Trends in the therapy of vascular dementia

A number of drugs has been tested with unsatisfactory results in patients w ith vascular dementia (VaD). It can be hypothesized that part of these fail ures depended on methodological pitfalls. First, it is now clear that VaD e ncompasses a collection of pathological processes with different pathogenes is and, therefore, potentially subject to benefit from diverse therapeutic approaches. In this light, some forms of VaD, such as those associated with small vessel disease and with subcortical structures damage, appear to hav e a clinical-radiological picture sufficiently defined to be proposed as a specific target for clinical trials. Second, the cognitive impairment assoc iated with cerebrovascular diseases is distributed along a spectrum of degr ees, while current criteria for VaD exclusively refer to the most severe th at appear the least susceptible to benefit from therapy. Finally, neuroimag ing was not mandatory in previous VaD clinical trials but has now acquired a major role in the definition of VaD subgroups. More precise definition of radiological changes to be used in trials as entry criteria are needed.