Uncommon causes of cerebrovascular dementia

Abstract

The concept of Binswanger's disease (BD) remains unclear and may not constitute a useful diagnostic category. However, cognitive decline may be present in a proportion of patients with subarachnoid hemorrhages (SAH) or subdural hematomas (SH). We provide a critical review of the concept of BD and summarize the main findings on the association between SAH, SH and cognitive decline. BD was originally identified as a type of dementia different from neurosyphilis and with characteristic white matter atrophy. The phenomenology of BD is currently construed around the concept of frontosubcortical dementia, but the validity of this construct is unclear. Patients with SAH frequently develop a variety of cognitive and behavioral problems that usually result in poor psychosocial adjustment and poor quality of life. SH is a rare cause of progressive cognitive impairment. A proportion of patients (particularly functionally impaired old individuals) are at a high risk for cognitive deficits after surgical drainage of the hematoma.