Dementias have been recognized for more than 2 millennia and attributed to many causes, but by the mid-20th century, dementia had become nearly synonymous with cerebrovascular insufficiency. By the end of the century, Alzheimer disease (AD) took the center stage, relegating vascular causes to the sidelines even though they might involve up to 70% of dementia cases.1 Despite more than 2000 studies, all AD-specific treatment options have failed. Meanwhile, growing evidence suggests that some dementia cases could be prevented by enhancing healthy lifestyles and controlling vascular risk factors. Vascular cognitive impairment, which ranges from the brain-at-risk stage to dementia, represents an important, potentially preventable part of the growing dementia challenge in the aging worldwide population. Now that evidence for vascular contributions to dementia has become incontestable, the dementia field is slowly moving back toward vascular causes; however, many answers likely lie in their interaction with neurodegeneration. It is important to ensure that the pendulum does not swing too far back.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Vargas-González J, Hachinski V. Insidious Cerebrovascular Disease—The Uncool Iceberg. JAMA Neurol. 2020;77(2):155–156. doi:10.1001/jamaneurol.2019.3933
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.