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Vascular dementia: a diagnosis running out of time

Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Tel: +44 (0)20 7848 0240; fax: +44 (0)20 7701 0167

Correspondence: e-mail: r.stewart{at}iop.kcl.ac.uk

Declaration of interest R.S. is supported by a Research Training Fellowship in Clinical Epidemiology from the Wellcome Trust.

See editorial, pp. 97–98, this issue.

ABSTRACT

Background The concept of vascular dementia has a long history but its usefulness as a diagnostic category has been called into question.

Aims To evaluate vascular disease as a risk factor for dementia and the interface between cerebrovascular pathology and Alzheimer's disease.

Method The literature on this topic was selectively reviewed and synthesised.

Results Risk factors for cerebrovascular disease are also risk factors for dementia. However, the course of dementia, once it has developed, appears to be frequently determined by Alzheimer's disease.

Conclusions As a public health measure, modification of vascular risk represents a potentially powerful means to prevent dementia through delaying its onset. However, an effect on progression of dementia, once it has developed, has yet to be established. The traditional view of vascular dementia and Alzheimer's disease as distinguishable conditions is becoming steadily less tenable.

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ELIZABETH WALSH
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ALISTAIR BURNS and IAN G. McKEITH
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