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.
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Vargas-González J, Hachinski V. Insidious Cerebrovascular Disease—The Uncool Iceberg. JAMA Neurol. 2020;77(2):155–156. doi:10.1001/jamaneurol.2019.3933
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