Vascular Dementia

Vascular dementia (VaD) is one of the most common causes of significant cognitive dysfunction in older adults. Cerebrovascular disease is nearly ubiquitous in older populations. Ischemic injury to small penetrating arteries is typically involved, though VaD can result from occlusion of cortical vessels, strategic single infarcts in the subcortex, or a combination of cortical and subcortical involvement. The specific clinical presentation varies according to the brain region affected; however most individuals exhibit a disproportionate degree of executive dysfunction as the primary cognitive phenotype. This presentation reflects the heavy involvement of subcortical white matter and basal ganglia in VaD. Current treatment options are limited to medications initially designed for Alzheimer's disease, with only modest therapeutic benefit. Interventions targeting the underlying cardiovascular disease (e.g., hypertension) are particularly important to prevent worsening of symptoms and disease morbidity.