Cerebrovascular pathology in cognitive impairment: New (in)sights

摘要

Over the past decade, the dominant model that relates cerebrovascular pathology to cognitive impairment has undergone a fundamental revision. The belief that most of the relevant pathology was macroscopic1'2 dominated thinking for many years. Unfortunately, the model of vascular dementia based on the "big stroke" and "known stroke" view did not fit experience. The diagnostic criteria3 based on that model have had rather low predictive value.4 It appeared that "big stroke" vascular pathology in dementia was very rare. The concept of vascular dementia reached a conceptual nadir in a 1997 article that asserted that large-vessel-related vascular dementia was present in only 6 out of "at least" 1,929 cases of dementia at several university dementia research programs.