Emerging Concepts in Vascular Dementia: A Review

Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a “minor stroke”. Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that “good” functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches. •Vascular mechanisms are increasingly recognized as a contributing factor to dementia in the elderly•Vascular dementia generally reflects a heterogeneity in terms of presentation related to the varying distributions of vascular involvement•Small vessel ischemic disease overlaps with both vascular and neurodegenerative dementia and has become an increasing focus of study•Hemorrhagic stroke is often associated with clinically significant cognitive deficit although its contribution to the spectrum of vascular dementia tends to be less emphasized•Identification of vascular cognitive impairment, preceding actual vascular dementia, may allow initiation of interventions with potential for halting or delaying progression of the cognitive deficit