ABSTRACT
Vascular dementia (VD) is defined as a dementia syndrome occurring after stroke (1) and accounts for 10-15% of all dementias, after Alzheimer’s disease (60%) and diffuse Lewy body disease (20%). Ideally, criteria for the definition of this entity should include (1) dementia, (2) vascular disease, and (3) a clear causal relationship between them, classically with sudden onset of focal neurological signs, but there is considerable variability in the clinical presentation. Various criteria have been used: NINDS-AIREN (2), ICD-10 (3, 4), DSM-IV (5), or the State of California Alzheimer’s Disease Diagnostic and Treatment Centers (SCADDTC) (6). All require a decline in multiple higher cortical functions, including memory, sufficient to interfere with daily living activities, and the evidence for at least one stroke, with a clearly documented temporal relationship (NINDS-AIREN: 3 months) to the onset of dementia. The ICD-10 definition represents a classification of subtypes of vascular dementia rather than diagnostic criteria. DSM-IV criteria are based on a general definition of dementias, but no criteria to establish a causal relationship between dementia and vascular disease is clearly defined. The SCADDTC was the first definition of probable, possible, or definite VD; memory deficit is not emphasized, but it does not allow much fine tuning in all subtypes. NINDSAIREN criteria provide a better approach, including an arbitrary time relationship with vascular event(s), also adding a neuropathological classification, but it is still not satisfactory, relying heavily on memory and not allowing the exclusion of underlying Alzheimer’s or other degenerative dementia. Neuroimaging is necessary (7), showing infarcts, lacunae, or white-matter lesions, but it is not certain so far that white-matter lesions really matter (7). Hemorrhages, anoxia, subdural hematomas, arteriovenous malforma-tions (AVMs), or venous thormobosis may also be found. None of the abovementioned definitions allow separation of mixed dementia, i.e., a pauci-or nonsymptomatic Alzheimer’s disease (AD) that is revealed or aggravated by a stroke or VD associated with AD.
