Table 3.

Subtypes of vascular cognitive impairment and dementia, mapped onto route, tempo and caliber

Subtype	Tempo	Caliber	Imaging signature	Cognitive profile
Multi-infarct dementia	Acute, repeated	Large, sometimes mixed	Multiple cortical and cortico-subcortical infarcts	Stepwise and patchy; deficits follow territories, with aphasia, neglect, apraxia
Strategic infarct dementia	Acute, single event	Large or small	One lesion in thalamus, angular gyrus, caudate, genu of the internal capsule or medial temporal region	Disproportionate to lesion volume; amnesia, abulia or executive failure by site
Subcortical ischemic vascular dementia (lacunar state, Binswanger type)	Chronic, insidious	Small	Confluent white matter hyperintensity, multiple lacunes, enlarged perivascular spaces	Slowed processing, dysexecutive syndrome, early gait disorder and urinary urgency, depression
Hypoperfusion and hypoxic-ischemic dementia	Acute or chronic	Systemic or watershed territory	Watershed infarction, laminar necrosis, hippocampal or basal ganglia injury, delayed leukoencephalopathy	Amnestic after CA1 injury; visuospatial after posterior watershed; executive and transcortical aphasia after anterior watershed
Hemorrhagic vascular cognitive impairment	Acute on chronic	Small	Lobar or deep intracerebral hemorrhage, microbleeds, cortical superficial siderosis	Depends on site and burden; amyloid angiopathy adds posterior and visuospatial features
Mixed vascular and Alzheimer disease	Chronic	Mixed	Any of the above with medial temporal atrophy and positive amyloid biomarkers	Combined amnestic and dysexecutive; the most common late-life substrate

Note. Complements Table 2, which classifies small vessel disease by vessel pathology, and Table 4, which maps lesion location to syndrome