Vascular dementia : review article

Vascular dementia (VaD) is a common but heterogeneous condition in which there is a clear temporal relationship between the dementia and vascular disease. It may result from multiple large or small vessel strokes or a single strategic stroke. Subcortical ischaemic VaD includes multiple lacunes and subcortical arteriosclerotic encephalopathy (Binswanger's disease) and imaging shows multiple deep white matter lesions or leukoaraiosis. Large vessel disease may result in VaD by causing multiple cortical and subcortical strokes, while strategic stroke VaD is caused by a single stroke in a specific area of the brain. On the basis of cinical features and imaging, definite, probable and possible VaD can be defined. Vascular risk factor reduction, particularly the use of antihypertensive agents, remains the most important means to prevent VaD. Treatment is limited although acetylcholinesterase inhibitors may have value. Treating behavioural symptoms may be difficult and newer antipsychotics as well as acetylcholinesterase inhibitor therapy should be considered.