[Vascular brain damage: an important and recognizable cause of cognitive and behavioral disorders]

Four patients presented symptoms of a dementia syndrome. A man aged 67 showed gradual aggravation of disorders of memory and gait, as well as subcortical infarctions. A man aged 65 had disorders of concentration non compatible with the infarctions on the MRI scan, which disappeared after discontinuation of use of flunarizine. A woman aged 55 and a man aged 52 had changes of character and infarctions in the frontal lobe. Vascular dementia is, contrary to what most criteria suggest, often a subcortical syndrome. The relationship between cerebrovascular pathology on CT and MRI scans and cognitive and behavioural disorders is often hard to establish. If the criteria for vascular dementia are applied blindly, other causes of the subcortical dementia syndrome can be missed. The present criteria offer almost no room for detecting the subtle cognitive and behavioural disorders of cerebrovascular pathology. It is important to recognize the early changes of a threatened brain, because treatment and prevention might be effective in preventing further damage.