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Vascular Cognitive Impairment: Preventable Dementia

Vascular Cognitive Impairment: Preventable Dementia edited by John V. Bowler, MD, FRCP, and Vladimir Hachinski, MD, FRCP, DSc, 368 pp, with illus, $125, ISBN 0-19-263267-1, Oxford, England, Oxford University Press, 2003. The notion that cerebrovascular disease can cause severe cognitive deficits has been recognized in literature for several centuries. However, the diagnosis of vascular dementia (VaD) is still problematic; this issue is addressed very well in this book. The first and last chapters by Drs Bowler and Hachinski provide a clear insight of the current problems in the clinical diagnosis of VaD and set the framework for future research. At the center of the debate about fundamental problems in the diagnosis of VaD is the current definition of dementia. The majority of the criteria for dementia are based on the assumption that memory is impaired. This Alzheimer-like definition of dementia precluded the identification of VaD patients with cognitive deficits outside the memory domains. The heterogeneity of the vascular lesions (eg, single ischemic lesion, multiple lesions, hemorrhagic lesions, leukoaraiosis), and the concomitant manifestation of Alzheimer disease and cerebrovascular disease are 2 additional critical factors that are still not well defined in their relationship to the dementia of vascular etiology. Because Alzheimer disease is the most frequent form of dementia in elderly patients and can coexist with severe cerebrovascular disease, it is difficult to determine whether the cognitive deterioration is a sole consequence of vascular factors or due to underlying Alzheimer disease. The chapter titled “Neuropsychological Differentation of Alzheimer's Disease and Vascular Dementia” by Perminder Sachdev, MD, and Jeffrey Looi, MD, has an extensive review of the literature of the neuropsychological differences between Alzheimer disease and VaD, which clearly shows the lack of homogeneity in the neuropsychological profile that separates these 2 conditions. Drs Bowler and Hachinski state that the concept of VaD has outlived its usefulness and they propose that all cases with cognitive problems secondary to any type of cerebrovascular disease should be called vascular cognitive impairment. This term will encompass all levels of cognitive decline from mild deficits to frank dementia. The purpose of the change in terminology is to find a better definition that will allow us to identify risk factors and treatments for cognitive deficits secondary to vascular disease. This book has 24 chapters and excellent contributors with solid experience in the study of vascular disease and dementia. It has an extensive review of the clinical aspects, experimental models, pathophysiology, and treatment of vascular dementia. This makes the book essential reading, especially for those who are in the field of cerebrovascular disease, neurodegenerative disorders, or dementia. Prose ★★★ Illustrations ★★★ Science ★★★ Usefulness ★★★★ Back to top Article Information Correspondence: Dr Lopez, Department of Neurology and Psychology, University of Pittsburgh School of Medicine, 3501 Forbes Ave, Suite 830, Oxford Bldg, Pittsburgh, PA 15213 (lopezol@upmc.edu). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Vascular Cognitive Impairment: Preventable Dementia

Archives of Neurology , Volume 62 (5) – May 1, 2005

Vascular Cognitive Impairment: Preventable Dementia

Abstract

edited by John V. Bowler, MD, FRCP, and Vladimir Hachinski, MD, FRCP, DSc, 368 pp, with illus, $125, ISBN 0-19-263267-1, Oxford, England, Oxford University Press, 2003. The notion that cerebrovascular disease can cause severe cognitive deficits has been recognized in literature for several centuries. However, the diagnosis of vascular dementia (VaD) is still problematic; this issue is addressed very well in this book. The first and last chapters by Drs Bowler and Hachinski provide a clear...
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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.62.5.831-b
Publisher site
See Article on Publisher Site

Abstract

edited by John V. Bowler, MD, FRCP, and Vladimir Hachinski, MD, FRCP, DSc, 368 pp, with illus, $125, ISBN 0-19-263267-1, Oxford, England, Oxford University Press, 2003. The notion that cerebrovascular disease can cause severe cognitive deficits has been recognized in literature for several centuries. However, the diagnosis of vascular dementia (VaD) is still problematic; this issue is addressed very well in this book. The first and last chapters by Drs Bowler and Hachinski provide a clear insight of the current problems in the clinical diagnosis of VaD and set the framework for future research. At the center of the debate about fundamental problems in the diagnosis of VaD is the current definition of dementia. The majority of the criteria for dementia are based on the assumption that memory is impaired. This Alzheimer-like definition of dementia precluded the identification of VaD patients with cognitive deficits outside the memory domains. The heterogeneity of the vascular lesions (eg, single ischemic lesion, multiple lesions, hemorrhagic lesions, leukoaraiosis), and the concomitant manifestation of Alzheimer disease and cerebrovascular disease are 2 additional critical factors that are still not well defined in their relationship to the dementia of vascular etiology. Because Alzheimer disease is the most frequent form of dementia in elderly patients and can coexist with severe cerebrovascular disease, it is difficult to determine whether the cognitive deterioration is a sole consequence of vascular factors or due to underlying Alzheimer disease. The chapter titled “Neuropsychological Differentation of Alzheimer's Disease and Vascular Dementia” by Perminder Sachdev, MD, and Jeffrey Looi, MD, has an extensive review of the literature of the neuropsychological differences between Alzheimer disease and VaD, which clearly shows the lack of homogeneity in the neuropsychological profile that separates these 2 conditions. Drs Bowler and Hachinski state that the concept of VaD has outlived its usefulness and they propose that all cases with cognitive problems secondary to any type of cerebrovascular disease should be called vascular cognitive impairment. This term will encompass all levels of cognitive decline from mild deficits to frank dementia. The purpose of the change in terminology is to find a better definition that will allow us to identify risk factors and treatments for cognitive deficits secondary to vascular disease. This book has 24 chapters and excellent contributors with solid experience in the study of vascular disease and dementia. It has an extensive review of the clinical aspects, experimental models, pathophysiology, and treatment of vascular dementia. This makes the book essential reading, especially for those who are in the field of cerebrovascular disease, neurodegenerative disorders, or dementia. Prose ★★★ Illustrations ★★★ Science ★★★ Usefulness ★★★★ Back to top Article Information Correspondence: Dr Lopez, Department of Neurology and Psychology, University of Pittsburgh School of Medicine, 3501 Forbes Ave, Suite 830, Oxford Bldg, Pittsburgh, PA 15213 (lopezol@upmc.edu).

Journal

Archives of NeurologyAmerican Medical Association

Published: May 1, 2005

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