Summary
Vascular dementia (VAD) is considered to be the second most common cause of dementia in Europe and the US. In Asia and many developing countries, it is more common than dementia of the Alzheimer’s type (DAT). VAD is the most preventable form of dementia associated with later life. The pathogenesis of VAD is multifactorial, and it represents a heterogeneous, not a homogeneous, clinical entity. Classification of VAD by pathogenesis is important for its prevention and treatment. Control of the risk factors for VAD reduces its incidence and stabilises or improves cognitive performance following stroke.
Proper diagnostic evaluation of VAD requires: (i) a well defined quantitative assessment of the cognitive deficits present; (ii) assessment of risk factors for stroke; (iii) identification of cerebral vascular lesions by history, neurological examination and neuroimaging; (iv) exclusion of other causes of dementia;(?) establishment of a positive diagnosis of possible, probable or definite VAD versus DAT or mixed VAD/DAT; and (vi) identification of the temporal relationship between cognitive deficits and cerebral vascular lesions.
VAD can be subdivided into 8 major types, as follows: (i) multi-infarct dementia secondary to large cerebral emboli [type 1]; (ii) strategically placed infarctions causing dementia [type 2]; (iii) multiple subcortical lacunar lesions secondary to atherosclerosis or degenerative arteriolar changes [type 3]; (iv) Binswanger’s disease (arteriosclerotic subcortical leukoencephalopathy) [type 4]; (v) mixtures of types 1, 2 and 3 [type 5]; (vi) haemorrhagic lesions causing dementia [type 6]; (vii) subcortical dementia secondary to hereditary factors (type 7); and (viii) mixtures of DAT and VAD (type 8). Treatment is dictated by the pathogenetic subtype of VAD that is present.
Similar content being viewed by others
References
Tomlinson BE, Blessed G, Roth M. Observations of the brains of demented old people. J Neurol Sci 1970; 11: 205–42
Jellinger K. Neuropathological aspects of dementias resulting from abnormal blood and cerebrospinal fluid dynamics. Acta Neurol Belg 1976; 76: 83–102
Schoenberg BS. Epidemiology of vascular dementia and multiinfarct dementia. In: Meyer JS, Lechner H, Marshall J, et al., editors. Vascular and multi-infarct dementia. Mt Kisco (NY): Futura Publishing Co., 1988: 47–59
Ueda K, Hasuo Y, Fujishima M. Prevalence and etiology of dementia in a Japanese community. Stroke 1992; 23: 798–803
Yoshitake T, Kiyohara Y, Kato I, et al. Incidence and risk factor of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population. Neurology 1995; 45: 1161–8
Skoog I, Nilsson L, Palmertz B, et al. A population-based study of dementia in 85-year-olds. N Engl J Med 1993; 328: 153–8
Meyer JS, Judd BW, Tawaklna T, et al. Improved cognition after control of risk factors for multi-infarct dementia. JAMA 1986; 256: 2203–9
Meyer JS, McClintic K, Sims P, et al. Etiology, prevention, and treatment of vascular and multi-infarct dementia. In: Meyer JS, Lechner H, Marshall J, et al., editors. Vascular and multi-infarct dementia. Mt Kisco (NY): Futura Publishing Co., 1988: 129–47
Meyer JS, Rogers RL, McClintic K, et al. Randomized clinical trial of daily aspirin therapy in multi-infarct dementia. J Am Geriatr Soc 1989; 37: 549–55
Meyer JS. Differential diagnosis, etiology, pathophysiology and treatment of multi-infarct dementia. Recent Adv Cardiovasc Dis 1990; 11 Suppl. 1: 83–9
Meyer JS, Muramatsu K, Mortel KF, et al. Prospective CT confirms differences between vascular and Alzheimer’s dementia. Stroke 1995; 26: 735–42
Hachinski VC. Preventable senility: a call for action against the vascular dementias. Lancet 1992; 340: 645–8
Loeb C, Meyer JS. Vascular dementia: still a debatable entity? J Neurol Sci 1996; 143: 31–40
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994
WHO. International statistical classification of related health problems, 10th revision (ICD-10). Geneva: WHO, 1992
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993; 43: 250–60
Chui HC, Victoroff JI, Margolin D, et al. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centers. Neurology 1992; 42: 473–80
Desmond DW. Vascular dementia: a construct in evolution. Cerebrovasc Brain Metab Rev 1996; 8: 296–325
Tatemichi TK, Desmond DW, Mayeux R, et al. Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort. Neurology 1992; 42: 1185–93
Meyer JS, McClintic KL, Rogers RL, et al. Aetiological considerations and risk factors for multi-infarct dementia. J Neurol Neurosurg Psychiatry 1988; 51: 1489–97
Skoog I. Risk factors for vascular dementia: a review. Dementia 1994; 5: 137–44
Lindsay J, Hébert R, Rockwood K. The Canadian Study of Health and Aging: risk factors for vascular dementia. Stroke 1997; 28: 526–30
Johansson BB. Pathogenesis of vascular dementia: the possible role of hypertension. Dementia 1994; 5: 174–6
Desmond DW, Tatemichi TK, Paik M, et al. Risk factors for cerebrovascular disease as correlates of cognitive function in a stroke-free cohort. Arch Neurol 1993; 50: 162–6
Tatemichi TK, Desmond DW, Paik M, et al. Clinical determinants of dementia related to stroke. Ann Neurol 1993; 33: 568–75
Ott A, Breteler MMB, Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study: the Rotterdam Study. Stroke 1997; 28: 316–21
Gorelick PB, Brody J, Cohen D, et al. Risk factors for dementia associated with multiple cerebral infarcts: a case-control analysis in predominantly African-American hospital-based patients. Arch Neurol 1993; 50: 714–20
Rockwood K, Ebly E, Hachinski V, et al. Presence and treatment of vascular risk factors in patients with vascular cognitive impairment. Arch Neurol 1997; 54: 33–9
Tatemichi TK, Paik M, Bagiella MS, et al. Risk of dementia after stroke in a hospitalized cohort: result of a longitudinal study. Neurology 1994; 44: 1885–91
Mortel KF, Meyer JS, Herod B, et al. Education and occupation as risk factors for dementias of the Alzheimer and ischemic vascular types. Dementia 1995; 6: 55–62
Gorelick PB. Status of risk factors for dementia associated with stroke. Stroke 1997; 28: 459–63
Plassman BL, Breitner CS. Recent advances in the genetics of Alzheimer’s disease and vascular dementia with an emphasis on gene-environment interactions. J Am Geriatr Soc 1996; 44: 1242–50
Moroney JT, Bagiella E, Desmond DW, et al. Risk factors for incident dementia after stroke: role of hypoxic and ischemic disorders. Stroke 1996; 27: 1283–9
Mortel KF, Meyer JS. Lack of postmenopausal estrogen replacement therapy and the risk of dementia. J Neuropsychiatry Clin Neurosci 1995; 7: 334–7
Meyer JS, Rogers RL, Judd BW, et al. Cognition and cerebral blood fluctuate together in multi-infarct dementia. Stroke 1988; 19: 163–9
Meyer JS. The nature of reduced cerebral perfusion in vascular and multi-infarct dementia. In: Meyer JS, Lechner H, Marshall J, editors. Vascular and multi-infarct dementia. Mt Kisco (NY): Futura Publishing Co., 1988: 113–27
Loeb C. Vascular dementia. Dementia 1990; 1: 175–84
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984; 34: 939–44
Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632–7
O’Brien MD. Vascular dementia is underdiagnosed. Arch Neurol 1988; 45: 797–8
Blacker D, Albert MS, Bassett SS, et al. Reliability and validity of NINCDS-ADRDA criteria for Alzheimer’s disease: the National Institute of Mental Health Genetics Initiative. Arch Neurol 1994; 51: 1198–204
Erkinjuntti T. Clinical criteria for vascular dementia: the NINDS-AIREN criteria. Dementia 1994; 5: 189–92
Tierney MC, Fisher RH, Lewis AJ, et al. The NINCDS-ADRDA work group criteria for clinical diagnosis of probable Alzheimer’s disease: a clinicopathologic study of 57 cases. Neurology 1988; 38: 359–64
Erkinjuntti T. Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study. J Neurol Neurosurg Psychiatry 1988; 51: 1037–44
Kukull WA, Larson EB, Reifler BV, et al. The validity of three clinical diagnostic criteria for Alzheimer’s disease. Neurology 1990; 40: 1364–89
Risse SC, Raskind MA, Nochlin D. Neuropathological findings in patients with clinical diagnoses of probable Alzheimer’s disease. Am J Psychiatry 1990; 147: 168–72
Jellinger K, Danielczyk W, Fischer P, et al. Clinicopathological analysis of dementia disorders in the elderly. J Neurol Sci 1990; 95: 239–58
Lopez OL, Larumbe MR, Becker JT, et al. Reliability of NINDS-AIREN clinical criteria for the diagnosis of vascular dementia. Neurology 1994; 44: 1240–5
Wetterling T, Kanitz RD, Borgis KJ. Comparison of different diagnostic criteria for vascular dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN). Stroke 1996; 27: 30–6
Wade JPH, Mirsen TR, Hachinski VC, et al. The clinical diagnosis of Alzheimer’s disease. Arch Neurol 1987; 44: 24–9
O’Brien MD. Vascular dementia: problems with nomenclature, definition, and classification. J Stroke Cerebrovasc Dis 1994; 4: 52–6
Wallin A, Blennow K. The clinical diagnosis of vascular dementia. Dementia 1994; 5: 181–4
Brun A. Pathology and pathophysiology of cerebrovascular dementia: pure subgroups of obstructive and hypoperfusive etiology. Dementia 1994; 5: 145–7
Meyer JS, Shirai T, Akiyama H. Vascular dementia. In: Welch KMA, Caplan L, Reis D, et al., editors. Primer on cerebrovascular disease. San Diego: Academic Press Inc., 1997: 364–6
Tatemichi TK. How acute brain failure becomes chronic: a view of the mechanisms of dementia related to stroke. Neurology 1990; 40: 1652–9
Loeb C, Gandolfo C, Croce R, et al. Dementia associated with lacunar infarction. Stroke 1992; 23: 1225–9
Roman GC. From UBOs to Binswanger’s disease: impact of magnetic resonance imaging on vascular dementia research. Stroke 1996; 27: 1269–73
Caplan LR. Binswanger’s disease — revisited. Neurology 1995; 45: 626–33
Tournier-Lasserve E, Iba-Zizen MT, Romero N, et al. Autosomal dominant syndrome with strokelike episodes and leukoencephalopathy. Stroke 1991; 22: 1297–302
Bousser MG, Tournier-Lasserve E. Summary of the proceedings of the first international workshop on CADASIL: Paris, May 19–21, 1993. Stroke 1994; 25: 704–5
You R, McNeil JJ, O’Malley HM, et al. Risk factors for lacunar infarction syndromes. Neurology 1995; 45: 1483–7
Skoog I, Lernfelt B, Landahl S, et al. 15-Year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5
Shaw TG, Mortel KF, Meyer JS, et al. Cerebral blood flow changes in benign aging and cerebrovascular disease. Neurology 1984; 34: 855–62
Masawa N, Yoshida Y, Yamada T, et al. Morphometry of structural preservation of tunica media in aged and hypertensive human intracerebral arteries. Stroke 1994; 25: 122–7
Watanabe N, Imai Y, Nagai K, et al. Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese. Stroke 1996; 27: 1319–27
Meyer JS, Muramatsu K, Shirai T, et al. Cerebral embolism as a cause of stroke and transient ischemic attacks. Echocardiography 1996; 13: 513–7
Stroke Prevention in Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study: final results. Circulation 1991; 84: 527–34
Stroke Prevention in Atrial Fibrillation Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994; 343: 687–91
Van Bergen PFMM, Jonker JJC, van der Meer FJM, et al., and the Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) Research Group. Effect of long-term anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Lancet 1994; 343: 499–503
Smith P, Amesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med 1990; 323: 147–52
Azar AJ, Koudstaal PJ, Wintzen AR, et al. Risk of stroke during long-term anticoagulant therapy in patients after myocardial infarction. Ann Neurol 1996; 39: 301–7
Ridker PM, Cushman M, Stampfer MJ, et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973–5
Kistler JP, Buonanno FS, Gress DR. Carotid endarterectomy: specific therapy based on pathophysiology. N Engl J Med 1991; 325: 505–7
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–53
Desmond DW, Moroney JT, Sano M, et al. Recovery of cognitive function after stroke. Stroke 1996; 27: 1798–803
Wolf PA. Cigarettes, alcohol and stroke. N Engl J Med 1986; 315: 1087–9
Gorelick PB, Rodin MB, Langenberg P, et al. Weekly alcohol consumption, cigarette smoking, and the risk of ischemic stroke: results of a case-control study at three urban medical centers in Chicago, Illinois. Neurology 1989; 39: 339–43
Rogers RL, Meyer JS, Shaw TG, et al. Cigarette smoking decreases cerebral blood flow suggesting increased risk for stroke. JAMA 1983; 250: 2796–800
Rogers RL, Meyer JS, Judd BW, et al. Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers. JAMA 1985; 253: 2970–4
Birge SJ. Is there a role for estrogen replacement therapy in the prevention and treatment of dementia? J Am Geriatr Soc 1996; 44: 865–70
Hass WK, Easton JD, Adams HP, et al., for the Ticlopidine Aspirin Stroke Study Group. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med 1989; 321: 501–7
Black RS, Barclay LL, Nolan KA, et al. Pentoxifylline in cerebrovascular dementia. J Am Geriatr Soc 1992; 40: 237–44
Molnar FJ, Dalziel WB. The pharmacoeconomics of dementia therapies. Drugs Aging 1997 Mar; 10(3): 219–33
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Konno, S., Meyer, J.S., Terayama, Y. et al. Classification, Diagnosis and Treatment of Vascular Dementia. Drugs & Aging 11, 361–373 (1997). https://doi.org/10.2165/00002512-199711050-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-199711050-00004