Vascular dementia: a diagnostic conundrum for the clinical neuropsychologist.

The contribution of cerebrovascular disease (CVD) to cognitive impairment in older persons is an important determination rendered by clinical neuropsychologists. However, it is often difficult to determine the relationship between CVD and severe cognitive dysfunction in this population. As a result, whether a patient meets diagnostic criteria for vascular dementia (VaD) or not is difficult to establish with reasonable clinical certainty. Our position is that five clinical myths regarding VaD complicate the diagnostic process for clinical neuropsychologists. Specifically, beliefs regarding a stepwise course of decline, patchy neuropsychological profile, prominent memory deficit, specificity of neuroimaging findings, and distinctions between VaD and Alzheimer's disease all represent factors that potentially confuse rather than clarify the diagnostic process. In this article we review these factors and offer suggestions for future research.