Preventable senility : a call for action against the vascular dementi as VLADIMIR

more can be seen than understood. The most striking example is the identification of white-matter changes in elderly people, particularly those with dementia. Such changes have been uncritically attributed to ischaemia. Binswanger's disease, which is neither Binswanger's nor a disease,'? is invoked with unjustified frequency since the label is seldom supported by pathological data. Such white-matter changes occur in over 40% of Alzheimer patients'S and in over 80% of individuals with multi-infarct dementia," as determined by CT of the brain. The old idea of chronic ischaemia killing neurons (gray matter) resurfaced as ischaernic damage to their myelin-sheathed extensions (white matter), with no more evidence for this than for the original idea. However, white-matter changes are common, vascular risk factors are treatable, strokes are preventable, so the vascular dementias need to be addressed because the solutions matter. Preventable senility: a call for action against the vascular dementi as