Vascular Dementia, Pathophysiology and Classification

Kim, Beum Saeng

Abstract

Vascular dementia (VaD) is a dementia syndrome resulting from brain dysfunction produced by cerebrovascular disease. It is one of the most common causes of in the elderly, along with Alzhedimer's disease. Identification of VaD is particularly importent since its course may be modifiable through controlling risk factors. Hypxic-ischemic injury is responsible for most of VaD, and leukoencephalopathy and lacunes;some have traditional cortical infarctions. Clinical course of VaD is variale and not all the cases exhibit a classic stepwise progression. The clinical manifestations of VaD is include focal neurologic signs, extrapyramidal dysfunction, and incontinence. Neurobehaviaral abnormalities most often resemble those of subcortical dementia, but some patients manifest cortical dysfunction syndromes (aphasia, agnosia, apraxia). Personality changes and depression are common. A variety of pathological alterations associated with VaD include arterial territory infarctions, laminar necrosis, granular atrophy, sclerosis, lacunes, and subcortical leukoencephalopathy. Diagnosis of VaD depends on meeting following three criteria;1) dementia, 2) clinical and neuroimaging evidence of cerbrovascular disease, and 3) a compelling temporal relationship between the cognitive changes and the vascular insults. Treatment of VaD includes prevention of further vascular injury, control of neuropsychiatric disturbances, and application of appropriate rehabilitative strategies.