Skip to main content

Vascular dementia: a pragmatic review

  • Hugh Series and Margaret Esiri

Vascular dementia is associated with a group of diverse pathologies affecting the cerebrovascular circulation and with other dementia pathologies, particularly Alzheimer's disease. It is rather rare on its own. There is a spectrum of severity of cerebrovascular disease ranging from pathology but no cognitive impairment, to mild cognitive impairment to a dementia syndrome (vascular dementia). Where present, cerebrovascular disease can magnify the impact of other pathologies such as Alzheimer's disease. Current criteria for diagnosing vascular dementia are inadequate. Neuroimaging can be very helpful in defining the extent of pathology. Assessment needs to take into account a wide range of issues. Specific evidence-based treatments are limited, but attention should be given to managing risk factors and associated psychiatric problems such as depression.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Vascular dementia: a pragmatic review
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Vascular dementia: a pragmatic review
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Vascular dementia: a pragmatic review
      Available formats
Corresponding author
Dr Hugh Series, South Locality CMHT for Older Adults, Mental Health Building, Abingdon Hospital, Marcham Road, Abingdon, OX14 1AG, UK. Email:
Hide All

Declaration of Interest

M.E. receives financial support from the National Institute for Health Research through the Oxford Biomedical Research Centre.

Hide All
Alexopoulos, GS, Abrams, RC, Young, RC et al (1988) Cornell Scale for Depression in Dementia. Biological Psychiatry 23: 271–84.
Alexopoulos, GS, Meyers, BS, Young, RC et al (1997) ‘Vascular depression’ hypothesis. Archives of General Psychiatry 54: 915–22.
Banerjee, S (2009) The Use of Antipsychotic Medication for People with Dementia: Time for Action. Department of Health.
Barkhof, F, Fox, NC, Bastos-Leite, AJ et al (2011) Neuroimaging in Dementia. Springer.
Black, S, Roman, GC, Geldmacher, DS et al (2003) Efficacy and tolerability of donepezil in vascular dementia: positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial. Stroke 34: 2323–32.
Bowler, JV (2007) Modern concept of vascular cognitive impairment. British Medical Bulletin 83: 291305.
Charlton, RA, Morris, RG, Nitkunan, A et al (2006) The cognitive profiles of CADASIL and sporadic small vessel disease. Neurology 66: 1523.
Erkinjuntti, T, Inzitari, D, Pantoni, L et al (2000) Research criteria for subcortical vascular dementia in clinical trials. Journal of Neural Transmission 59 (suppl): 2330.
Erkinjuntti, T, Kurz, A, Gauthier, S et al (2002) Efficacy of galantamine in probable vascular dementia and Alzheimer's disease combined with cerebrovascular disease: a randomised trial. Lancet 359: 1283–90.
Erkinjuntti, T, Roman, G, Gauthier, S et al (2004) Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke 35: 1010.
Erkinjuntti, T, Gauthier, S (2009) Diagnosing vascular cognitive impairment and dementia: concepts and controversies. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, LO, Erkinjuntti, T, Gauthier, S) 39. Cambridge University Press.
Esiri, MM, Wilcock, GK, Morris, JH (1997) Neuropathological assessment of the lesions of significance in vascular dementia. Journal of Neurology, Neurosurgery & Psychiatry 63: 749.
Fischer, P, Jellinger, K, Gatterer, G et al (1991) Prospective neuropathological validation of Hachinski's Ischaemic Score in dementias. Journal of Neurology, Neurosurgery & Psychiatry 54: 580.
Folstein, MF, Folstein, SE, McHugh, PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12: 189–98.
Forette, F, Seux, ML, Staessen, JA et al (2002) The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Archives of Internal Medicine 162: 2046–52.
Fratiglioni, L, Launer, LJ, Andersen, K et al (2000) Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology 54: S105.
Hachinski, VC, Lassen, NA, Marshall, J (1974) Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 304: 207–9.
Hachinski, V, Iadecola, C, Petersen, RC et al (2006) National Institute of Neurological Disorders and Stroke–Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 37: 2220–41.
Hebert, R, Brayne, C (1995) Epidemiology of vascular dementia. Neuroepidemiology 14: 240–57.
Hebert, R, Lindsay, J, Verreault, R et al (2000) Vascular dementia: incidence and risk factors in the Canadian study of health and aging. Stroke 31: 1487.
Ikeda, M, Hokoishi, K, Maki, N et al (2001) Increased prevalence of vascular dementia in Japan. Neurology 57: 839.
Ince, G (2001) Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet 357: 169–75.
Lopez, OL, Wolk, DA (2009) Clinical evaluation: a systematic but user-friendly approach. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, LO, Erkinjuntti, T, Gauthier, S) 3245. Cambridge University Press.
McGuinness, B, Todd, S, Passmore, P et al (2009) Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database of Systematic Reviews issue 4: CD004034 (doi: 10.1002/14651858. CD004034.pub3).
Moorhouse, P, Rockwood, K (2008) Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurology 7: 246–55.
Nagy, ZS, Esiri, MM, Jobst, KA et al (1995) Relative roles of plaques and tangles in the dementia of Alzheimer's disease: correlations using three sets of neuropathological criteria. Dementia and Geriatric Cognitive Disorders 6: 2131.
National Institute for Health and Clinical Excellence (2011a) Dementia: Supporting People with Dementia and their Carers in Health and Social Care (Clinical Guideline 42) (amended March 2011). NICE.
National Institute for Health and Clinical Excellence (2011b) Alzheimer's Disease – Donepezil, Galantamine, Rivastigmine and Memantine (Technology Appraisal 217). NICE.
O'Brien, JT, Erkinjuntti, T, Reisberg, B et al (2003) Vascular cognitive impairment. Lancet Neurology 2: 8998.
Orgogozo, J, Rigaud, A, Stoffler, A et al (2002) Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke 33: 1834–9.
Pendlebury, ST, Rothwell, PM (2009) Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurology 8: 1006–18.
Price, CC, Jefferson, AL, Merino, JG et al (2005) Subcortical vascular dementia. Neurology 65: 376–82.
Rockwood, K, Davis, H, MacKnight, C et al (2003) The Consortium to Investigate Vascular Impairment of Cognition: methods and first findings. Canadian Journal of Neurological Sciences 30: 237–43.
Román, GC, Tatemichi, TK, Erkinjuntti, T et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43: 250–60.
Román, G (2005) Therapeutic strategies for vascular dementia. In Dementia (3rd edn) (eds Burns, A, O'Brien, J, Ames, D) 574600. Hodder Arnold.
Sachdev, PS, Looi, JCL (2003) Neuropsychological differentiation of Alzheimer's disease and vascular dementia. In Vascular Cognitive Impairment: Preventable Dementia (eds Bowler, JV, Hachinski, V) 152–76. Oxford University Press.
Scheltens, P, Erkinjuntti, T, Leys, D et al (2000) White matter changes on CT and MRI: an overview of visual rating scales. European Neurology 39: 80–9.
Sheline, YI, Pieper, CF, Barch, DM et al (2010) Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Archives of General Psychiatry 67: 277–85.
Smith, AD, Smith, SM, De Jager, CA et al (2010) Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PloS One 5: e12244.
Stewart, R (2002) Vascular dementia: a diagnosis running out of time. British Journal of Psychiatry 180: 152–6.
Tatemichi, TK, Desmond, DW, Mayeux, R et al (1992) Dementia after stroke. Neurology 42: 1185.
Tzourio, C, Anderson, C (2003) Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Archives of Internal Medicine 163: 1069–75.
Ueda, K, Kawano, H, Hasuo, Y et al (1992) Prevalence and etiology of dementia in a Japanese community. Stroke 23: 798.
Van der Flier, W, Staekenborg, SS, Barkhof, F et al (2009) Structural neuroimaging: CT and MRI. In Vascular Cognitive Impairment in Clinical Practice (eds Wahlund, LO, Erkinjuntti, T, Gauthier, S) 5869. Cambridge University Press.
Verhey, FRJ, Lodder, J, Rozendaal, N et al (1996) Comparison of seven sets of criteria used for the diagnosis of vascular dementia. Neuroepidemiology 15: 166–72.
Wiederkehr, S, Simard, M, Fortin, C et al (2008) Validity of the clinical diagnostic criteria for vascular dementia: a critical review. Part II. Journal of Neuropsychiatry and Clinical Neuroscience 20: 162–77.
Wilcock, GK, Bucks, RS, Rockwood, K (1999) Diagnosis and Management of Dementia: A Manual for Memory Disorders Teams. Oxford University Press.
Wilcock, G, Möbius, HJ, Stöffler, A (2002) A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500). International Clinical Psychopharmacology 17: 297305.
Wilkinson, D, Doody, R, Helme, R et al (2003) Donepezil in vascular dementia: a randomized, placebo-controlled study. Neurology 61: 479–86.
Wilkinson, DG, Doody, RS, Black, SE et al (2005) Donepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dementia and Geriatric Cognitive Disorders 20: 338–44.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 55 *
Loading metrics...

Abstract views

Total abstract views: 265 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 16th July 2018. This data will be updated every 24 hours.

Vascular dementia: a pragmatic review

  • Hugh Series and Margaret Esiri
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *