Methodological issues and therapeutic perspectives in vascular dementia: areview

Vascular dementia (VaD) is the most common form of dementia after Alzheimer 's disease (AD). However, it is now increasingly recognized that not only i s VaD a heterogeneous syndrome but also that VaD and AD are not mutually ex clusive. Thus, the currently used criteria may no longer be sufficient for an accurate diagnosis of VaD. In addition, although it is widely assumed th at risk factors for vascular disease are also risk factors for VaD, the evi dence, in most cases, is circumstantial. For the effective prevention of Va D, therefore, large-scale and long-term clinical trials are required to inv estigate the validity of these putative risk factors. These trials should a lso include the VaD subtypes in their outcome measurements and to this end a simplified classification system should be adopted. Additional large-scal e trials are required to facilitate the secondary prevention and symptomati c treatment of VaD, in particular to investigate the potential application of several nootropic and neuroprotective drugs. In both cases, these clinic al trials should aim to move the field of VaD from opinion-based medicine t o evidence-based medicine. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.