Pathophysiology

To what extent pathological changes in the brain cause, compound, or only coexist with the vascular dementia syndrome is still not known precisely. The vascular changes in the brain can be the main cause of cognitive impairment (as assumed in vascular dementia(2,25'), they can contribute to the clinical picture of other dementia syndromes including Alzheimer's disease/7,2.6) or they may be coincidental.

It is not certain which are the critical changes in the brain leading to the clinical picture of vascular dementia. the syndrome has been related to the volume of brain infarcts (with a critical threshold), the number of infarcts, the site of infarcts (bilateral, in strategic cortical or subcortical, or affecting white matter), to other ischaemic factors (incomplete ischaemic injury, delayed neuronal death, functional changes), to the atrophic changes (origin, location, extent), and finally to the additive effects of other pathologies (Alzheimer's disease, Lewy body dementia, frontal lobe dementias). But it is uncertain which type, extent, side, site, and tempo of vascular lesions in the brain, and which combinaton with other pathologies, relate to vascular dementia. (45 and 6.,!3>

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