Subcortical ischemic vascular disease (SIVD) is a major cause of vascular cognitive impairment and dementia, particularly among ethnic minorities, such as Asian and African American populations.
Two pathways, occlusion and hypoperfusion, lead to brain ischemia, complete versus incomplete infarction, and cognitive impairment associated with cerebral small artery disease. Lacunes and deep white matter changes, visualized by computed tomographic scanning or magnetic resonance imaging, provide sensitive and respective markers for these two ischemic pathways. Brain atrophy and deep white matter changes predict severity of dementia. The value of other clinical features for diagnosis of dementia attributable to SIVD is reviewed using evidence-based metrics (e.g., odds ratios and likelihood ratios). The importance of recognizing and managing hypertension and diabetes mellitus, the two major risk factors for SIVD, is emphasized.
Progress in understanding and treating vascular dementia may be accelerated by focusing on more homogeneous subtypes, such as those caused by SIVD.
From the Department of Neurology, University of Southern California, Los Angeles, California.
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