Vascular dementia (VaD) incorporates different vascular mechanisms and changes in the brain, and has different causes and clinical manifestations. Current criteria for VaD select an aetiologically and clinically heterogeneous group and this definitional heterogeneity has affected clinical trial results. Focus on a more homogeneous group, such as that with subcortical (ischaemic) VaD, could be an alternative in clinical drug trials. This subtype incorporates two small vessel clinical entities – ‘Binswanger’s disease’ and ‘the lacunar state’. It comprises small vessel disease as the primary vascular aetiology, lacunar infarct(s) and ischaemic white matter lesions as the primary type of brain lesions, subcortical location as the primary location of lesions, and the subcortical clinical syndrome as the primary clinical manifestation. Subcortical VaD is expected to show a more predictable clinical picture, natural history, outcome and treatment responses.

Erkinjuntti T, Hachinski VC: Rethinking vascular dementia. Cerebrovasc Dis 1993;3:3–23.
Chui HC: Rethinking vascular dementia: Moving from myth to mechanism; in Growdon JH, Rossor MN (eds): The Dementias. Boston, Butterworth-Heinemann, 1998, pp 377–401.
Tatemichi TK: How acute brain failure becomes chronic. A view of the mechanisms and syndromes of dementia related to stroke. Neurology 1990;40:1652–1659.
Chui HC: Dementia: A review emphasizing clinicopathologic correlation and brain- behavior relationships. Arch Neurol 1989;46:806–814.
Desmond DW: Vascular dementia: A construct in evolution. Cerebrovasc Brain Metab Rev 1996;8:296–325.
Pasquier F, Leys D: Why are stroke patients prone to develop dementia? J Neurol 1997;244:135–142.
Skoog I: Status of risk factors for vascular dementia. Neuroepidemiology 1998;17:2–9.
Erkinjuntti T: Cerebrovascular dementia. Pathophysiology, diagnosis and treatment. CNS Drugs 1999;12:35–48.
Wallin A, Blennow K: The clinical diagnosis of vascular dementia. Dementia 1994;5:181–184.
Rockwood K, Howard K, MacKnight C, Darvesh S: Spectrum of disease in vascular cognitive impairment. Neuroepidemiology 1999;18:248–254.
Wetterling T, Kanitz RD, Borgis KJ: Comparison of different diagnostic criteria for vascular dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN). Stroke 1996;27:30–36.
Erkinjuntti T, Ostbye T, Steenhuis R, Hachinski V: The effect of different diagnostic criteria on the prevalence of dementia. N Engl J Med 1997;337:1667–1674.
Skoog I, Nilsson L, Palmertz B, Andreasson LA, Svanborg A: A population-based study of dementia in 85-year-olds. N Engl J Med 1993;328:153–158.
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Dementia three months after stroke. Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 1997;28:785–792.
Erkinjuntti T, Bowler JV, DeCarli C, Fazekas F, Inzitari D, O’Brien JT, et al: Imaging of static brain lesions in vascular dementia: Implications for clinical trials. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S81–S90.
Rockwood K, Bowler J, Erkinjunti T, Hachinski V, Wallin A: Subtypes of vascular dementia. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S59–S64.
Pohjasvaara T, Mäntylä R, Ylikoski R, Aronen HJ, Kaste M, Erkinjuntii T: Comparison of different clinical criteria for the vascular cause of vascular dementia (ADDTC, DSM-III, DSM-IV, ICD-10, NINDS-AIREN). Stroke 2000;31:2952–2957.
Inzitari D, Erkinjuntti T, Wallin A, del Ser T, Romanelli M, Pantoni L: Subcortical vascular dementia as a specific target for clinical trials. Ann NY Acad Sci 2000;903:510–521.
Erkinjuntti T, Pantoni L: Subcortical vascular dementia; in Gauthier S, Cummings JL (eds): Alzheimer’s Disease and Related Disorders Annual. London, Duniz, 2000, pp 101–133.
Erkinjuntti T, Inzitari D, Pantoni L, Wallin A, Scheltens P, Rockwood K, et al: Research criteria for subcortical vascular dementia in clinical trials. J Neural Transm 2000;59(suppl 1):23–30.
Roman GC: Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. JAMA 1987;258:1782–1788.
Babikian V, Ropper AH: Binswanger’s disease: A review. Stroke 1987;18:2–12.
Ishii N, Nishihara Y, Imamura T: Why do frontal lobe symptoms predominate in vascular dementia with lacunes? Neurology 1986;36:340–345.
Erkinjuntti T: Types of multi-infarct dementia. Acta Neurol Scand 1987;75:391–399.
Mahler ME, Cummings JL: The behavioural neurology of multi-infarct dementia. Alzheimer Dis Assoc Disord 1991;5:122–130.
Cummings JL: Fronto-subcortical circuits and human behavior. Arch Neurol 1993;50:873–880.
Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al: Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250–260.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.