Cerebrovascular disease is currently viewed as a distinctly secondary cause of dementia that is of uncertain importance. Although it is commonly cited as the second leading cause of dementia, a lack of well-validated diagnostic criteria, which in turn reflects important gaps in fundamental knowledge about disease mechanisms, makes accurate epidemiology difficult. Two basic facts about vascular dementia share wide consensus. First, it is a disorder in which the pathologic features vary, spanning a wide spectrum in terms of type (from microscopic infarction to infarcts that derive from occlusion of major arteries) and location. Second, the pathologies of cerebrovascular disease and Alzheimer disease (AD) commonly co-occur, the latter being the usual primary cause of the cognitive and functional symptoms of these patients. Indeed, AD, as the predominant cause of dementia in North America and Europe, defines the backdrop against which research on vascular dementia proceeds. There is little interest in large cortical strokes as a cause of dementia, because the pathogenesis is apparent and the clinical issues are largely distinct from those of AD. It is dementia associated with small vessel disease in which the pathogenesis is not apparent and in which the differentiation from AD is difficult that has attracted most attention from researchers in dementia.
Alois Alzheimer (1864-1915). Forever associated with his reports describing plaques and tangles in the brain of patient August D., Alzheimer also devoted considerable attention to "arteriosclerotic" dementia. In a series of prescient papers at the turn of the century, he described the clinical features and the variable neuropathologic features of what is now known as ischemic vascular dementia. (Photograph courtesy of the National Library of Medicine, Bethesda, Md.)
Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.