Brain imaging findings

Work on the relationship between brain lesions and cognition in vascular dementia has used varying definitions and measures of cognitive impairment, varying techniques to reveal brain changes, and varying criteria for the selection of patients. (!Z>

CT and magnetic resonance imaging (MRI) studies on vascular dementia have shown that bilateral ischaemic lesions are important. ^Il7' Some studies emphasize deep infarcts in the frontal and limbic areas, while others report cortical lesions especially in the temporal and parietal areas. There is disagreement about the number and volume of the infarcts, as well as the extent and location of atrophy. Diffuse and extensive white-matter lesions have been suggested as an important factor leading to functional disconnection of cortical brain areas. Some general conclusions on brain lesions in vascular dementia may be drawn.

1. There is no single pathological feature, but a combination of infarcts, ischaemic white-matter lesions of varying size and type, and atrophy of varying degree and site.

2. Infarcts associated with vascular dementia tend to be bilateral, multiple (more than two), and located in the dominant hemisphere and in the limbic structures (frontolimbic or prefrontal-subcortical and medial-limbic or medial-hippocampal circuits).

3. White-matter lesions on CT or magnetic resonance imaging ( MRI) associated with vascular dementia are extensive, extending in periventricular white matter, and confluent to extending in the deep white matter.

4. It is doubtful whether a single small lesion on imaging can be accepted as evidence for vascular dementia.

5. Absence of cerebrovascular lesions on CT or MRI is contrary to a diagnosis of vascular dementia.

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