Vascular dementia: dead or alive?

The term 'Vascular Dementia' remains popular as a diagnostic entity, since it encompasses a variety of vascular pathologies. This is in stark contrast to many clinical classificatory systems that weight their definitions strongly towards stroke alone. A diagnosis of vascular dementia is complicated by compounding factors that reduce both the validity and specificity of diagnostic systems. This review highlights some of the problems faced in epidemiological, clinical, neuropathological and radiological studies attempting to define a clear-cut syndrome of dementia associated with cerebrovascular disease. The role of non-stroke ischaemia is also discussed. It is concluded that the term vascular dementia may have outlived its usefulness as a valid concept; alternative approaches are suggested.