What are the recommended management strategies for patients diagnosed with vascular dementia?

Management strategies for patients diagnosed with vascular dementia focus primarily on non-pharmacological interventions and addressing vascular risk factors, as pharmacological treatments specifically approved for vascular dementia are limited.

Non-drug approaches include offering tailored activities to promote wellbeing, such as group cognitive stimulation therapy and cognitive rehabilitation or occupational therapy to support functional ability in people with mild to moderate dementia. Group reminiscence therapy may also be considered to enhance cognitive and emotional wellbeing. These interventions should be personalised to the patient's preferences and needs to maintain independence and quality of life ¹.

Pharmacological treatment with acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine is generally not recommended for vascular dementia unless there is suspected comorbid Alzheimer's disease or other dementias such as Parkinson's disease dementia or dementia with Lewy bodies ¹. This reflects the current NICE guideline stance that these medications are off-label for pure vascular dementia and should not be routinely offered ¹.

Management should also focus on controlling vascular risk factors such as hypertension, diabetes, and hyperlipidaemia to potentially slow progression, although NICE does not recommend these medicines specifically to slow dementia progression outside their usual indications ¹. Recent literature highlights the importance of vascular risk factor management and suggests that addressing cerebrovascular health may improve cognitive outcomes and delay progression in vascular cognitive impairment and dementia (Mok et al., 2024; Reuben et al., 2024).

Supportive care includes regular pain assessment and management, fall risk assessment and prevention tailored to dementia severity, sensory impairment screening (hearing and vision), and nutritional support. Palliative care should be flexible and needs-based from diagnosis, with anticipatory care planning as the disease progresses ¹.

Carer support is essential, offering psychoeducation, skills training, and information about services to help carers manage behavioural changes and maintain their own wellbeing ¹.

Emerging evidence from expert consensus and recent reviews suggests potential adjunctive therapies such as Ginkgo biloba extract (EGb 761®) may have some benefit in vascular cognitive impairment, but these are not yet established in NICE guidelines and require further research (Kandiah et al., 2019; Mok et al., 2024).