Vascular dementia: an Australian perspective

We performed a review of the published literature on dementia, stroke, and vascular dementia (VaD) emanating from Australia and sought the opinions of senior clinicians and investigators in the field of dementia. We conclude from these sources that the public health importance of cognitive impairment and dementia secondary to cerebrovascular disease is recognized in Australia as is the potential to alter the public health burden significantly by preventative strategies. VaD is considered to be a heterogenous group of syndromes, and there is a lack of consensus on the appropriate diagnostic criteria. The concept is considered to be in evolution and empirical support is needed for its definition, subtyping, and the understanding of the pathophysiological mechanisms. An alternative term--vascular cognitive disorder--is suggested to overcome some of the difficulties inherent in the concept of "dementia" as used currently. The importance of noncognitive disorders of vascular origin is highlighted. No treatment is recognized to be specifically effective in VaD. Australian clinicians and researchers are beginning to grapple with the many difficulties entailed in our understanding of the cognitive and noncognitive consequences of cerebrovascular disease. There is a need for an international consensus on diagnostic criteria, particularly for drug development and research.