Vascular neurocognitive disorder is a rare form of dementia that commonly affects the elderly today. According to Burhan (2017), it impacts between 16 and 30% of individuals diagnosed with dementia, often after a temporary blockage of blood flow, resulting in blood and nutrient depravation in regions of the brain (p. 462). As a consequence, health conditions such as aneurysms, ischemia, cerebral vascular disease, and transient ischemic attacks (TIAs) are major causes of the disorder. The condition may also develop due to genetic causes, elevated cholesterol levels, a sedentary lifestyle, and hypertension. Initial symptoms typically vary depending on the affected area of the brain; but range from memory problems, body weakness, to an overall inability to pay attention. A review of the diagnostic criteria of vascular neurocognitive disorder, evidenced-based psychotherapy and psychopharmacologic available, and risks associated with therapy options is, therefore, fundamental when aiming for an in-depth comprehension of the condition.
Diagnostic Criteria for Vascular Neurocognitive Disorder
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies vascular neurocognitive disorder as an etiological subtype of neurocognitive disorder. One of the foremost criteria used in diagnosis is the presence of either moderate or severe cognitive decline evident to long-time acquaintances or family; affecting focused attention, memory, executive function, and language (American Psychiatric Association, 2013). A cognitive performance test must also confirm significant impairment of function in the patient.
Major signs of the condition must align with vascular etiology, evident in slower processing capacity as a major sign of cognitive impairment. The patient’s medical history and struggle with conditions such as cerebrovascular disease is also a significant element of the diagnostic criteria (American Psychiatric Association, 2013). Additionally, the condition is subsequently diagnosed if initial assumptions are supported neuroimaging or as consequence of cerebrovascular events. By meeting the benchmarks listed with a temporal link to neurocognitive syndrome, it is thus possible to diagnose vascular neurocognitive disorder.
Evidence-based psychotherapy and psychopharmacologic treatment
Presently, there are no medication approved by the United States Food and Drug Administration (FDA) to treat vascular neurocognitive disorder. Non-pharmacological strategies are therefore endorsed as a first-line intervention approach in addressing disruptive behavior among patients (Karamchandani & Barbas, 2017). Group therapy is typically recommended for persons diagnosed with vascular neurocognitive disorder. The primary aim of group therapy is to alleviate loneliness and lift patient’s moods when striving to promote recovery and instituting practicable coping strategies. A study by Cohen-Mansfield (2017) employed the use of the Comprehensive Process Model of Group Engagement (CPMGE) framework, revealing considerable improvement in patient’s temperament and level of engagement in group activities while in group therapy sessions.
Antipsychotics may also be prescribed in scenarios where the patients become a danger to themselves and others around them. They target aggression and symptoms of distress among patients experiencing a great deal of difficulty coping. Second-generation antipsychotics (SGAs) such Quetiapine and Olanzapine are some of the most common anti-psychotics in treating neurocognitive disorder (Karamchandani & Barbas, 2017). Patients typically prescribed this treatment option are monitored regularly to gauge improvement after starting the medication. An appropriately titrated dose is expected to reduce the frequency of disruptive behavior, agitation, or a negative response to a specific medication (Rhondali & Filbet, 2015, p. 222). Patients who respond well to medication but still grappling with archetypal characteristics of the condition should receive a gradual increase in dose after reevaluation. Conversely, antipsychotic medication should be discontinued immediately when patients report an adverse reaction
Cognitive enhancers and selective serotonin reuptake inhibitors SSR are also recommended in treating vascular neurocognitive disorder. Cognitive enhancers slow the rate of cognitive decline typically witnessed among patients with the condition (Levada, 2017). Furthermore, they are linked to an overall reduction in agitation and distress ultimately resulting in considerable improvements in disposition. SSRIs such as Sertraline and Escitalopram are also effective in treating vascular neurocognitive disorder. (Kumral & Özgören, 2017, p.7). They are also better tolerated by patients and likely to improve their overall improvement. Patients prescribed SSRI’s should also be monitored regularly to ascertain adherence, response, and overall effectiveness of the medication offered
Risks associated with psychotherapy and psychopharmacologic treatment
The treatment provided above also present a degree of risk to patient. For instance, a disproportionately high mortality is associated with this antipsychotic intervention among the elderly, with 3.5% of all deaths attributed to drugs in the SGA class (Evered, 2019). They are also associated excessive weight gain and cognition problems among patients. Cognitive enhancers may also cause gastrointestinal problems, sleep disruption, and regular falls (Román, 2014). SSRI use in treating vascular neurocognitive disorder should also be accompanied by regular monitoring of patients. Adverse reactions to SSRIs are mainly characterized by an increased risk in falls, bleeding, decline in cognition, and anxiety (Smith & Cieskla, 2017).
Conclusion
Vascular neurocognitive disorder is a subset of neurocognitive disorder affecting a section of dementia patients. The current DSM-5 diagnostic criteria for the condition lists moderate to severe cognitive decline, presence of cerebrovascular disease, and neuroimaging support as major factors to consider. Although antipsychotics, cognitive enhancers, and selective serotonin reuptake inhibitors (SSRIs) are recommended for vascular neurocognitive disorder, it’s till crucial to consider potential risks to safeguard patient’s wellbeing.
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