The so-called ‘‘mixed dementia syndrome’’ (which usually refers to the combination of Alzheimer’s disease and VaD) may have been underrepresented in our estimation of dementia subtypes. VaD and AD seem to be more closely linked than might be explained on the basis of coincidence. Several vascular risk factors related to VaD have been shown also to be risk factors of clinical AD. In addition, infarcts and WMLs relate to an earlier clinical manifestation of AD. Further VaD and AD also share common pathogenic mechanisms such as delayed neuronal death and apoptosis. Overlap of these two mechanisms relate especially to the late-onset AD.
Clinical recognition of patients with mixed dementia or AD with CVD can be a problem. These patients can give a clinical history and signs of CVD, in this respect being clinically closer to VaD. On the other hand, many patients with AD are only found to have ischemic features in the neurophosis. In search of the therapeutic approaches however, we may have to choose a new focus. Instead of being prisons of old diagnostic dichotomies (pure AD vs. pure VaD), we should change the focus on etiopathogenetic factors, measure both the vascular burden of the brain, as well as the Alzheimer burden of the brain, and their consequences.
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