Meeting the challenges of vascular dementia. Introduction.

Ongoing controversy over the challenges associated with the diagnosis and management of patients with vascular dementia (VaD) or Alzheimer's disease with cerebrovascular disease (CVD) has led to difficulties with establishing epidemiology and diagnostic guidelines, as well as deciding upon optimal management practices. In March 2001, an international group of physicians and researchers gathered to resolve some of these issues and provide clinicians with useful information relating to this large patient group. In addition to simple coexistence, VaD and Alzheimer's disease appear to share common pathophysiological mechanisms, such as neurotransmitter abnormalities. Treatments that target the common pathophysiology of the two conditions may prove useful. To date, no reports have been published of any agent demonstrating broad efficacy (on cognitive and noncognitive outcomes) in VaD and Alzheimer's disease with CVD in randomised, controlled trials. Recent developments in understanding the pathophysiology of the conditions, however, have taken researchers an important step closer to finding an effective treatment, not only for patients with Alzheimer's disease, but also for those with coexisting CVD and those with VaD.