The featured article is ‘The Decline and Resurgence of Vascular Dementia’ by Vladimir Hachinski and freely available here.
As with other papers reviewed previously I would classify this as an unstructured review. More specifically this is an opportunity for Hachinski, an established expert in this field, to give us his opinions (informed by the evidence) on a number of areas relating to Vascular Dementia. As a result, the review takes the reader on a narrative journey through the field of vascular dementia giving pause to think about a number of important issues in this area. Initially he notes that there has vascular dementia was the most prominent explanation for cognitive decline but was later replaced by Alzheimer’s Disease before once again experiencing a return to prominence. Hachinski gives us a number of reasons for why this might be the case. He then looks at the underlying theory and gives us a ‘comprehensive theory’ which includes a fascinating consideration of the flow of the cerebrospinal fluid which he argues will change the structure of the ventricles due to the convergence ‘at the dorsal lateral angle of the frontal horns’. Furthermore he also considers an evolutionary explanation of a ‘vascular centrencephalon’ relating to what he describes as the most primitive areas of the brain. Also of interest is his discussion of the centrum semiovale lesions which may results from periods of hypotension as well as hypertension although he emphasises the need for systematic studies in this area. He also notes the importance of recognising abulia as a symptom of frontal lobe dysfunction and the importance of both grey matter and white matter lesions with the latter causing a disconnection syndrome. He gives this invaluable quote in the conclusions
‘Vascular dementia needs to be redefined, the emphasis to be shifted from categorization to identification of vascular mechanisms that contribute to cognitive impairment‘
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