Elsevier

Neurologic Clinics

Volume 25, Issue 3, August 2007, Pages 717-740
Neurologic Clinics

Subcortical Ischemic Vascular Dementia

https://doi.org/10.1016/j.ncl.2007.04.003Get rights and content

Subcortical ischemic vascular dementia (SIVD) has been proposed as a subtype of vascular cognitive impairment. MRI often discloses “silent” hyperintensities in 20% to 40% of community-dwelling elderly. Efforts to relate MRI-measured lacunes and white matter changes to cognitive impairment have not been straightforward. The possibility that Alzheimer's disease pathology contributes to cognitive impairment increases with age. A rare disorder known as cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) provides an opportunity to study SIVD in the absence of Alzheimer's disease. Lacunes and deep white matter changes are associated with dysexecutive syndrome. Hypertension, the leading risk factor for sporadic SIVD, is treatable. High priority must be given to reducing vascular risk profiles.

Section snippets

Conceptualization: history, frontal-subcortical loops, diagnostic criteria

The wide range of cerebrovascular disease (CVD) and its associated clinical phenotypes have inspired many classification schemes. CVD is divided into large versus small artery disease. Stroke is divided into ischemic versus hemorrhagic subtypes. Multi-infarct dementia (MID) was split into cortical versus subcortical dementia. This article focuses on a proposed subtype known as subcortical vascular dementia (SVD) or SIVD, which is characterized by lacunar infarctions and deep white matter

Brain-behavior correlations: imaging-clinical-pathologic data

The versatility and power of MRI offer exciting clinical and research opportunities. High-field MRI at 3 or more tesla offers unprecedented anatomic resolution, functional MRI and perfusion MRI give excellent temporal resolution, and diffusion tensor imaging provides information about architectural integrity. This review focuses on new findings using structural MRI (ie, T1-weighted, T2-weighted, and proton density sequences).

When studies are designed to address specific hypotheses, a

Epidemiologic evidence

Many factors, such as age, hypertension, diabetes mellitus, smoking, high cholesterol, and heart disease, are risk factors for stroke, regardless of subtype (Fig. 12) [51]. In a recent meta-analysis of 16 studies, hypertension and diabetes seemed somewhat more common with lacunar versus nonlacunar or cardioembolic stroke, but this may be confounded by the circular inclusion of risk factor profiles in the definition of stroke subtype [52]. In the Atherosclerosis Risk in Communities study, the

Summary

Epidemiologic data suggest that prevention of SIVD is akin to prevention of stroke. Identification and treatment of vascular risk factors, such as hypertension, diabetes mellitus, and hyperlipidemia, is a high priority [71]. Overall, antihypertensive therapy is associated with a 35% to 44% reduction in the incidence of stroke. Only 70% of Americans who have hypertension are aware of their condition, 60% are under treatment, and 34% are controlled successfully [72]. Lack of diagnosis and

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    This work was supported by NIH Grant P01 AG12435 “The Aging Brain: Vasculature, Ischemia, Behavior” and the State of California Department of Health Services.

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