ABSTRACT
Neuroimaging is now an essential tool for the assessment and investigation of those with suspected vascular cognitive impairment (VCI) and vascular dementia (VaD). Traditionally used as a means of excluding any other intracranial lesion that may be responsible for dementia, it is increasingly necessary to add support and provide confirmation of the clinical diagnosis and to help determine the subtype of VaD (e.g. hemorrhagic vs ischemic; cortical vs subcortical; single strategic infarct vs multi-infarct) (Roman et al, 1993). Imaging can also be useful in individual cases to inform clinical understanding and management. As a number of different vascular pathologies can cause dementia, including hemorrhage, infarction (both single large and multiple small infarction) and diffuse white matter change (O’Brien et al, 2003), it is not surprising that there are no pathognomonic neuroimaging features of VaD. All these vascular changes can be visualized using the structural imaging techniques of computed tomography (CT) and magnetic resonance imaging (MRI), though it should be emphasized that the role of imaging is to provide confirmatory support for a diagnosis of VaD which has been formulated on clinical grounds. A diagnosis of VaD can and should never be made on the basis of scan appearances alone.
