The Neuropathologic Substrates of Vascular-Ischemic Dementia

Abstract

Although Alzheimer’s disease (AD) has become widely accepted as the most common cause of dementia in advanced age (1), the role of cerebrovascular disease (CVD) and ischemic brain lesions in cognitive decline remains controversial and confusing (2–5). Until the 1950 and 1960s, dementia in elderly subjects was usually labeled “atherosclerotic dementia,” although in 1919, Mingazzini (6) stated that this was the result of cerebral infarctions, similar to the concept stressed by Fisher (7). Tomlinson et al. (8) described the relationship between the volume of infarcted tissue and cognitive impairment, suggesting that destruction of large volumes of cortex may be necessarily followed by dementia, whereas subtle cerebrovascular lesions (CVLs) may or may not contribute to dementia, probably depending on their location. Hachinsky et al. (9) criticized the term “arteriosclerotic dementia” as both inaccurate and misleading and coined the term “multi-infarct dementia” (MID). Because MID constitutes only a small subdivision of all dementias of vascular etiology, the terms “vascular dementia” (VaD) (4,10–13), “cerebrovascular dementia” (14), “dementia associated with stroke” (15), or, more recently, “ischemic-vascular dementia” (16,17) “vascular-ischemic dementia” or “vascular cognitive impairment” (ViD) (18) were chosen.