Vascular Dementia

As early as 1896 ‘‘arteriosclerotic dementia’’ (referring to VaD) was separated from ‘‘senile dementia’’ (referring to AD). Nevertheless, until the 1960s and 1970s cerebral atherosclerosis by chronically impairing blood supply to the brain was thought to be the commonest cause of dementia, and AD was regarded as a rare cause affecting only younger patients. Tomlinson et al. (Tomlinson, Blessed, and Roth) rediscovered AD as the more frequent cause of dementia than that of arteriosclerotic dementia. In 1974 Hachinski and colleagues used the term multi-infarct dementia (MID) to describe the mechanism by which they considered VaD was produced (Hachinski, Lassen, and Marshall). As the pendulum swung in the direction of AD, vascular forms of dementia became relegated to a position of relative obscurity.

Until the 1990s, the concept of VaD has been dominated by MID, i.e., a dementia caused by small or large brain infarcts. VaD has come full circle to be understood as cognitive impairment caused by chronic ischemic with or without stroke.