To the Editor.
—Dr Snowdon and colleagues1 emphasized the important contribution of lacunar infarcts to cognitive decline in patients with AD. However, with few exceptions, no clear correlation exists between location or number of lacunar infarcts and development of vascular dementia.2,3 More than a direct cause of dementia, lacunar infarcts per se probably represent a surrogate or a marker for small-vessel disease(arteriolosclerosis) leading also to periventricular ischemic white matter disease in the elderly.4 These lesions, rediscovered by brain imaging techniques under the name leukoaraiosis, constitute the pathological substratum of Binswanger disease,5 a vascular form of senile dementia.Moreover, Brun and Englund6 demonstrated these lesions in about 60% of patients with AD. However, periventricular ischemic white matter lesions in the elderly may be undetectable to the naked eye examination of the brain
Roman GC. Brain Infarction and the Clinical Expression of Alzheimer Disease. JAMA. 1997;278(2):113-114. doi:10.1001/jama.1997.03550020045023