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The enigma of vascular cognitive disorder and vascular dementia

Jellinger, Kurt A.·2007·Acta Neuropathologica
DOI 10.1007/s00401-006-0185-2
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Abstract

The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment, are a matter of discussion, and currently used clinical diagnostic criteria show moderate sensitivity (average 50%) and variable specificity (range 64-98%). In Western clinic-based series, VaD is suggested in 8-10% of cognitively impaired aged subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with reasonable values of 8-15%, while in Japan it is seen in 22-35%. Neuropathologic changes associated with cognitive impairment include multifocal and/or diffuse disease and focal lesions: multi-infarct encephalopathy, white matter lesions or arteriosclerotic subcortical (leuko)encephalopathy, multilacunar state, mixed cortico-subcortical type, borderline/watershed lesions, rare granular cortical atrophy, post-ischemic encephalopathy and hippocampal sclerosis. They result from systemic, cardiac and local large or small vessel disease. Recent data indicate that cognitive decline is commonly associated with widespread small ischemic/vascular lesions (microinfarcts, lacunes) throughout the brain with predominant involvement of subcortical and functionally important brain areas. Their pathogenesis is multifactorial, and their pathophysiology affects neuronal networks involved in cognition, memory, behavior and executive functioning. Vascular lesions often coexist with Alzheimer disease (AD) and other pathologies. Minor cerebrovascular lesions, except for…

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Metadata

Authors
Jellinger, K. A.
Venue
Acta Neuropathologica
Publisher
Springer Science and Business Media LLC
Published
2007-02-07
Volume
113
Issue
4
Pages
349-388
ISSN
  • 0001-6322
  • 1432-0533
DOI
10.1007/s00401-006-0185-2
Cited by
166
References
49
Language
en
Licence
www.springer.com/tdm (tdm)

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