title: Towards defining the neuropathological substrates of vascular dementia.
abstract: Cerebrovascular disease is highly heterogeneous but can culminate in vascular cognitive impairment or vascular dementia (VaD). As much as the clinical diagnosis warrants scrutiny, the neuropathological substrates of VaD also need to be better defined. Atherosclerosis and small vessel disease are the main causes of brain infarction. Lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter are associated with more than half of VaD cases consistent with subcortical ischaemic VaD. White matter changes including regions of incomplete infarction are usually widespread in VaD, but their contribution to impairment is not explicit. Other pathologies including hippocampal injury and Alzheimer type of lesions may also modify the course of dementia. Similar to other common dementias consensus criteria for VaD need unambiguous definition to impact on preventative and treatment strategies and are critical for selective recruitment to clinical trials.
authors.affiliation: Institute for Ageing and Health, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE, UK. r.n.kalaria@ncl.ac.uk
authors.forename: Raj N
authors.initials: RN
authors.lastname: Kalaria
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
authors.forename: Clive G
authors.initials: CG
authors.lastname: Ballard
authors.forename: Robert
authors.initials: R
authors.lastname: Perry
authors.forename: Paul
authors.initials: P
authors.lastname: Ince
authors.forename: Tuomo
authors.initials: T
authors.lastname: Polvikoski
mesh_terms: D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D001921:Brain / Q000473:pathology; D016657:Cerebral Amyloid Angiopathy / Q000473:pathology; D002544:Cerebral Infarction / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000473:pathology*; D015140:Dementia, Vascular / Q000473:pathology*; D006801:Humans; D009336:Necrosis