[An update on the diagnosis of vascular dementia]

Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance.

Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.