The clinical diagnosis of vascular dementia.

The question was addressed whether the three vascular dementia (VAD) subtypes, multi-infarct dementia (MID), strategic-infarct dementia (SID), and subcortical white matter dementia (SWMD) fulfil the basic criteria for a disease: does a distinct pattern of clinical features match a distinct pathological picture for the various VAD subtypes? No obvious correspondence between structural pathological changes and symptoms or signs was found in the MID and SID subtypes. Therefore, the disease status of these VAD subtypes can be questioned. The VAD subtype SWMD, however, appeared to fulfil the basic criteria for a disease, as the subcortical white matter changes corresponded to the subcortical symptom pattern, with mental slowness, extrapyramidal and bilateral pyramidal deficits.