Pathophysiology of vascular dementia and white matter changes

Vascular dementia (VaD) can be defined as a dementia syndrome likely to be the consequence of lesions of the brain, vascular in origin, irrespective o f their ischemic, hemorrhagic or hypoxic nature. Six subtypes (1) multi-inf arct dementia, (2) strategic single infarct dementia, (3) small-vessel dise ase with dementia, (4) hypoperfusion dementia, (5) hemorrhagic dementia and other VaD, have been proposed, indicating the broad clinical spectrum of t his disorder. Major determinants of the dementia syndrome are (i) stroke ch aracteristics - i.e., lacunar infarcts, localization in the left hemisphere and/or in strategic regions -, (ii) white matter changes frequently seen i n stroke patients, especially in those who have lacunes or deep hemorrhages , represent a strong predictor for risk of dementia - and (iii) associated Alzheimer pathology - Alzheimer and vascular lesions are frequently associa ted. Finally, it should also be considered the role of the summation of var ious lesion types, since many cases of dementia occurring in stroke patient s are multifactorial.