The decline and resurgence of vascular dementia

Arteriosclerotic narrowing of cerebral arteries was once viewed as the key to mental decline. As Alzheimer's disease gained recognition and the concept of multi-infarct dementia achieved acceptance, vascular dementia came to be regarded as uncommon. The changing nature of cerebral vascular disease, the aging of the population and the widespread use of brain imaging techniques have brought new prominence to vascular dementia, chiefly in the form of an epidemic of "Binswanger's disease". Growing evidence suggests that not only grey matter lesions but also white matter lesions contribute to dementia, that vascular factors commonly coexist and interact with Alzheimer changes and that Alzheimer's disease has a vascular and potentially treatable component. Vascular dementia needs to be redefined, reappraised and reinvestigated.