Dementia and cerebrovascular disease

Cerebrovascular disease is an important cause of cognitive impairment and dementia in the elderly. However, there is no accepted neuropathological scheme for quantitating cerebrovascular disease in cognitive disturbances. Further, there is incomplete agreement on clinical definitions of vascular dementia. Despite these two deficiencies, many consistencies in the clinical, imaging, epidemiological, and neuropathological aspects of cerebrovascular disease and cognitive impairment have emerged. Summary points are: (1) A history of stroke, imaging evidence of stroke and neurological signs typical of stroke are the best clinical indicators of cerebrovascular disease; (2) The more clinical evidence for cerebrovascular disease implies greater cerebrovascular pathology; (3) AD is the most common accompaniment of cerebrovascular disease in dementia; (4) AD pathology can never be ruled out on clinical or imaging grounds; and (5) The more cerebrovascular pathology implies less AD pathology and vice versa for a particular level of cognitive impairment.