Course and prognosis

Traditionally, vascular dementia has been characterized by a relative abrupt onset (days to weeks), a stepwise deterioration (some recovery after worsening), and fluctuating course (e.g. differences between days) of cognitive functions. These features are seen in patients with repeated lesions affecting cortical and corticosubcortical brain structures, i.e. large-vessel multi-infarct vascular dementia, and with watershed infarcts related to haemodynamic problems. However, in patients with small-vessel dementia, i.e. subcortical vascular dementia, the onset is more insidious and course more slowly progressive. (2 ¿M753)

The mean duration of vascular dementia is around 5 years.(2) In most studies survival is less than for the general population or those with Alzheimer's disease. (5 ,55) Surprisingly little is known about the rate and pattern of cognitive decline, either overall or among different subgroups of vascular dementia. (56) This underlines the lack of studies detailing the natural history of vascular dementia.

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