REMARKABLY LITTLE progress has been made in understanding when dementia will develop in persons who have had strokes. When dementia was considered a global disturbance of brain function, the total volume of infarcted tissue was believed to be the best predictor of dementia.1 However, relatively small strokes occurring in specific sites can lead to disabling dementia, while in other patients large infarcts leave cognition unscathed. Consequently, the location, not just the number or size of strokes, seems critical, but the correlations of specific sites of stroke with dementia are weak, and formulations using this principle have not been helpful in clinical practice. While the basic mechanisms that underlie the development of dementia in other common dementing illnesses are yielding their secrets, the complexity of dementia in stroke has continued to confound even the most diligent efforts of investigators.
Foster NL, Hickenbottom SL. When Do Strokes Cause Dementia?Effects of Subcortical Cerebral Infarction on Cortical Glucose Metabolism and Cognitive Function. Arch Neurol. 1999;56(7):778-779. doi:10.1001/archneur.56.7.778