Erin Jackson

January 23, 2016

Period 1

Annotated Source List

"Acupuncture Alleviates Dementia and Cognitive Impairment." Healthcare Medical Institute, 6
Dec. 2015, www.healthcmi.com/Acupuncture-Continuing-Education-News/1563-
acupuncture-alleviates-dementia-and-cognitive-impairment.
Finding alternative, nonpharmacologic treatments is very important when it comes to
treating vascular dementia (VaD). Acupuncture is a form of alternative medicine and is the
practice of using needles and applying them to pressure points to treat the illnesses and
impairments of patients. When treating VaD, acupuncturists apply needles to the scalp and other
pressure points involved with the brain. Researchers at the Anhui University of Chinese
Medicine conducted a study that showed a 90% effectiveness rate when treating vascular
dementia, meaning they saw significant improvement in 90% of the patients. The researchers
hypothesized that the the practice of acupuncture increases blood flow to the brain. The study
divided sixty VaD patients into two groups, one received scalp acupuncture exclusively in longer
sessions, while the other received general acupuncture in 30 minute sessions. The researchers
found that the longer sessions were more effective as they increased blood flow to the brain even
more. Acupuncture could be a promising alternative therapy.
Acupuncture is a well-known treatment but not many people know of its use in treating
VaD. This article was effective in summarizing the findings of the study and explaining how
acupuncture can be used to treat VaD. Although this article wrote about how acupuncture can
help VaD, it did not compare the use of acupuncture with alternative therapies and which one
was more effective. Healthcmi is a program that helps train people to improve their skills in
acupuncture. The author detailed a study to help prove why people should try acupuncture in
treating VaD. The nature of this source makes cross examining sources crucial to evaluate this
source.

"Acupuncture Stabilizes Dementia Patients." Health Care Medical Institute, 14 Oct. 2014,
www.healthcmi.com/Acupuncture-Continuing-Education-News/1388-acupuncture-
steadies-dementia-patients.
Acupuncture is a type of alternative therapy used to treat many different conditions,
including types of dementia. However, this article specifically talks about treating vascular
dementia (VaD). Acupuncture involves the therapist inserting needles into certain pressure
points, depending on the illness. When treating VaD, acupuncturists need to know the patients
symptoms since they can vary widely depending on where the brain was damaged. This article
specifically discusses gait disorders, which is when the patients have trouble walking and have a
greater risk of falling. Studies show putting acupuncture needles into certain points significantly
helps alleviate the gait symptoms of VaD. Also, when putting needles into forehead and scalp,
they found increased oxygen and blood flow to the brain, thus increasing brain activity. Glucose
metabolism also improved in the brain areas that affect memory. It also reduced oxidative
damage meaning it reduced the giving off of electrons, and improved antioxidant enzymes.
Acupuncture can benefit greatly in treating VaD as it can treat a variety of symptoms, also if
acupuncture does not work the patient, adverse effects are rare.
 Alternative therapies are essential when treating VaD and this article was very helpful in
explaining how acupuncture works. It also effectively explained the symptoms acupuncture
treats and how effectively the symptoms of the patients were treated. Researchers still need to
know how effective acupuncture is compared to other therapies, if acupuncture is the best option
and what to do if acupuncture does not work.

Albert, DeKosky & Dickson et. al. "The Diagnosis of Mild Cognitive Impairment Due to
Alzheimers Disease: Recommendations from the National Institute on Aging-
Alzheimers Association Workgroups on Diagnostic Guidelines for Alzheimers
Disease." Alzheimer's and Dementia, vol. 7, 2011,
www.alzheimersanddementia.com/article/S1552-5260(11)00104-X/fulltext.
Researchers decided to help define the diagnosis criteria of Alzheimers disease (AD) and
other dementias. They outlined what needed to be present in order for a patient to be diagnosed
with AD and concluded that a patient needed to experience a decrease in cognitive function.
These impairments could be something basic, such as losing arithmetic skills, but that the
patients loss of skills has to be unusually high based on their educational background, and age.
Another criteria, involves a patients family. The patients loved ones needed to show worry for
how the patient is behaving and notice considerable symptoms, such as not being able to recall
events. Patients also need to have mild trouble in doing every day and relatively simple tasks
such as shopping, and paying taxes and bills. Although these patients might be slower, they
should still be able to do all of these tasks on their own. Also, in order to be diagnosed with
dementia, patients need to have a significant change in language and speech. People with AD
might also experience a change in episodic memory, which means a way there remember a
specific event. Knowing these symptoms can help a patient be better treated with AD.
It is helpful to learn about the criteria of diagnosing Alzheimers disease in order to
differentiate it from vascular dementia (VaD). Also, Alzheimers disease and VaD have similar
symptoms which can help doctors develop initial treatment plans for both diseases. After reading
this article, readers can still be unsure about how to definitively differentiate between the various
types of dementia and how the brain structure differs between the diseases.

Auchus, Alexander, et al. "Galantamine Treatment of Vascular Dementia: A Randomized Trial."

Neurology, vol. 69, July 2007, pp. 448-58,
www.researchgate.net/publication/6175563_Galantamine_treatment_of_vascular_dement
ia_A_randomized_trial.
There is a lack of effective medications in treating vascular dementia (VaD), so
researchers are eager to test medicines and see if they can be helpful in treating symptoms. A
group of international researchers conducted a multinational study of 788 VaD patients testing
galantamine, which is a cholinesterase inhibitor that increases cholinergic transmission in the
brain. It is specifically designed for treating Alzheimer's disease (AD) but since VaD and AD
can have similar symptoms, some experts use AD medicines to treat VaD. In this study, patients
underwent a test to see if they met the criteria of VaD, including an MRI and a clinical diagnosis.
Once it was confirmed the patients had VaD, they were divided into a group who took
galantamine, and a group who took the placebo. They were given the medicines for twenty six
weeks, and the results of the two groups were compared. Unfortunately, there was no difference
between the group who took the placebo and the group who took galantamine. Both, the placebo
did improve the condition of the patients, specifically cognitive function but not to a significant
level. Therefore, cholinesterase inhibitors may not be the best option in treating VaD.
It was helpful to gain insight into what experts used when they are evaluating the
effectiveness of treating VaD. The journal article was effective in explaining the study and how
it was conducted. Going forward, researchers need to know why galantamine did not work as
they would hope, and how can medicines for treating VaD be improved.

Baskys, Andrius, and Anthony C. Hou. "Vascular Dementia: Pharmacological Treatment

Approaches and Perspectives." Journal of Clinical Interventions in Aging, vol. 2, no. 3,
Sept. 2007, pp. 327-35. PubMed Central,
www.ncbi.nlm.nih.gov/pmc/articles/PMC2685259/.
Vascular dementia (VaD) is an extremely common disorder; one to four percent of
people over sixty-five will get the disease. In people over eighty, the percentage rises to fourteen
to sixteen percent. Despite the number of people with the disorder and all of the money going
into research, there is no cure. VaD is caused by brain tissue and cells dying because of clogged
veins, making the cause different from other dementias, such as Alzheimers and Lewy Body.
VaD can also be caused by brain hemorrhaging. The lack of medications to cure the disorder
makes treatment more complicated. VaD is linked to mood disorders, such as depression, and
caretakers often have a harder time when caring for VaD patients as opposed to Alzheimers
patients. The authors of this study reviewed multiple medications and therapy in their journal
article. The first medication that worked on VaD patients is Memantine, which was first
developed to treat Parkinsons disease and works by releasing dopamine while also opposing the
glutamate NMDA receptor. Galantamine, which works by inhibiting cholinesterase, did not help
with daily life but helped with organization. The researchers found memantine and galantamine
to both be helpful in treating VaD.
The authors question why there is no cure for dementia, which is a very important
question, that needs to be answered. The article explains that it is harder for caretakers to look
after VaD patients, but does not explain why. This can make researchers wonder what makes
VaD patients harder to care for and also why more patients with VaD experience mood
disorders. Another question this article raises is how can these issues be solved to improve
patients quality of life.

Daiko, Jimbi, et al. "Effect of Aromatherapy on Patients with Alzheimer's Disease."

Psychogeriatrics, vol. 9, no. 4, Dec. 2009, pp. 173-79,
onlinelibrary.wiley.com/doi/10.1111/j.1479-8301.2009.00299.x/full.
Vascular dementia (VaD) is an illness which many doctors prefer to treat with alternative,
nonpharmacological therapies such as aromatherapy. This type of treatments involves using the
smells of essential oils and other essences to improve a patients quality of life, when specifically
treating vascular dementia, aromatherapists tend to focus on improving cognitive function. This
journal article specifically focuses on Alzheimers Disease (AD) however, many AD therapies
can also be used in treating VaD. This study conducted in Japan after researchers observed a
significant increase in dementia and noticed the effectiveness of complementary therapies in
addition to pharmacologic treatment. The study used older patients with a mean age of 86 years
old. They observed a total of twenty eight patients, three of whom had VaD and seventeen who
had AD, the others had mixed AD. Patients experienced aromatherapy for twenty eight days, and
asked these same patients to not have aromatherapy for twenty eight days and the observed the
difference in the progression of the disease. All patients had significant improvement in
cognitive function while undergoing aromatherapy.
This article was helpful and effective in explaining an alternative treatment option for
dementia. This study can be helpful in a meta-analysis and can be used to introduce the concept
of aromatherapy in treating VaD. One question that this article does not answer is how effective
is aromatherapy compared to other therapies, such as acupuncture.

Ehrlich, Steven D. "Dementia." University of Maryland Medical Center, VeriMed Healthcare

Network, 1 Apr. 2016, umm.edu/health/medical/altmed/condition/dementia.
Dementia is a broad term that describes the loss of brain function, caused by damaged
brain cells. In order to be diagnosed with dementia patients have to experience memory loss.
Doctors also look for one of the following symptoms when diagnosing patients with dementia:
trouble with language, losing range of movement, not being able to plan and other difficulty with
organization, and not knowing how to behave appropriately at home or at work. Other symptoms
include being confused often, falling repeatedly, being easily agitated, inability to hold urine and
urinating frequently. Dementia is a debilitating disease and many victims will have to live in a
nursing home as they cannot to properly care for themselves. Dementia may cause a person to
not be able to dress his or herself and feed his or herself. Some also have trouble dealing with
finances and become lost in familiar places. Vascular dementia (VaD) usually happens in older
people. Common causes of VaD can include vascular disease, where brain cells die due to a
blood vessel blockage and stroke. Other causes include brain tumors, vitamin B deficiency,
brain hemorrhaging and brain injury. Currently there is no cure for VaD but there are treatments.
Elrich explains what doctors look for when diagnosing dementia and why it is a
debilitating disorder. This article can be helpful when researching how to treat symptoms of the
disorder and how to improve a patients quality of life. The questions this article raises is how
can people be better treated for dementia. Also, the author can make researchers wonder why is
there no cure and what treatments work the best for patients?

Erkinjuntti, Timo. "Emerging Therapies for Vascular Dementia and Vascular Cognitive
Impairment." Stroke, vol. 35, 2004, pp. 1010-17,
stroke.ahajournals.org/content/35/4/1010.
There are many treatments for dementia some pharmacologic and others not. Doctors
prefer to treat vascular dementia (VaD) in nonpharmacologic ways. Treatments can also be
divided into two categories, preventive and symptomatic. Many doctors agree that exercise is
best for preventing the development or worsening of VaD. They also agree that maintaining a
balanced diet, treating diabetes, and maintaining a healthy weight are also essential in preventing
VaD. When doctors treat VaD and decide to use medication, they often decide to use
cholinesterase inhibitors (ChEls). These are used to treat Alzheimers Disease (AD), but since no
medicines are specifically designed to treat VaD, many physicians use AD medicines. ChEls
work by preventing the acetylcholinesterases from properly working thus preventing the
breakdown of acetylcholine in the brain, allowing for more of that substance in the brain. This
will allow the neurotransmitter to properly improve motor skills and other VaD symptoms. There
are three types of ChEls inhibitors available: Donepezil, Galantamine, and Rivastigmine;
Donepezil only inhibits acetylcholinesterase, while Galantamine increase cholinergic
transmission in addition to inhibiting acetylcholinesterase; and,Rivastigmine inhibits
acetylcholinesterase and butyrylcholinesterase. Only Galantamine and Donepezil have been
shown to be effective in treating symptoms of VaD.
VaD is a complex condition which medications are not available for, and this article is
effective in explaining how to use the medications that are available for treating AD in treating
symptoms of VaD. The article also helps explain how these medicines work and why they may
be helpful. However, this article does not answer the questions of how to develop more effective
medicines for VaD and what symptoms need to be treated the most.

"The Face of Vascular Dementia." Youtube, uploaded by NHS Choices, Google, 11 Nov. 2012,
www.youtube.com/watch?v=6KDDotTbjfo. Accessed 16 Sept. 2016.
Vascular Dementia (VaD) is a real disease that affects both the patient and their family.
Dr. Daphne Wallace is a retired psychiatrist, who is in her sixties and suffers from VaD. She
mainly worked with older adults, and about half of her patients had a form of dementia. he talked
to NHS choices about her story of the disease. Before Wallace was diagnosed with VaD, she
started noticing that some of her symptoms, like losing skills were similar to her patients. For
example, she was very good at arithmetic but could no longer do simple math. She had a hard
time being diagnosed because her short term memory was not so obviously affected but her long
term memory was, for example she had trouble recalling faces, when she used to be able to
recognize faces from twenty years ago. Early in her disease, she became a bit depressed, feeling
the disease was very diminishing. She got very frustrated at first, when she could not do
everyday skills. Her husband was concerned about her before the diagnosis as he noticed that
Wallace was more anxious. She was concerned about her family would take her diagnosis.
Luckily, since she was a psychiatrist, she knew steps to take in her treatment. She was diagnosed
by a specialist and needed support right from the beginning. She knew her family would be very
important in her treatment.Part of her treatment was finding ways of eliminating difficulties.
They were very supportive and she learned to live with the disease.
When learning about a disease, it is helpful to hear a patients perspective. The National
Health Service interviewed some VaD sufferers about their experience with the disease.
Wallaces interview will be helpful as a background source. This background source video raises
questions about how her family coped with her diagnosis.

Fields, R. Douglas. The Other Brain: From Dementia to Schizophrenia, How New Discoveries
about the Brain Are Revolutionizing Medicine and Science. Simon & Schuster, 2009.
Brains are complex organs with many components with no part being irrelevant. Experts
used to think that only neurons affected how the brain and body functioned, as scientists only
viewed the electrical signals that the neurons sent. However neurons only make up 15 percent of
the brain. The rest is called glia and they were looked at as packing cells with no purpose but to
fill volume. After, over one hundred years, researchers realized that glia communicate among
themselves and had to serve a more significant purpose. These functions include forming brain
proteins called myelin, maintaining internal balance or homeostasis and protecting neurons. This
discovery could be key in how to treat many brain disorders including vascular dementia (VaD).
The book explains how aging in the brain works, saying that neurons do not divide like other
body cells and are not replaced like other body cells. As people age, these neurons begin to die at
different paces making the brain weigh less as it ages. As brain gets older, piles junk protein
begin to form outside the neurons causing Alzheimers disease. However glia is affected by
aging just as much as neurons. If researchers can figure out how to limit the effects of aging in
the brain including glia then, dementia could be treated more effectively.
This book was helpful as it explained brain structures, and the history of how researchers
discovered the brain. The author also explains how the discovery of glia can help treat various
illnesses. The book could have gone more in depth about how glia can help treat dementia and
the new research on how glia can help treat dementia.

Hogan, David B., et al. "Diagnosis and Treatment of Dementia: Five Nonpharmacologic and
Pharmacologic Therapy for Mild to Moderate Dementia." Canadian Medical Association
Journal, vol. 179, no. 10, 2008, pp. 1019-26, www.cmaj.ca/content/179/10/1019.full.pdf.
Most doctors prefer not to use medication unless absolutely necessary when treating
dementia. As a result, doctors look for different non-medicinal therapies to treat dementia. A
group of physicians and other researchers performed a review of 954 studies to determine the
most effective treatments. They also made recommendations for treating dementia. One major
symptom of dementia is cognitive impairment. Caretakers can attempt to manage these
symptoms in a variety of ways. The first way is nonpharmacologic treatment such as exercise
which has proven to prevent the worsening of vascular dementia (VaD). However cognitive
training, rehabilitation and environmental interventions do not have enough evidence to establish
its effectiveness. Cholinesterase Inhibitors (ChEls) are a class of medicines used to treat
Alzheimers Disease (AD) and VaD. They work by preventing the breakdown acetylcholine in
the brain. Researchers saw that ChEls to somewhat improve symptoms in AD, but not in VaD.
Memantine is another medicine used to treat VaD, that does not help in mild dementia. However
researchers found that when combined with ChEls in treating moderate to severe AD.
This review was effective in explaining and recommending treatment options for
dementia. Although it did not find an effective treatment option for VaD. This leads researchers
to wonder why has a medicine for VaD not been developed and how symptoms of VaD can be
treated.

Horie, Pereira, Niizuma et. al. "Transplanted Stem Cell-Secreted Vascular Endothelial Growth
Factor Effects Poststroke Recovery, Inflammation, and Vascular Repair." Stem Cells, vol.
29, no. 2, 24 Feb. 2011, pp. 274-85, onlinelibrary.wiley.com/doi/10.1002/stem.584/full.
Stem cell medicine is a new, experimental and controversial technique. Researchers
turned to stem cell medicine to see if it could help patients who have vascular dementia caused
by a stroke. The researchers thought implanting different types of cells would help patients
manage their symptoms better. In the past, other experts found that stem cell therapy could
benefit patients but do not really understand why and how. So new researchers studied stem cell
medicine to see if it could help patients who have stroke induced VaD. In this study, the
researchers implanted central nervous system cells into rats, specifically hCNS-SCns, to
counteract vascular endothelial growth factor (VEGF). The found that although the cells started
moving within two weeks, the implanted cells took 3-4 weeks to reach the damaged area,most
commonly the rats barrel field cortex. After treatment, the experimental group had healthier
tissue, and were able to use their paws better than the control. The researchers concluded that
neutralizing VEGF by implanting hCNS-SCns was very helpful for speedier recovery from
stroke and also slowing the progression of vascular dementia. Implanting hCNS-SCns also
reduced brain vessel swelling and creating new blood vessels.
 VaD can be treated in many ways, but stem cell therapy is not extremely common and
widely discussed. This article was effective in explaining how stem cell therapy can treat
vascular dementia. However researchers may still question the ethics of stem cell therapy, the
cost, and the will of the families.

Jellinger, Kurt A. "Pathology and Pathogenesis of Vascular Cognitive Impairmenta Critical

Update." Frontiers in Aging Neuroscience, 10 Apr. 2013,
journal.frontiersin.org/article/10.3389/fnagi.2013.00017/full.
Vascular dementia (VaD) is becoming more common along with Alzheimers disease and
other types of dementia. One current and constant criteria of a dementia diagnosis is to have
memory loss. Another requirement for diagnosis is to have the disease interfere with daily
function. From defining new symptoms, researchers have found controversy in how to diagnose
it. Researchers discovered that pathologic examination, which involves involves diagnosing
diseases based on chemical, molecular, microscopic examination of cells in organs and tissues.
can be an effective way to diagnose dementia. Using this type of experimental diagnosis method
could help differentiate between the types of dementia and help diagnose if there was a brain
injury such as a stroke or anemia, which could help diagnose the type of dementia. VaD is most
common in older adults rather than other demographics and VaD tends to not be hereditary,
although genetics may increase the risk of developing the disease. People with dementia have
affected areas or lesions in the brain The type of lesions differ in various types of dementia.
Knowing all of these previously discussed criteria can help diagnose VaD easier.
In order to treat a disease effectively, researchers need to know the diagnosed symptoms.
These basic criteria of VaD help doctors know the beginning symptoms and develop an initial
treatment program. From reading this article, researchers can be unsure about how the diagnosis
criteria is going to change in the near future and the risks of treating symptoms.

Lee, Hsuing, Seitz et. al. "Cholinesterase Inhibitors." British Columbia Medical Journal, vol. 53,
no. 8, 8 Oct. 2011, pp. 404-08, www.bcmj.org/articles/cholinesterase-inhibitors
Cholinesterase Inhibitors (ChEls) are a type of medicine commonly used to treat the
symptoms of dementia. They work by inhibiting or preventing the function of cholinesterases,
enzymes that process and reduce acetylcholine. ChEls cause an increased level of acetylcholine
in the brain. A part of the brain that often functions poorly in people with dementia is the
cholinergic pathway. Acetylcholine helps these pathways to function and the use of ChEls helps
increase acetylcholine levels, with fewer major side effects than other medications. Donepezil,
galantamine, and rivastigmine are the three types of ChEls that are legal in Canada. Galantamine
has a side effect of helping to regulate nicotinic acetylcholine receptors. ChEls did seem to help
improve patients symptoms and were more effective than the placebo as they showed more
improvement in symptoms. ChEls can be combined with other treatments such as occupational
therapy. Although ChEls will not cure dementia, these medicines can help patents have a better
quality of life.
Dementia is a common topic, but specifics treatments of the disease are not widely
discussed. ChEls are complex and this journal article helped explain how they work. It can also
help researchers define treatment options as well as evaluate the best medicine for vascular
dementia patients. The authors raise questions such as how do ChEls help improve a patients
quality of life and are there more effective medication options than ChEls. Another question the
article raises is if what is available in Canada the same as the United States.
Leichman, Abigail Klein. "Oxygen Chamber Can Boost Brain Repair." Israel 21C, 3 Feb. 2013,
www.israel21c.org/oxygen-chamber-can-boost-brain-repair/.
Hyperbaric Oxygen Therapy (HBOT) is a new therapy used to treat vascular dementia
(VaD) and other neurodegenerative disorders. HBOT involves putting a patient into high
pressure chambers with high oxygen levels. This increased exposure to oxygen helps increase the
bodys oxygen levels by almost ten times. The goal of this HBOT is to reactivate or regenerate
dead brain cells. Researchers, especially Dr. Shai Efrati and Professor Eshel Ben-Jacob from Tel
Aviv University and Assaf Harofeh Medical Center in Israel conducted a study to test the
effectiveness of HBOT. The study used patients with poststroke VaD whose conditions were not
improving. Some patients who have done this therapy experienced improvements in motor
functions and memory. The researchers noticed that the treated patients brain imaging revealed
much more neuronal activity, as opposed to those who were not being treated. People with VaD
did have better brain function even years after initial onset. Efrati stated he observed improved
brain cognition in patients who suffered a stroke up to twenty years before the treatment. HBOT
may help patients relearn some previously lost activities because of the increased oxygen levels
in the brain.
This article is effective in helping explain a new alternative therapy for VaD. Medications
designed to treat VaD are not particularly helpful so finding alternate therapies is very important.
Learning this type of therapy will be helpful in locating articles for a meta-analysis. However,
still unclear is how realistic this type of therapy, if it is effective in everybody, the cost, the
amount of improvement in daily function, and the effectiveness compared to a placebo.

Motomura, Naoyasu, et al. "Animal Assisted Therapy for People with Dementia."
Psychogeriatrics, vol. 4, no. 2, June 2004, pp. 40-42,
onlinelibrary.wiley.com/doi/10.1111/j.1479-8301.2004.00062.x/full.
Animal Assisted Therapy (AAT) is a type of alternative therapy used to treat a variety of
illnesses including vascular dementia (VaD). This particular study was conducted in Japan,
where the elderly population is rapidly growing. Researchers predict that in 2020 twenty-five
percent of the population will be over sixty-five. VaD and Alzheimer's Disease are the two
most common types of dementia. The growth of elderly population indicates that there will be an
increase in the population with dementia. This increase will require a more effective treatment
for dementia. Dementia can affect the families very deeply as a symptom is a change in behavior.
These symptoms include anxiety, delusion, depression, apathy, irritability, and difficulty with
social situations. Researchers speculate that AAT can treat these symptoms as it uses the strong
human-animal bond. In Japan, not many researchers showed interest in conducting studies on
AAT; so the authors of the study felt AAT could be an effective treatment. The participants in
the study were eight female patients who had a mean age of 84.8 years. Four patients were
diagnosed with AD, while the other four had VaD. They were all given dog therapy to see if it
could help improve the patients symptoms. In terms of irritability, the researchers did notice a
significant improvement in irritability or depression. However most patients really enjoyed the
therapy and liked dogs.
The results of this particular study were interesting as specific symptoms were not
improved but the overall quality of life could be improved. Since the patients enjoyed AAT, it
could be something they look forward to every week. The authors effectively explained how
AAT works and its results but did not consider the logistics of AAT, and how effective it is
compared to other therapies.

Nordgren, Lena, and Gabriella Engstrom. "Effects of Animal-Assisted Therapy on Behavioral

and Psychological Symptoms in Dementia: A Case Report." American Journal of
Alzheimer's Disease & Other Dementias, vol. 27, no. 8, 25 Oct. 2012,
journals.sagepub.com/doi/full/10.1177/1533317512464117.
The goal of treatment is to help improve a patients quality of life but some doctors
noticed medicines side effects worsening a patients quality of life; as a result, the interest in
using alternative therapies to treat vascular dementia (VaD) has increased. Researchers are eager
to evaluate the effectiveness of animal-assisted therapy (AAT) in VaD, so researchers conducted
a pilot study. This case involved observing an 84-year old woman with vascular dementia. AAT
can be defined in a variety of different ways including dogs living with the patients, visiting
animals, using animals to assist in interventions and using pet therapy. AAT works in dementia
by using the bond between animals and humans to improve psychological symptoms and
behavior and it tries to improve communication and social engagement. This pilot study allowed
the patient to walk a four-year-old flat coated retriever and to groom the dog. In this particular
case, the patient, who used to work in retail, had a complicated medical history and was moved
to a nursing home after being diagnosed with VaD in 2007. Before being diagnosed with VaD,
this patient loved nature and animals, and she seemed a viable candidate for AAT, so for eight
weeks, she received AAT once a week. The patients walking improved but only minor
improvements were noticed in her behavior or psychological symptoms.
Understanding and using alternative therapies is crucial when it comes to treating VaD,
and reading this article helps researchers learn how AAT can be used and what symptoms it can
treat. However, this article does not answer how realistic AAT is and does not show an AAT
study conducted at a larger level.

Orgogozo, Jean-Marc, et al. "Efficacy and Safety of Memantine in Patients with Mild to
Moderate Vascular Dementia." Stroke, vol. 33, no. 7, 1 July 2002, pp. 1834-39,
http://stroke.ahajournals.org/content/33/7/1834

Vascular Dementia (VaD) is the second most common type of dementia, yet there are no
medicines designed specifically for VaD. As a result, psychiatrists and neurologists may use
medicines designed to treat Alzheimers Disease (AD) for VaD patients who do not respond to
other therapies. Doctors prefer to control vascular risk factors to prevent vascular VaD from
developing or worsening. Memantine, an NMDA receptor which reacts with glutamine, is an AD
medicine which is also used to treat VaD. Previous studies have shown some improvement in
brain cognition and function with the use of memantine. Doctors in France conducted a study
using patients over sixty years old to test the side effects and effectiveness of memantine in
patients 60 or older. There were two groups, one taking metamine, and the other taking a
placebo. They used a cognitive test to determine the effectiveness. They were given the test
before taking a drug, and then 28 weeks after the use of the medicines. They found the group
taking a placebo had a decrease of 1.6 points while the group taking memantine had an
improvement of 0.4 points. While the drug is significantly more effective than placebo, it only
shows a modest increase in brain function. This marginal increase may mean it will be better to
take no medicine at all.
 This journal article helped define the usefulness of memantine. It was effective in
explaining how memantine can help and how it works compared to a placebo. This article may
be helpful in a meta-analysis. The study does not define how well memantine compares to a
patient who is not taking any medication, and if memantine benefits are great enough to
outweigh the side effects.

Passmore, Peter, et al. "What Is Vascular Dementia?" Alzheimer's Society, Nov. 2014,
www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=161.
Vascular Dementia (VaD) is the second most common type of dementia. VaD is caused by
reduced blood supply to the brain due to diseased blood vessels. Brain cells die if blood cannot
reach them and this usually happens because of a stroke. VaD is further divided into various
subtypes. The first type is stroke related. Strokes happen when blood vessels narrow and become
blocked by a blood clot preventing certain brain functions from working. Another type of VaD is
post-stroke dementia. This occurs when a large vessel is permanently blocked, not allowing
blood to flow through it. Single-infarct and multi-infarct dementia happens when a person suffers
from smaller strokes. A small vessel becomes blocked which is known as a mini stroke. The last
form of VaD discussed in the factsheet is subcortical. This is caused by small diseased blood
vessels that are located very deep in the brain. These small vessels develop thick, stiff walls
around them, preventing blood flow through them and cause other brain cells to die. Early
symptoms of VaD include problems with decision making, solving problems, organizing and
planning. Individuals may also suffer from slower thought speed and have problems
concentrating, memory problems and short periods of sudden confusion. VaD is progressive and
gradually gets worse. There is currently no cure but certain treatments can slow the progression
of the disease and improve the victims quality of life.
Dementia is a widely discussed topic but it is a very complex disorder. VaD and its
subtypes are not commonly known. The factsheet from the Alzheimers society that was
reviewed by two professors and one doctor provided an easy to understand introduction to the
VaD. This article raises the questions about how people can prevent VaD and to what extent are
people willing to go. It can also make readers what are people willing to do treat VaD.

Qaseem, Amir, et al. "Current Pharmacologic Treatment of Dementia: A Clinical Practice

Guideline from the American College of Physicians and the American Academy of
Family Physicians." Annals of Internal Medicine, vol. 148, 2008, pp. 141-46,
www.nursinghomehelp.org/CPGs/ACP.pdf.
Researchers have found many ways to treat vascular dementia (VaD) and evidence to
support these different methods. A group of physicians decided to test five treatments, in attempt
to alleviate symptoms and create a guideline for other doctors. In this study, the researchers
found that treating patients with a cholinesterase inhibitor as the first therapy was ineffective,
classifying it as weak. They thought other medicines might work better, but did not find a way
to guarantee the prescriptions would work. As a result, the authors of this study decided that
doctors should make a plan for each patient after several attempts because medicines do not
work for all patients. They also found it would take multiple trials of different medications to
find the right one for the patient. The researchers found memantine to work in some VaD
patients, but not others. The doctors defined ethical implications of VaD treatment and defined
the guidelines for treating VaD such as a making sure benefits outweigh the side effects and that
patients can tolerate the medicine. Another ethical consideration is that patients are also affected
by the cost of medicine. The doctors also encouraged other physicians to do more research as
part of their guidelines.
The doctors effectively defined how VaD should be treated as the complex disorders has
multiple ways to treat it. The authors defined the ethics that should be considered when choosing
a method. This article can make researchers wonder how are people and their families affected
economically and socially by the treatment of VaD.

Sami, Nathalie, and Janice Wong. "Hyperbaric Oxygen: A Spectrum of Emerging Treatments."
Scientific American, 28 June 2013,
https://blogs.iscientificamerican.com/expeditions/hyperbaric-oxygen-a-spectrum-of-
emerging-treatments/.
A new form of therapy used to treat many different ailments is hyperbaric oxygen therapy
(HBOT). This therapy involves putting a person in a chamber with only oxygen. The pressure in
the chamber is also above atmospheric levels., which allows the body to saturate the oxygen
more effectively. The goal of this therapy is to significantly increase blood oxygen levels. This
therapy is also known to treat vascular dementia (VaD) as this disease is caused by decreased
blood flow to the brain. Symptoms associated with VaD are memory loss, confusion, speech and
comprehension problems and becoming more dependent on others. VaD is a terminal illness with
no cure and no effective established treatment. HBOT shows the ability to increase blood supply
to the brain. Another trait HBOT demonstrates is it helps encourage nerve tissue formation. The
risks of HBOT include oxygen toxicity which can lead to seizures and respiratory issues.
Another side effect is barotrauma in the middle ear. Some doctors might say that the benefits
outweigh the risks and this new form of experimental treatment could be very promising.
This article is helpful in explaining a new form of alternative treatment. The authors go
into detail about which disease HBOT can help treat and why the alternative therapy works. It
was also one of the first articles in the annotated bibliography to explain the risks. However, after
reading this article, it is still not clear how realistic HBOT is in terms of costs and availability.

Seniow, Joanna, et al. "New Approach to the Rehabilitation of Post-Stroke Focal Cognitive
Syndrome: Effect of Levodopa Combined with Speech and Language Therapy on
Functional Recovery from Aphasia." Journal of Neurological Sciences, vol. 283, Apr.
2009, pp. 214-18,
www.researchgate.net/publication/24184522_New_approach_to_the_rehabilitation_of_p
oststroke_focal_cognitive_syndrome_Effect_of_levodopa_combined_with_speech_and_l
anguage_therapy_on_functional_recovery_from_aphasia.
Researchers are curious about how levodopa and speech therapy together can help treat
aphasia (speech problems) in patients who have suffered stroke induced vascular dementia. The
scientists who conducted this study thought that targeting specific neural pathways can help
speech improve faster. Since levodopa treats the dopaminergic system meaning where dopamine
is transmitted, they decided to test this. Both test groups had similar levels of education, age,
length of disease, and initial levels of speech function; one group was given a placebo, and the
other, levodopa. After the patients started undergoing treatment, they were retested. Both people
in the groups who took the placebo and levodopa had very notable changes in their test scores, as
their speech function improved dramatically. However, the group taking levodopa improved the
most. The group taking levodopa had the most dramatic increase in speech function. The
researchers believe that levodopa helps the brain mold faster and more effectively, which helps
treat symptoms.
These researchers effectively summarized and gave evidence for why they think
levodopa is effective. It is helpful to learn about new techniques for treating people post stroke
and reducing the severance of vascular dementia. The questions that arise from this article are:
how can levodopa reach more people, and is there enough evidence to start using levodopa.

Sauer, Alissa. "Treating Alzheimers Symptoms with Acupuncture." Alzheimer's Research, 19

Nov. 2014, www.alzheimers.net/11-19-14-acupuncture-for-alzheimers/.
As more research is being done in treating vascular dementia (VaD), alternative therapies
are starting to be looked at more carefully. One way to improve a patients quality of life without
causing severe side effects is acupuncture. This type of treatment is 2500 years old, and
originated in China. Acupuncture is a type of alternative therapy which is widely accepted to
treat many different illnesses. Researchers are now experimenting with acupuncture as a
treatment for VaD and Alzheimers Disease (AD). The practice originated because people
believed that there were patterns of energy called Qi, which flow through the body and is crucial
for health. They think that if Qi is interrupted, than diseases and other ailments can occur.
Acupuncturists than attempt to fix the disruption of Qi by inserting needles into places based on
the ailment to help correct the Qi imbalance. The studies have shown promising results for
dementia patients. Acupuncture helped improve verbal and motor skills, mood and brain
function, which are all symptoms associated with VaD. There were also some signs of
acupuncture improving patients memory. When done regularly, acupuncture has the potential to
help improve the symptoms of dementia.
Acupuncture is a type of nonpharmacological treatment with the potential to help
improve a patients quality of life. Understanding the therapy that seems to have promising
results could help improve many patients quality of life. The article was effective in explaining
the concept of acupuncture but did not consider the logistics of treating patients in a nursing
home with acupuncture.

Shea, Therese. Dementia. New York, Rosen Publishing Group, 2012.

There are three major parts of the brain that affect dementia. The cerebellum is at the
back and underside of the brain. It controls movement, coordination, and balance. Dementia
patients who suffer from coordination issues have damage to this region of the brain. The
cerebrum, which is the largest part of the brain and contains the brains lobes, controls many
aspects of the brain. There are two sides of the cerebrum, and each one controls the opposite side
of the body. This region also controls intelligence functions such as organizing, making
decisions, reasoning, creating, and information processing. It is also responsible for memory,
language fluency and spatial issues. Damage to this region, causes a severe form of VaD. The
brain stem which is responsible from important functions that people do not control such as
breathing. It is very important to understand the brain when diagnosing dementia, and one
important step is differentiating between forgetfulness and actual dementia. There are key
differences such as a forgetful person might lose their keys, but a person with dementia might
not remember the function of keys. People with dementia also do not know that they are
forgetting and suffering from memory loss. VaD is complex as there is no single recommended
treatment. Some doctors think VaD patients will benefit from the same medicine as Alzheimers
patients, while others will give medicine to help prevent progression.
 The author of this book effectively describes how the brain affects dementia and how it is
treated. This book raises important questions such as how can brain damage be reversed. Another
question researchers may have from this article is how does VaD medications affect the
functions of the brain. It also makes researchers wonder why treatment is more difficult than the
more common Alzheimers disorder.

Tjia, Briesacher, Peterson et. al. "Use of Medications of Questionable Benefit in Advanced
Dementia." Journal of the American Medical Association Intern Med., vol. 174, no. 11,
2014, http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1901117.
People with advanced dementia live in nursing homes or under some caretaker, as they
have a fatal disease. Most patients have very severe symptoms, such as not being able to
recognize family members and not being able to walk properly, despite having to take 5 to 15
medicines on average. When dementia advances to the point that it almost reaches the mortality
stage, the goal of most patients is to be comfortable. The experts who wrote this article asked
geriatricians and physicians who specialize in pain management to evaluate medicines and write
a list of medicines that probably will not help in advanced dementia treatment. Eighty-five
percent of the participants in this 90-day study were aged 85 or older and also suffered from
other diseases such as as diabetes. One result of the study was that 59.3% of patients took a
minimum of one medicine with questionable benefits; the medicines probably would not help
make the patient more comfortable. The study found that using such medicines to treat advanced
illnesses can have a damaging effect on both the patient and their family.
The authors of this journal article argue which medicines should be given or whether they
should be given at all, successfully helping researchers understand the best treatment options and
summarize the vascular dementia treatment in the future. Researchers may question which
medicines should be taken, and if there is a point when medicine should be taken at all. If the
answer to the medicine question is yes, when should patients stop taking medicine?

"Vascular Dementia: Causes & Prevention." Youtube, uploaded by Peter Lawrence and David
Hess, 27 Apr. 2016, www.youtube.com/watch?v=B_sq6qwmTK0.
Dementia means any disease that causes a permanent, debilitating, and gradual loss of
memory and cognitive function. Physicians recently separated vascular dementia (VaD) from
other types of dementia such as Alzheimers. Doctors and researchers noticed that most people
who had vascular dementia showed signs by the age of seventy. Researchers identified VaD
small vessel disease (SVD) as a cause of VaD. SVD is when cerebral microvessels become
clogged and prevent blood flow to certain areas of the brain. The loss of elastin happens with
aging, making old age a major risk factor in obtaining SVD. Other risk factors include such as
high blood pressure and fibrin buildup in the small vessels causing reduced blood flow to the
brains white matter. There are ways to prevent SVD and therefore VAD. One major way to
prevent SVD is exercise. Maintaining a healthy weight, diet and lifestyle is essential in reducing
the risk of VaD. An herbal remedy of preventing VaD is drinking beetroot juice, as it is rich in
nitric oxide. This nutrient helps people improve their blood pressure and therefore blood flow to
the brain. The last way to prevent VaD is called Remote Ischemic Conditioning meaning
gradually improve an organs tolerance over time.
Videos can be helpful especially if it illustrates new concepts. In this case, the video was
helpful in explaining a new technique that is not very common. It effectively explained the
causes of VaD and how to prevent it. This source raised questions about how remote ischemic
conditioning can be effective and also what are people willing to do to prevent VaD.

"Vascular Dementia." National Health Service, Gov.UK, 22 Jan. 2015,

www.nhs.uk/Conditions/vascular-dementia/Pages/Introduction.aspx. Accessed 16 Sept.
2016.
Dementia is defined as a type of brain impairment and it is common in people over age
65. There are multiple types of dementia, including vascular dementia (VaD). Early symptoms
and warning signs of VaD include having a hard time planning, slow thinking, experiencing
challenges with language, having problems with attention and concentration, and experiencing
mood challenges. Paying attention to early warning signs is very important because steps can be
taken to prevent or slow down progression of the disease.VaD happens when a buildup of fats,
cholesterol and other substances block and narrow blood vessels. This reduces blood flow to the
brain. This lack of blood to the affected regions, cause blood cells to die. Major strokes which
occurs when large vessels are blocked and mini strokes happen when small vessels are
compromised. Serious VaD happens if the brain damage becomes permanent. Controlling risk
factors like high blood pressure, high cholesterol smoking, being overweight can help slow the
progression of VaD. Other risk factors include diabetes, old age, being male, and being African
American. VaD is diagnosed when specialists give physical checkups, test brain capabilities,
blood tests, and brain scans. VaD cannot be cured but can be managed through physical therapy,
occupational therapy, and speech therapy can help people relearn lost brain functions.
The National Health Service is a government medical service in the United Kingdom.
This article raises questions such as how can brain damage be reversed? It can also make readers
wonder how treatment works and how patients cope with the disease.

"Vascular Dementia." University of California, San Francisco Memory and Aging Center,
Regents of the U of California, 15 Nov. 2010,
memory.ucsf.edu/education/diseases/vascular.
Cerebrovascular disease, also known as strokes, occur when brain blood vessels become
blocked because of buildup of fatty substances. These walls then thicken and harden causing
vessels or arteries to narrow, preventing blood flow to these areas. This same phenomenon also
happens because buildups of other substances such as saturated fat. Vascular Dementia (VaD)
happens when memory and brain functions slowly deteriorate over time. VaD is chronic reduced
blood flow to the brain and is one of the most common types of dementia. Advanced VaD
happens overtime when sufferers become severely impaired. Early detection can help prevent
VaD because risk factors like blood pressure, heart disease, high fats in blood, high cholesterol,
diabetes, smoking and alcoholism can be controlled. It is more common in African Americans,
males and older adults. The disease is diagnosed through looking for brain impairments.
Neurologists, psychiatrists and physicians have to rule out other conditions with similar
symptoms such as depression. Symptoms of VaD include memory loss, mood changes such as
depression, irritability and apathy. People may also have hallucinations and delusions. There is
no cure for the disease, but there are treatments to help improve the quality of a patients life.
University of California, San Francisco (USCF) has a memory and aging center that
researches diseases such as VaD. The center published a very helpful resource for the public
about the complex disease. It was an easy to understand article that can help in establishing
background for research projects on the disease. The article can cause researchers to question
how diagnosis works and how the various types of dementia are differentiated.

"Why Vascular Dementia May Be Highly Treatable." Youtube, uploaded by David Gill, Steven
P. Ringle and Neurology Today, 23 Jan. 2014,
www.youtube.com/watch?v=jepyMxx3biU.
Researchers conducted a study on neurodegenerative disease and concurrent vascular
disease in order to compare vascular dementia to Alzheimers disease and other types of
dementia. This groundbreaking study conducted by the National Alzheimers Coordinating
Center provided evidence against those who thought dementia was a degenerative disease and
was not caused by vascular disease, because the study found that vascular disease is linked to
dementia. They also found that vascular dementia was most similar to Alzheimers disease their
symptoms overlap more than other types of dementia. Doctors are conflicted on whether they
should treat dementia aggressively, for patients with vascular symptoms; the answer is yes
because they need to address vascular risk factors, such as diabetes. Diabetes and vascular
disease were associated with people diagnosed with Alzheimers disease, researchers found
people with dementia who do not have major white matter changes in the brain, may have their
disease progress slower if major risk factors are treated, but there is less evidence to support that
claim.
The doctors who made this video successfully explain how vascular disease is linked to
dementia. The video may help researchers when explaining vascular disease, as well as defining
treatment option. The experts in this video also raise the question of how dementia should be
treated. Some researchers may argue it should be treated aggressively with medicine, but others
may argue against that. This is a question that doctors have to decide every day.

Young, Kaylene. "The Journal of Quality Research in Dementia (Issue 8): Does Stem Cell
Research Provide of Hope for the Treatment of Dementia?" Alzheimer's Society,
www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1094&pageNumb
er=2.
Memory loss is associated with many types of diseases, but the most common are the
various types of dementia. One of the most common types of dementia is Alzheimers Disease
(AD). This type of dementia has many overlapping symptoms with vascular dementia (VaD).
Also since there is no specific medical treatment for VaD, many doctors will use those designed
for VaD. Symptoms of both AD and VaD have diminished cognitive functions, which can
include: diminished memory, loss of communication skills, and loss of skills required for daily
functioning. In Great Britain, the projected population of people with AD is one million as
opposed to the current 700,000. AD costs Great Britain 17 billion annually. In the past, it was
believed that brain cells died and were not replaced. However, stem cells are present in certain
areas of the brain. One goal researchers have is to understand how the adult brain regulates stem
cells. One speculated effect of dementia on the brain is that the disease may directly affect the
stem cells in the brain. Scientists have successfully transplanted stem cells in rats which indicates
that stem cells may effectively treat dementia in humans.
Dementia is an increasingly common and costly illness. The projected increase in people
with dementia requires a more effective treatment for dementia. Stem cell therapy could be a
great option, as it would stimulate brain cell growth. The article does not answer how viable stem
cell therapy is and how it would work in treating VaD.