ABSTRACT
Cerebral vascular disease holds a position as a major cause of neurological disability and mental disorder, especially in old age with a wide spectrum of psychiatric manifestations such as delirium, dementia, personality change, affective disorder, hallucinations, paranoia and other psychotic reactions, as well as circumscribed cognitive deficits such as dysphasia, memory impairment and dyspraxia. This chapter focuses on the historical background of the distinction and classification of dementia syndromes, caused by vascular lesions of the brain, here called vascular dementia (VaD). Dementia, derived from the Latin ‘de mens’, meaning ‘without mind’, is an acquired clinical syndrome, by definition of long duration and usually progressive. Dementia was often used synonymously with ‘insanity’ and ‘madness’ and when Kraepelin (Kraepelin, 1893) introduced the concept of dementia praecox in 1893, this implicated a presumption of an underlying organic defect. The word ‘dementia’ has, however, been given different meanings in different contexts. It may denote a clinical syndrome, irrespective of etiology, but also imply that the etiology of this syndrome is organic brain disease. Moreover, dementia may be used in a wider sense, describing the underlying brain disease from its early, subtle manifestations to the advanced stage of severe deterioration. Dementia was long considered to be irreversible, although this nihilistic view was open to criticism (Critchley, 1953). Terms such as treatable and reversible dementia and dysmentia (Chiu, 1994) have been suggested to emphasize the etiological and clinical heterogeneity and the possibility of treatment and prevention.
