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July 1988

Vascular Dementia: Too Much, or Too Little?

Author Affiliations

Chief Editor

Arch Neurol. 1988;45(7):801. doi:10.1001/archneur.1988.00520310119027

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The excellent editor of the CONTROVERSIES OF NEUROLOGY section has asked me to comment on these two presentations. He requested to disallow himself because of his own close identification with the subject; it may be said that he initiated the gold standard for diagnosis.

Dr O'Brien argues cogently that the number of patients with vascular dementia is understated. As he points out, patients with severe cerebral vascular disease often die much earlier than those with Alzheimer's disease. Thus, a hospital series with long-term patients will be weighted in favor of older patients who have more Alzheimer's disease. Also, it is possible that smaller strokes may cause dementia because of strategic location and not because of the amount of tissue destroyed. It is also possible that a small stroke in a patient with earlier Alzheimer's disease may make the dementia much worse. Thus, there may be an even greater contribution

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