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Vascular dementia: an updated approach to patient management. A roundtable discussion: Part 3.

A new clinical approach to the prevention and treatment of vascular dementia is evolving. The physician has numerous options to consider when the patient is in an asymptomatic "brain-at-risk" stage. These include treatment of hypertension, elevated cholesterol, and atrial fibrillation, as well as smoking cessation, exercise, and dietary changes. When there are early signs of cerebrovascular disease, such as TIAs and subtle cognitive changes, more aggressive therapy may be warranted, including carotid endarterectomy, anticoagulants, aspirin, and ticlopidine. For patients with vascular dementia, treatment focuses on preventing further cerebrovascular damage and managing related symptoms, such as depression.