Vascular dementia (VD) is a dementia syndrome associated with cerebrovascular disease. Among the several subtypes of VD, most common subtypes are multi-infarct dementia, single-infarct dementia, and subcortical vascular dementia. In patients with multi-infarct dementia, dementia occurs with a close temporal relationship to stroke episodes. Brain imaging usually shows multiple territory cortico-subcortical infarcts. Single-infarct dementia, in contrast, is caused by a single infarct in specific regions of the brain such as thalamus, caudate nucleus, capsular genu, angular gyrus, or hippocampus. In subcortical VD, primary lesion is lacunar infacts or ischemic white matter lesions that are located in subcortical regions, i.e., deep nuclei (basal ganglia and thalamus) or white matter (periventricular and deep white matter). The diagnosis of subcortical vascular dementia is challenging, since stroke episodes are often unrecognized, thus temporal relationship between onset of dementia and stroke is lacking. This article describes 1) subtypes of VD, 2) illustrative cases with vascular dementia, 3) research criteria for VD, 4) treatment of VD, and 5) a general guideline on caregiving for patients with VD, which will enable clinicians to provide better diagnosis and management of patients with VD.
Brain ; Caudate Nucleus ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Diagnosis ; Ganglia ; Hippocampus ; Humans ; Neuroimaging ; Stroke ; Thalamus

Vascular dementia (VaD) subtypes include multi-infarct dementia, subcortical ischemic vascular dementia, strategic-infarct dementia, etc. Poststroke dementia may be related to preexisting cognitive level, and the frequency increased with aging, lower educational level and accompanied vascular risk factors. Vascular cognitive impairment (VCI) forms a spectrum that includes VaD, mixed Alzheimer's disease (AD) with a vascular component, and VCI without dementia. The concept of VCI will improve the early diagnoses and secondary prevention and treatment of VaD, and promote the further research on vascular component in neurodegenrative disorders.
Cognition ; Cognition Disorders ; classification ; diagnosis ; etiology ; Dementia, Multi-Infarct ; classification ; diagnosis ; Dementia, Vascular ; classification ; diagnosis ; Humans

Differential diagnosis of Alzheimer's disease (AD) and vascular dementia(VaD) has an important bearing on the diagnosis and management of patients with dementia. This article provides a guideline for the differential diagnosis through 1) history taking, 2) neurological examination, 3) neuropsychological tests, and 4) neuroimaging studies. VaD consists of etiologically and clinically heterogeneous subtypes that include multi-infarct dementia (MID), single strategic infarct dementia, and subcortical vascular dementia. Patients with MID and single infarct dementia con be easily differentiated from patients with AD. However, clinical manifestations of subcortical vascular dementia can mimic those of AD, which may lead primary physicians to misdiagnose subcortical vascular dementia as AD. The issue of differential diagnosis is further complicated by the fact that many patients may have AD with concomitant VaD (mixed dementia).
Alzheimer Disease* ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Humans ; Neuroimaging ; Neurologic Examination ; Neuropsychological Tests

We report a 52-yr-old Korean woman with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) whose diagnosis was confirmed by skin biopsy and the presence of a novel mutation in the NOTCH3 gene. The patient's clinical features were rather unusual in that 1) clinical presentations were only two episodes of stroke and mild dementia unaccompanied by mood disturbances or migraine, and 2) there was no family history. Brain MRI showed T2 hyperintensities in both temporal pole areas in line with the recent suggestion by O'Sullivan et al. that the abnormality could be a radiologic marker of CADASIL. FDG-PET also showed a hypometabolism in the temporal pole areas with an abnormal finding on MRI in addition to the hypometabolism in cortical and subcortical regions. We could learn from this case that CADASIL may be included in the differential diagnoses in patients with vascular dementia associated with a small vessel disease, even in the absence of a family history, especially when there are no known stroke risk factors and when the MRI shows T2 hyperintensity in the temporal pole regions.
Amino Acid Substitution ; Biopsy ; Brain/pathology ; Codon/genetics ; Dementia, Multi-Infarct/diagnosis ; Dementia, Multi-Infarct/genetics* ; Dementia, Multi-Infarct/pathology ; Dementia, Multi-Infarct/radionuclide imaging ; Female ; Human ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Mutation, Missense* ; Neuropsychological Tests ; Point Mutation* ; Proto-Oncogene Proteins/genetics* ; Skin/pathology ; Tomography, Emission-Computed

Hachinski coined the term 'multi-infarct dementia', which now changed to 'vascular demntia', and used the Hachiski Ischemia Score (HIS) to differentiate multi-infarct dementia from Alzheimer's disease since 1974. The past two decades has seen a renewed interest in vascular dementia. New classification systems like DSM-IV, ICD-10, NINDS-AIREN and ADDTC have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke. Various aspects of clinical manefestation of vascular dementia were discussed and presented as tables.
Alzheimer Disease ; Classification ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; International Classification of Diseases ; Ischemia ; Neuroimaging ; Numismatics ; Stroke