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To the Editor:
Looi and Sachdev1 are to be commended for their timely review of the neuropsychological differences between vascular dementia (VaD) and AD. Their findings suggest that patients with VaD exhibit more executive impairment and less verbal memory impairment than patients with AD. Based on our own experience, we agree with the authors.
We believe that many of the problems associated with the clinical diagnosis of VaD stem from the application of criteria that are overly biased toward the clinical presentation of a single disease (e.g., AD) at the expense of VaD. However, we should also be wary of case definitions that are biased by the pathophysiology of VaD.
It is important to determine whether we are describing a disease process (VaD) or a dementia syndrome. Syndromes are patterns of signs and symptoms that cluster together. Ideally, they should be described without reference to any specific pathology. A profound finding is that AD and VaD can be distinguished by the pattern of their cognitive impairments. It does not merely suggest that the distribution of their lesions is different, but rather that there are two dementia syndromes.
This position was first proposed 20 years ago by several authors2 under the name cortical and subcortical dementias. However, this anatomic rubric is not strictly tenable. We prefer a phenomenologic classification (e.g., Type 1 versus Type 2) for dementias with and without posterior cortical features.3 Several simple bedside measures are available to assist in this distinction.4–6 We have emphasized …
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