Assessing the Impact of Vascular Disease in Demented and Nondemented Patients

That vascular diseases can induce dementia has been known for more than a century. For example, in the 19th and early 20th centuries, the major differential diagnosis of patients with dementia was neurosyphilis versus vascular disease. Also, it is a little known fact that Alzheimer himself wrote 5 articles on vascular dementia and that many of Alzheimer’s observations with respect to vascular dementia subtypes, and the effect of vascular disease on behavior and cognition, have withstood the test of time.1For a few decades interest in vascular dementia (VaD) waned, but there is now keen interest in how cerebrovascular disease influences cognition. Beginning in the early 1990s, new algorithms for the diagnosis of VaD were developed and proposed.2,3 However, subsequent research has shown that the relationships between Alzheimer disease (AD) and VaD are far more complex than previously believed.4,5 For example, risk factors traditionally associated with stroke/VaD are now also considered risk factors for AD. Numerous longitudinal, population-based studies have demonstrated links between vascular risk factors, such as atherosclerosis,6 diabetes,7 hyperlipidemia,8 and stroke9 and the development of AD. Although AD and VaD are usually associated …