Subcortical vascular dementia: lights and shadows

SIVD "subcortical ischemic vascular dementia" represents an important and homogeneous subtype of Vascular Dementia, related to small vessel disease that includes two different aspects, represented by the Binswanger's disease and lacunar state((1)). The syndrome is defined clinically by cognitive impairment and evidence of subcortical vascular brain injury, including lacunar infarcts (lacunar state's lesions) and deep white matter lesions (WMLs)((1)). Lacunar state and Binswanger's syndrome represent only a small part of a more complex disease. In fact, classification is difficult, remaining a not clear and universally accepted definition((1)). Symptoms include motor and cognitive dysexecutive slowing, forgetfulness, dysarthria, mood changes, urinary symptoms and short-stepped gait((2)). These manifestations probably result from ischemic interruption of parallel circuits from the prefrontal cortex to the basal ganglia((2)). The involvement of these circuits has also been enhanced by the results obtained from neurophysiology studies, performed by transcranial magnetic stimulation (TMS) in patients with this form of dementia, showing cortical-excitability changes. Currently, brain imaging is necessary for the diagnosis, especially MRI. Many cardio-cerebrovascular risk factors are involved, but hypertension is the most important because it is the most correlated with the small vessel disease. Primary prevention of these risk factors is considered the best treatment for SIVD(2).