Brain imaging of vascular dementia

I. Topography

Radiologic lesions associated with dementia include ANY of the following or combinations thereof:

1. Large-vessel strokes in the following territories:

Bilateral anterior cerebral artery

Posterior cerebral artery, including paramedian thalamic infarctions, inferior medial temporal lobe lesions

Association areas: parietotemporal, temporo-occipital territories (including angular gyrus)

Watershed carotid territories: superior frontal, parietal regions

2. Small-vessel disease:

Basal ganglia and frontal white matter lacunes

Extensive periventricular white matter lesions

Bilateral thalamic lesions

II. Severity

In addition to the above, relevant radiologic lesions associated with dementia include:

Large-vessel lesions of the dominant hemisphere

Bilateral large-vessel hemispheric strokes

Leukoencephalopathy involving at least ?4 of the total white matter

Although volume of lesion is weakly related to dementia, an additive effect may be present. White matter changes observed only on T, MRI but not on T, MRI or CT may not be significant.

Absence of vascular lesions on brain CT/MRI rules out probable vascular dementia.