ABSENCE OF VASCULAR DEMENTIA IN AN AUTOPSY SERIES FROM A DEMENTIA CLINIC

OBJECTIVE: The role of cerebrovascular disease in dementia in older pe ople has been the subject of controversy. This study was undertaken to examine the prevalence of vascular disease in a prospective autopsy s eries of patients with clinically diagnosed dementia. DESIGN: Structur ed review of clinical and neuropathological examinations. Clinical dia gnoses were assigned in accordance with the recommendations of the NIN CDS/ADRDA consensus panel. Neuropathological examinations were perform ed at an academic neuropathology service using published consensus cri teria for the diagnosis of Alzheimer's disease and other forms of deme ntia. SETTING: A subspecialty, outpatient dementia clinic in a univers ity-affiliated suburban American hospital. PARTICIPANTS: Eighty-seven unselected patients coming to autopsy who had undergone clinical demen tia evaluation. RESULTS: Dementia could not be attributed to the effec ts of cerebrovascular disease alone in any of the 87 patients coming t o autopsy. Seventy-six (87%) of the patients were found to have Alzhei mer's disease (AD), 44 had AD alone, and 32 had AD in combination with cerebrovascular disease (CVD). All of the patients with signs of CVD at autopsy were also found to have some concomitant neurodegenerative disease. The absence of patients in whom vascular dementia could be di agnosed at neuropathology was not the result of recruitment bias. CONC LUSION: Clinicians should maintain a high index of suspicion of AD or other neurodegenerative process in older patients whose presenting com plaint is dementia, even in the presence of well documented cerebrovas cular disease.