motor Activity ; Obsessive-Compulsive Disorder/prevention & control/therapy ; Schizophrenia/prevention & control/therapy ; Substance-Related Disorders/prevention & control/therapy