Should the term subcortical vascular dementia replace the eponym "Binswanger's disease"?

The name of Otto Binswanger (1856-1929) is nowadays honored for the contrib ution he published in 1894 when he briefly reported on a patient presenting with slow impairment of mental function and hemispheric white matter atrop hy for which the author hypothesized a vascular origin. In 1902, Alzheimer added to the original case a more detailed microscopic description. In the following years, very few reports of "Binswanger's disease" were published and their analysis shows that some of them were disparate from the patholog ical point of view. The eponym began to be extensively used in the '80s to describe subjects with white matter changes that were being discovered with increasing frequency by CT and MRI at that time. The incomplete original d escription, the absence of validated clinical and pathological criteria for defining the disease, and the lack of specificity of CT and MRI white matt er changes, led many authors to criticize the use of the term "Binswanger's disease", while others still strongly defend it. Besides this fruitless debate, today there is a urgent need of clinical, ra diological, and pathological criteria to define a form of vascular dementia (VaD) related to damage of subcortical structures. Subcortical VaD is char acterized by progressive cognitive decline, behavior changes, gait and urin ary disturbances, usually in the absence of major strokes. From the radiolo gical and pathological points of view, white matter changes and lacunar inf arcts are the hallmarks of this type of VaD. In most cases of subcortical V aD small vessel disease (particularly arteriolosclerosis) seems to play a m ajor role.