Subcortical Ischemic Vascular Dementia

Abstract

Subcortical ischemic vascular dementia (SIVD) has been proposed as a subtype of vascular cognitive impairment (VCI). The syndrome is defined clinically by cognitive impairment and evidence of subcortical vascular brain injury, including lacunar infarcts and deep white matter changes. SIVD has been traditionally recognized as lacunar state, strategic infarct dementia, and Binswanger syndrome, but these clinical syndromes represent the tip of the iceberg. Proton density magnetic resonance (MRI) often discloses "silent" hyperintensities in 20-40% of community dwelling elderly. Efforts to relate MRI-measured lacunes and white matter changes to cognitive impairment have not been straightforward. The hidden possibility that concomitant Alzheimer disease pathology contributes significantly to cognitive impairment increases with age. Nonetheless, new knowledge is being gained from longitudinal MRI and systematic neuropathological studies. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukencephalopathy (CADASIL), a rare genetic disorder, provides an opportunity to study pure SIVD in the absence of AD. Dysexecutive syndrome characterized by slowing of mental processing speed, decreased working memory, and impairment of abstract reasoning are associated with lacunes and deep white matter changes. But data related to sensitivity and specificity which would support dysexecutive syndrome as diagnostic criteria are limited. Hypertension, by far the leading risk factor for sporadic SIVD, is eminently treatable. High priority must be given to reducing vascular risk profiles.

Assessment of hemodynamic and vascular parameters in Alzheimer's disease, vascular dementia and mild cognitive abnormalities: a pilot study

“…This finding reinforces the theory that vascular pathogenesis is more present in the small vessels in neurodegenerative disorders associated with cognitive deficits classified as AD 27,28 .…”

Elevated Concentrations of Neurofilament Light Chain in the Cerebrospinal Fluid of Bipolar Disorder Patients

“…The association between white matter pathology and BD has been further supported by morphometric studies showing reductions in total white matter volumes (Strakowski et al, 1993;Kieseppa et al, 2003;Davis et al, 2004;Rosso et al, 2007). Patients with cerebral small vessel disease share common features with bipolar patients such as poor performance on tests of executive function and processing speed, generalized brain atrophy as well as ventricular enlargement, blood brain barrier (BBB) dysfunction, and white matter changes in periventricular as well as in the deep white matter (Chui, 2007). In small vessel disease, the periventricular lesions in particular have been associated with cognitive impairment and a decline in executive function and processing speed (Bolandzadeh et al, 2012), whereas deep white matter changes have been associated with depressive symptoms (Krishnan et al, 2006).…”

Cerebral gray matter volume reduction in subcortical vascular mild cognitive impairment patients and subcortical vascular dementia patients, and its relation with cognitive deficits

“…The pathogenesis of svMCI and SVaD remains unclear, which leads to the hypothesis that the disruption of frontal-subcortical loops and long association fibers may play a significant part (Helena C. Chui, 2007). Nevertheless, multiple lacunar infarctions or WMH, which represent cerebral small vessel disease, is limited to diagnose dementia because some elderly people, with similar subcortical vascular lesions, have no cognitive deficits (Pascual et al, 2010).…”