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---
title: "Vascular Dementia"
docid: "f59dab57-c511-4369-8fcc-592421a4b8d1"
authors:
- key: "1fa14dfd-71ea-4960-908e-e720313bc63a"
value: "Santhosh Gaddikeri, MD"
- key: "a25c450b-3d34-4f64-bba3-cc0834813df6"
value: "Miral D. Jhaveri, MD, MBA"
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name: "Brain"
slug: "brain"
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name: "Diagnosis"
slug: "diagnosis"
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slug: "pathology-based-diagnoses"
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name: "Acquired Toxic/Metabolic/Degenerative Disorders"
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treeNodeId: "ba3cfeaf-64d9-4117-91e8-d2ce58783fc5"
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name: "Vascular Dementia"
slug: "vascular-dementia"
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category: "Brain"
cmeTopicId: "a7dd2d05-d82a-4ed2-87b6-9525d7f4a6a4"
documentVersionId: "f043b936-64b6-4a76-92f4-a926111caa85"
imageCount: 24
lastUpdated: "10/08/20"
pageDescription: "Vascular Dementia"
pageKeywords: "Brain, Diagnosis, Pathology-Based Diagnoses, Acquired Toxic/Metabolic/Degenerative Disorders, Dementias and Degenerative Disorders, Vascular Dementia"
pageTitle: "Vascular Dementia | STATdx"
enhancedTitle: "Vascular Dementia"
type: "DX"
references: true
breadcrumbs:
- "Brain"
- "Diagnosis"
- "Pathology-Based Diagnoses"
- "Acquired Toxic/Metabolic/Degenerative Disorders"
- "Dementias and Degenerative Disorders"
- "Vascular Dementia"
---
# KEY FACTS
- ## Terminology
- Vascular dementia (VaD), multiinfarct dementia (MID), vascular cognitive impairment (VCI)
- Stepwise progressive ↓ in cognitive function
- Heterogeneous group of disorders with varying etiologies, pathologic subtypes
- VaD often mixed etiology
- Can occur alone or in association with Alzheimer disease
- MID secondary to repeated cerebral infarctions
- VaD: Dementia caused by cerebrovascular disease or ↓ cerebral blood flow
- VCI: Cognitive impairment caused by or associated with vascular factors
- Can occur alone or in association with Alzheimer disease (AD)
- ## Imaging
- General features
- Multifocal infarcts [cortical gray matter (GM), subcortical white matter (WM)]
- Basal ganglia (BG), pons
- Territorial as well as lacunar lesions
- Coexisting microvascular WM disease common
- Multiple remote microhemorrhages
- CT
- Multifocal infarcts
- Single or multiple, lacunar to territorial
- WM hypointensities (discrete to confluent)
- FDG PET
- Multifocal regions ↓ metabolism in cortex, WM
- ## Top Differential Diagnoses
- AD
- Frontotemporal lobar degeneration
- CADASIL
- Dementia with Lewy bodies
- ## Clinical Issues
- 2nd most common dementia (after AD)
- Mood & behavioral changes more typical than memory loss
- ## Diagnostic Checklist
- Report strategically placed infarcts
- Look for hemorrhage, DWI abnormalities
# TERMINOLOGY
- ## Abbreviations
- Vascular dementia (VaD)
- ## Synonyms
- Multiinfarct dementia (MID)
- Vascular cognitive disorder (VCD)
- Vascular cognitive impairment (VCI)
- Subcortical ischemic VaD
- Poststroke dementia
- ## Definitions
- Dementia caused by cerebrovascular disease or ↓ cerebral blood flow (CBF)
- VCI: Cognitive impairment caused by or associated with vascular factors
- Secondary to repeated cerebral infarctions
- Can occur alone or in association with Alzheimer disease (AD)
- 2nd most common cause of dementia next to AD
# IMAGING
- ## General Features
- ### Best diagnostic clue
- Multifocal infarcts
- Cortical gray matter (GM), subcortical white matter (WM)
- Basal ganglia (BG), pons
- Territorial as well as lacunar infarcts
- Changes of microvascular WM ischemia common
- ### Location
- Typically involves cerebral hemispheres & BG
- Usually bilateral but may be unilateral
- ### Size
- Vary from single to multiple, punctate to large/confluent
- ### Morphology
- Small infarcts are rounded or oval; large confluent abnormalities are ill defined
- ## CT Findings
- ### NECT
- Hypodensity in periventricular WM
- Cortical, subcortical, BG infarcts
- Generalized atrophy with focal cortical infarcts typical
- ## MR Findings
- ### T1WI
- Generally have hypointense BG lacunar infarcts
- Atrophy with enlargement of ventricles & sulci
- ### T2WI
- Punctate or confluent regions of hyperintense WM
- Central pontine infarcts
- Large areas of volume loss with widened sulci
- ### FLAIR
- Hyperintense foci within BG
- Multifocal diffuse & confluent WM hyperintensities
- ### T2* GRE
- Multiple blooming hypointensities in cortex & along pial surface
- ### DWI
- ↓ fractional anisotropy & ↑ ADC within lesions, normal-appearing WM (NAWM)
- ↑ in mean diffusivity of NAWM correlates with disability found on tests of executive function
- ### MRA
- Most abnormalities in small arteries, generally not well seen on MRA
- ### MRS
- ↓ NAA in both cortical & WM regions
- Frontal cortex NAA negatively correlated with volume of WM signal hyperintensity
- ## Ultrasonographic Findings
- Transcranial Doppler sonography: Pulsatility indices in large arteries ↑ compared to AD
- ## Nuclear Medicine Findings
- FDG PET
- Multiple areas of hypometabolism without specific lobar predominance
- Severity of MID neuropsychiatric symptoms correlates with extent of ↓ metabolism in cortex & WM
- SPECT
- Iodine-123-iodoamphetamine: ↓ frontal & BG CBF, which correlates with low cognitive scores
- Tc-99m hexamethyl propyleneamine oxime: CBF heterogeneity more prominent in anterior portion of brain
- Unlike pattern in AD, in which posterior abnormalities predominate
- ## Imaging Recommendations
- ### Best imaging tool
- MR
- PET/SPECT may also provide specificity
- ### Protocol advice
- Axial FLAIR to detect WM infarcts
- Axial & coronal T2WI to assess regions of atrophy
- T2* GRE/SWI to identify hemorrhage
# DIFFERENTIAL DIAGNOSIS
- [Alzheimer Disease](/document/alzheimer-disease/f71f5cf5-b1af-4c6d-b145-b4c10eec7b58)
- Striking hippocampus & amygdala atrophy
- PET: Bilateral temporoparietal hypoperfusion/hypometabolism (BG spared)
- Often coexists with VaD
- [Frontotemporal Lobar Degeneration](/document/frontotemporal-lobar-degeneration/49510d0e-acf7-45cb-9eb1-53f8193b0b6d)
- Characterized by early onset of behavioral changes with intact visual, spatial skills
- Frontal, temporal lobe atrophy
- Marked atrophy → knife-like gyri
- [Alcoholic Encephalopathy](/document/alcoholic-encephalopathy/88021852-b73d-4cdf-a719-dd4ae3231e45)
- 3rd most common cause of dementia
- Generalized > focal atrophy; superior vermis atrophy
- [CADASIL](/document/cadasil/6b5a24c8-afd7-4106-bb4b-11421ed1592c)
- Most common heritable cause of stroke, VaD in adults
- Earlier age of onset
- Imaging looks like small vessel disease
- [Dementia With Lewy Bodies](/document/dementia-with-lewy-bodies/e8e46d1d-46d2-4e5a-880f-f025a84c5871)
- Hypometabolism of entire brain
- Without infarcts or significant atrophy
# PATHOLOGY
- ## General Features
- ### Etiology
- MID is usually due to multiple small infarctions
- Infarcts involving entire major vessel territories are usually absent
- Minority may be secondary to single or few large infarctions
- ~ 75% of all MID patients exhibit small vessel disease rather than thromboembolism
- Growing evidence exists for involvement of cholinergic system in VaD
- Cholinergic deficits well documented in VaD, independent of concomitant AD pathology
- Cholinergic neuron loss in 70% of AD, 40% of VaD
- ### Genetics
- Apolipoprotein E (*APOE*)
- Serum protein involved in lipid metabolism
- Encoded at single gene locus on chromosome 19 by 3 alleles: ε2, ε3, ε4
- Frequency of ε4 allele significantly higher among patients with AD & VaD compared to controls
- Odds of developing AD or VaD are 4.4x & 3.7x higher (respectively) in presence of even single ε4 allele
- Paraoxonase (*PON1*)
- Component of high-density lipoproteins with antioxidative potential
- 2 *PON1* polymorphisms (Gln192Arg associated with enzyme activity & T-107C associated with enzyme concentration) are independent risk factors for VaD, particularly in *APOE* (ε4)
- ## Staging, Grading, & Classification
- 8 subtypes of VaD
- MIDs: Due to large cerebral emboli, usually readily identifiable
- Strategically placed infarctions causing dementia
- Multiple subcortical lacunar lesions: Develop VaD 5-25x more frequently than age-matched controls
- Binswanger disease: Small vessel disease → widespread incomplete infarction of WM
- Mixtures of 2 or more VaD subtypes
- Hemorrhagic lesions causing dementia
- Subcortical dementias due to other causes [e.g., cerebral autosomal dominant arteriopathy with subcortical infarcts & leukoencephalopathy (CADASIL)]
- Hybrid forms of AD & VaD
- ## Gross Pathologic & Surgical Features
- Multifocal infarctions with atrophy
- ## Microscopic Features
- Arteriosclerosis & amyloid angiopathy major underlying pathologies in small vessel vascular disease
- Vessels display atheromata, lipohyalinosis, subintimal thickening, fibrinoid necrosis
- Infarcted tissue undergoes necrosis → gliotic wall surrounding CSF cavity
- Myelin & axonal loss with astrocytosis
# CLINICAL ISSUES
- ## Presentation
- ### Most common signs/symptoms
- Infarcts with transient focal neurologic deficits
- Most deficits persist
- Mood & behavioral changes
- Deterioration of executive function & attention, changes in personality (rather than memory loss) predominate
- Severe depression is more common in VaD than AD
- ### Clinical profile
- Main risk factors
- Advanced age, HTN, diabetes, smoking
- Hypercholesterolemia, hypercoagulable states
- ## Demographics
- ### Age
- Generally earlier age than AD
- Incidence ↑ with age
- ### Sex
- M > F
- ### Epidemiology
- 10% of dementias
- 2nd most common dementia (after AD)
- ~ 25% of elderly stroke patients meet VaD criteria
- Cerebral small vessel disease accounted for 33% of dementia risk
- ## Natural History & Prognosis
- Poststroke dementia: Progressive, episodic, stepwise cognitive decline following stroke
- VaD without recent stroke: Progressive or stepwise cognitive decline without concurrent history of symptomatic stroke but with imaging evidence of clinically unrecognized cerebrovascular disease
- Neuropsychiatric & motor signs: VaD accompanied by neuropsychiatric signs, such as depression, abulia, apathy, & psychosis with delusions or hallucinations
- Intervals of clinical stabilization ± limited recovery
- 5-year survival with VaD ~ 50% of age-matched controls
- ## Treatment
- Prevent further vascular insult
- Control precipitating factors (e.g., HTN, diabetes)
# DIAGNOSTIC CHECKLIST
- ## Image Interpretation Pearls
- Not single entity but large group of conditions with variable clinical & imaging findings
- ## Reporting Tips
- Report strategically placed infarcts, hemorrhagic components, DWI abnormalities, pattern of cortical volume loss if present
6999ad9a-6bd9-47dd-8707-b571f32301e3
## References
# Selected References
1. [Alber J et al: White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): knowledge gaps and opportunities. Alzheimers Dement (N Y). 5:107-17, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31011621%5Bpmid%5D)
1. [Huang WQ et al: Susceptibility weighted imaging (SWI) recommended as a regular magnetic resonance diagnosis for vascular dementia to identify independent idiopathic normal pressure hydrocephalus before ventriculo-peritoneal (V-P) shunt treatment: a case study. Front Neurol. 10:262, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30984097%5Bpmid%5D)
1. [Lim J et al: Utilization of magnetic resonance imaging by comorbidity of patients with dementia. Int J Environ Res Public Health. 16(23), 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31783540%5Bpmid%5D)
1. [Mahalingam S et al: Neuroimaging in dementias. Semin Neurol. 39(2):188-99, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30925612%5Bpmid%5D)
1. [Sengupta P et al: Pattern of cognitive deficits in vascular dementia. Indian J Med Res. 149(4):503-7, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31411174%5Bpmid%5D)
1. [Smith EE et al: Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration. Alzheimers Dement (Amst). 11:191-204, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30859119%5Bpmid%5D)
1. [Shivamurthy VK et al: Brain FDG PET and the diagnosis of dementia. AJR Am J Roentgenol. 204(1):W76-85, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25539279%5Bpmid%5D)
1. [Venkat P et al: Models and mechanisms of vascular dementia. Exp Neurol. 272:97-108, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25987538%5Bpmid%5D)
1. [Villeneuve S et al: Imaging vascular disease and amyloid in the aging brain: implications for treatment. J Prev Alzheimers Dis. 2(1):64-70, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25844350%5Bpmid%5D)
1. [Yamada M: Cerebral amyloid angiopathy: emerging concepts. J Stroke. 17(1):17-30, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25692104%5Bpmid%5D)
1. [Ihara M et al: Understanding and preventing the development of post-stroke dementia. Expert Rev Neurother. 14(9):1067-77, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25105544%5Bpmid%5D)
1. [Dufouil C et al: Severe cerebral white matter hyperintensities predict severe cognitive decline in patients with cerebrovascular disease history. Stroke. 40(6):2219-21, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19390070%5Bpmid%5D)
1. [Targosz-Gajniak M et al: Cerebral white matter lesions in patients with dementia - from MCI to severe Alzheimer's disease. J Neurol Sci. 283(1-2):79-82, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19268974%5Bpmid%5D)
1. [Jellinger KA: Morphologic diagnosis of "vascular dementia" - a critical update. J Neurol Sci. 270(1-2):1-12, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18455191%5Bpmid%5D)
1. [O'Sullivan M et al: DTI MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry. 75(3):441-7, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=14966162%5Bpmid%5D)
1. [Yoshikawa T et al: Heterogeneity of cerebral blood flow in Alzheimer disease and vascular dementia. AJNR Am J Neuroradiol. 24(7):1341-7, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12917125%5Bpmid%5D)
## Images
### Selected Images
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_168_quality_85_10c7b385_20251014T204618Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_168_quality_85_cf66966e_20251014T185346Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_174_quality_85_4209a27c_20251014T193347Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_174_quality_85_6c5c380d_20251014T185333Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_174_quality_85_8f25c137_20251014T190917Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_add7af59-3e22-4ebd-bda3-585280f734e0_size_174_quality_85_a757a42b_20251014T204456Z.jpg)
*Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts <img src='img/arrows/CS.png'/>, an acute left occipital lobe infarct <img src='img/arrows/CO.png'/>, and small lacunar infarcts in the basal ganglia/thalami <img src='img/arrows/CC.png'/>.*
![Axial T2 MR in a 72-year-old man with VaD demonstrates multiple remote lacunar infarcts in bilateral deep gray nuclei <img src='img/arrows/CS.png'/> and extensive white matter (WM) hyperintensity <img src='img/arrows/CO.png'/> due to chronic WM ischemic changes. Also note prominent cortical sulci <img src='img/arrows/CC.png'/> due to cerebral atrophy.](images/app.statdx.com_image_thumbnail_2c3b6697-d2c3-4855-884a-888e30aa5d66_size_168_quality_85_85ffbff9_20251014T204618Z.jpg)
*Axial T2 MR in a 72-year-old man with VaD demonstrates multiple remote lacunar infarcts in bilateral deep gray nuclei <img src='img/arrows/CS.png'/> and extensive white matter (WM) hyperintensity <img src='img/arrows/CO.png'/> due to chronic WM ischemic changes. Also note prominent cortical sulci <img src='img/arrows/CC.png'/> due to cerebral atrophy.*
![Axial T2 MR in a 72-year-old man with VaD demonstrates multiple remote lacunar infarcts in bilateral deep gray nuclei <img src='img/arrows/CS.png'/> and extensive white matter (WM) hyperintensity <img src='img/arrows/CO.png'/> due to chronic WM ischemic changes. Also note prominent cortical sulci <img src='img/arrows/CC.png'/> due to cerebral atrophy.](images/app.statdx.com_image_thumbnail_2c3b6697-d2c3-4855-884a-888e30aa5d66_size_168_quality_85_bf7caf4c_20251014T185347Z.jpg)
*Axial T2 MR in a 72-year-old man with VaD demonstrates multiple remote lacunar infarcts in bilateral deep gray nuclei <img src='img/arrows/CS.png'/> and extensive white matter (WM) hyperintensity <img src='img/arrows/CO.png'/> due to chronic WM ischemic changes. Also note prominent cortical sulci <img src='img/arrows/CC.png'/> due to cerebral atrophy.*
![Axial FLAIR MR in an 80-year-old man with VaD demonstrates extensive confluent hyperintense signal in bilateral cerebral hemispheric WM <img src='img/arrows/CS.png'/> due to chronic ischemic changes and a remote lacunar infarct in right coronal radiata <img src='img/arrows/CO.png'/>. Note the prominent cortical sulci <img src='img/arrows/CC.png'/> due to diffuse parenchymal volume loss.](images/app.statdx.com_image_thumbnail_50d8db23-1f00-41ef-81eb-b29baab2ee48_size_168_quality_85_88ca9630_20251014T185346Z.jpg)
*Axial FLAIR MR in an 80-year-old man with VaD demonstrates extensive confluent hyperintense signal in bilateral cerebral hemispheric WM <img src='img/arrows/CS.png'/> due to chronic ischemic changes and a remote lacunar infarct in right coronal radiata <img src='img/arrows/CO.png'/>. Note the prominent cortical sulci <img src='img/arrows/CC.png'/> due to diffuse parenchymal volume loss.*
![Axial FLAIR MR in an 80-year-old man with VaD demonstrates extensive confluent hyperintense signal in bilateral cerebral hemispheric WM <img src='img/arrows/CS.png'/> due to chronic ischemic changes and a remote lacunar infarct in right coronal radiata <img src='img/arrows/CO.png'/>. Note the prominent cortical sulci <img src='img/arrows/CC.png'/> due to diffuse parenchymal volume loss.](images/app.statdx.com_image_thumbnail_50d8db23-1f00-41ef-81eb-b29baab2ee48_size_168_quality_85_b00cf1bb_20251014T204618Z.jpg)
*Axial FLAIR MR in an 80-year-old man with VaD demonstrates extensive confluent hyperintense signal in bilateral cerebral hemispheric WM <img src='img/arrows/CS.png'/> due to chronic ischemic changes and a remote lacunar infarct in right coronal radiata <img src='img/arrows/CO.png'/>. Note the prominent cortical sulci <img src='img/arrows/CC.png'/> due to diffuse parenchymal volume loss.*
![Axial SWI MR in the same patient demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> bilaterally in both central and peripheral distribution.](images/app.statdx.com_image_thumbnail_81e11be6-034c-40b9-bef8-83f032dc467b_size_168_quality_85_b0e4d64a_20251014T204618Z.jpg)
*Axial SWI MR in the same patient demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> bilaterally in both central and peripheral distribution.*
![Axial SWI MR in the same patient demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> bilaterally in both central and peripheral distribution.](images/app.statdx.com_image_thumbnail_81e11be6-034c-40b9-bef8-83f032dc467b_size_168_quality_85_de4c9676_20251014T185346Z.jpg)
*Axial SWI MR in the same patient demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> bilaterally in both central and peripheral distribution.*
![Sagittal (top row), axial (bottom left) and coronal (bottom right) reformats of FDG PET in a patient with VaD show hypometabolic areas due to remote territorial infarcts <img src='img/arrows/CS.png'/> and chronic WM ischemic changes <img src='img/arrows/CC.png'/>. (Courtesy J. Singh, MD.)](images/app.statdx.com_image_thumbnail_c0e76a06-c23c-411e-8de6-a7a89b1ec705_size_168_quality_85_b614c98f_20251014T185346Z.jpg)
*Sagittal (top row), axial (bottom left) and coronal (bottom right) reformats of FDG PET in a patient with VaD show hypometabolic areas due to remote territorial infarcts <img src='img/arrows/CS.png'/> and chronic WM ischemic changes <img src='img/arrows/CC.png'/>. (Courtesy J. Singh, MD.)*
![Sagittal (top row), axial (bottom left) and coronal (bottom right) reformats of FDG PET in a patient with VaD show hypometabolic areas due to remote territorial infarcts <img src='img/arrows/CS.png'/> and chronic WM ischemic changes <img src='img/arrows/CC.png'/>. (Courtesy J. Singh, MD.)](images/app.statdx.com_image_thumbnail_c0e76a06-c23c-411e-8de6-a7a89b1ec705_size_168_quality_85_f11890da_20251014T204618Z.jpg)
*Sagittal (top row), axial (bottom left) and coronal (bottom right) reformats of FDG PET in a patient with VaD show hypometabolic areas due to remote territorial infarcts <img src='img/arrows/CS.png'/> and chronic WM ischemic changes <img src='img/arrows/CC.png'/>. (Courtesy J. Singh, MD.)*
![Axial T2 MR through the pons in a patient with VaD demonstrates remote lacunar infarct <img src='img/arrows/CS.png'/> in pons and also associated chronic WM ischemic changes <img src='img/arrows/CC.png'/>. Note focal gliosis in the left anterior temporal lobe <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_311793cd-e68e-4182-9f9b-2826e0eefae0_size_168_quality_85_53da49ff_20251014T185346Z.jpg)
*Axial T2 MR through the pons in a patient with VaD demonstrates remote lacunar infarct <img src='img/arrows/CS.png'/> in pons and also associated chronic WM ischemic changes <img src='img/arrows/CC.png'/>. Note focal gliosis in the left anterior temporal lobe <img src='img/arrows/CO.png'/>.*
![Axial T2 MR through the pons in a patient with VaD demonstrates remote lacunar infarct <img src='img/arrows/CS.png'/> in pons and also associated chronic WM ischemic changes <img src='img/arrows/CC.png'/>. Note focal gliosis in the left anterior temporal lobe <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_311793cd-e68e-4182-9f9b-2826e0eefae0_size_168_quality_85_9e641f8a_20251014T204618Z.jpg)
*Axial T2 MR through the pons in a patient with VaD demonstrates remote lacunar infarct <img src='img/arrows/CS.png'/> in pons and also associated chronic WM ischemic changes <img src='img/arrows/CC.png'/>. Note focal gliosis in the left anterior temporal lobe <img src='img/arrows/CO.png'/>.*
![Axial FLAIR MR in a patient with VaD shows large remote infarction in the left middle cerebral artery distribution <img src='img/arrows/CS.png'/>. Note associated prominent cortical sulci <img src='img/arrows/CC.png'/> and ex vacuo dilation of left lateral ventricle <img src='img/arrows/CO.png'/> due to parenchymal atrophy.](images/app.statdx.com_image_thumbnail_60a3b75e-5670-4c57-88cd-70f31a90dd98_size_168_quality_85_00649a52_20251014T185347Z.jpg)
*Axial FLAIR MR in a patient with VaD shows large remote infarction in the left middle cerebral artery distribution <img src='img/arrows/CS.png'/>. Note associated prominent cortical sulci <img src='img/arrows/CC.png'/> and ex vacuo dilation of left lateral ventricle <img src='img/arrows/CO.png'/> due to parenchymal atrophy.*
![Axial FLAIR MR in a patient with VaD shows large remote infarction in the left middle cerebral artery distribution <img src='img/arrows/CS.png'/>. Note associated prominent cortical sulci <img src='img/arrows/CC.png'/> and ex vacuo dilation of left lateral ventricle <img src='img/arrows/CO.png'/> due to parenchymal atrophy.](images/app.statdx.com_image_thumbnail_60a3b75e-5670-4c57-88cd-70f31a90dd98_size_168_quality_85_65466ede_20251014T204618Z.jpg)
*Axial FLAIR MR in a patient with VaD shows large remote infarction in the left middle cerebral artery distribution <img src='img/arrows/CS.png'/>. Note associated prominent cortical sulci <img src='img/arrows/CC.png'/> and ex vacuo dilation of left lateral ventricle <img src='img/arrows/CO.png'/> due to parenchymal atrophy.*
![Axial SWI MR in a 73-year-old woman with VaD demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> predominantly in peripheral distribution.](images/app.statdx.com_image_thumbnail_6394f4bf-e00d-430b-8385-7f5a74321693_size_168_quality_85_086d8521_20251014T204618Z.jpg)
*Axial SWI MR in a 73-year-old woman with VaD demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> predominantly in peripheral distribution.*
![Axial SWI MR in a 73-year-old woman with VaD demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> predominantly in peripheral distribution.](images/app.statdx.com_image_thumbnail_6394f4bf-e00d-430b-8385-7f5a74321693_size_168_quality_85_cee3d790_20251014T185347Z.jpg)
*Axial SWI MR in a 73-year-old woman with VaD demonstrates multiple scattered remote microhemorrhagic foci <img src='img/arrows/CS.png'/> predominantly in peripheral distribution.*
![Axial NECT shows WM hypodensity as well as bilateral frontal and parietal evolving cortical remote infarctions <img src='img/arrows/CS.png'/>. Note the associated focal biparietal cortical atrophy <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_57158719-86a2-4c84-8df4-2682d4eca3cd_size_168_quality_85_22449822_20251014T204618Z.jpg)
*Axial NECT shows WM hypodensity as well as bilateral frontal and parietal evolving cortical remote infarctions <img src='img/arrows/CS.png'/>. Note the associated focal biparietal cortical atrophy <img src='img/arrows/CC.png'/>.*
![Axial NECT shows WM hypodensity as well as bilateral frontal and parietal evolving cortical remote infarctions <img src='img/arrows/CS.png'/>. Note the associated focal biparietal cortical atrophy <img src='img/arrows/CC.png'/>.](images/app.statdx.com_image_thumbnail_57158719-86a2-4c84-8df4-2682d4eca3cd_size_168_quality_85_5d0dba89_20251014T185346Z.jpg)
*Axial NECT shows WM hypodensity as well as bilateral frontal and parietal evolving cortical remote infarctions <img src='img/arrows/CS.png'/>. Note the associated focal biparietal cortical atrophy <img src='img/arrows/CC.png'/>.*
![Axial FDG PET in a patient with multiinfarct dementia demonstrates multiple wedge-shaped areas of hypometabolism <img src='img/arrows/CC.png'/> due to chronic infarcts. (Courtesy A. Ali, MD.)](images/app.statdx.com_image_thumbnail_881ca45a-cfdc-4825-891c-1537de42caf9_size_168_quality_85_64fcd2cc_20251014T204618Z.jpg)
*Axial FDG PET in a patient with multiinfarct dementia demonstrates multiple wedge-shaped areas of hypometabolism <img src='img/arrows/CC.png'/> due to chronic infarcts. (Courtesy A. Ali, MD.)*
![Axial FDG PET in a patient with multiinfarct dementia demonstrates multiple wedge-shaped areas of hypometabolism <img src='img/arrows/CC.png'/> due to chronic infarcts. (Courtesy A. Ali, MD.)](images/app.statdx.com_image_thumbnail_881ca45a-cfdc-4825-891c-1537de42caf9_size_168_quality_85_f4803349_20251014T185346Z.jpg)
*Axial FDG PET in a patient with multiinfarct dementia demonstrates multiple wedge-shaped areas of hypometabolism <img src='img/arrows/CC.png'/> due to chronic infarcts. (Courtesy A. Ali, MD.)*
### Additional Images
![Sagittal T1WI MR demonstrates frontal cortical thinning with white matter hypointensity <img src='img/arrows/WS.png'/> from infarction. Also note the separate focus of white matter abnormality <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_752c31dc-e7da-400b-be70-457d5715e119_size_168_quality_85_6556d737_20251014T204618Z.jpg)
*Sagittal T1WI MR demonstrates frontal cortical thinning with white matter hypointensity <img src='img/arrows/WS.png'/> from infarction. Also note the separate focus of white matter abnormality <img src='img/arrows/WO.png'/>.*
![Sagittal T1WI MR demonstrates frontal cortical thinning with white matter hypointensity <img src='img/arrows/WS.png'/> from infarction. Also note the separate focus of white matter abnormality <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_752c31dc-e7da-400b-be70-457d5715e119_size_168_quality_85_9e3fdcf6_20251014T185346Z.jpg)
*Sagittal T1WI MR demonstrates frontal cortical thinning with white matter hypointensity <img src='img/arrows/WS.png'/> from infarction. Also note the separate focus of white matter abnormality <img src='img/arrows/WO.png'/>.*
![Axial FLAIR MR shows diffuse, confluent white matter hyperintensity in a patient with vascular dementia.](images/app.statdx.com_image_thumbnail_0037b7cd-dee9-48dc-acad-ad09047d8bed_size_168_quality_85_55014c1e_20251014T185346Z.jpg)
*Axial FLAIR MR shows diffuse, confluent white matter hyperintensity in a patient with vascular dementia.*
![Axial FLAIR MR shows diffuse, confluent white matter hyperintensity in a patient with vascular dementia.](images/app.statdx.com_image_thumbnail_0037b7cd-dee9-48dc-acad-ad09047d8bed_size_168_quality_85_8bc979ce_20251014T204618Z.jpg)
*Axial FLAIR MR shows diffuse, confluent white matter hyperintensity in a patient with vascular dementia.*
![Axial T2WI MR reveals bilateral thalamic lacunar infarctions <img src='img/arrows/BS.png'/>, as well as confluent periventricular white matter hyperintensity. Note the ventricular enlargement from associated atrophy.](images/app.statdx.com_image_thumbnail_bff764f5-0005-4505-bdc2-4de221b9740b_size_168_quality_85_10eb5cdf_20251014T204618Z.jpg)
*Axial T2WI MR reveals bilateral thalamic lacunar infarctions <img src='img/arrows/BS.png'/>, as well as confluent periventricular white matter hyperintensity. Note the ventricular enlargement from associated atrophy.*
![Axial T2WI MR reveals bilateral thalamic lacunar infarctions <img src='img/arrows/BS.png'/>, as well as confluent periventricular white matter hyperintensity. Note the ventricular enlargement from associated atrophy.](images/app.statdx.com_image_thumbnail_bff764f5-0005-4505-bdc2-4de221b9740b_size_168_quality_85_7e7a20f2_20251014T185346Z.jpg)
*Axial T2WI MR reveals bilateral thalamic lacunar infarctions <img src='img/arrows/BS.png'/>, as well as confluent periventricular white matter hyperintensity. Note the ventricular enlargement from associated atrophy.*
![Axial FLAIR MR demonstrates only mild white matter hyperintensity, as well as a very small cortical/subcortical infarct <img src='img/arrows/WS.png'/> in a patient with vascular dementia.](images/app.statdx.com_image_thumbnail_5865b573-9ca1-4dd6-a94b-4dfdb28ab76f_size_168_quality_85_0c5cafca_20251014T204618Z.jpg)
*Axial FLAIR MR demonstrates only mild white matter hyperintensity, as well as a very small cortical/subcortical infarct <img src='img/arrows/WS.png'/> in a patient with vascular dementia.*
![Axial FLAIR MR demonstrates only mild white matter hyperintensity, as well as a very small cortical/subcortical infarct <img src='img/arrows/WS.png'/> in a patient with vascular dementia.](images/app.statdx.com_image_thumbnail_5865b573-9ca1-4dd6-a94b-4dfdb28ab76f_size_168_quality_85_e3e7be62_20251014T185346Z.jpg)
*Axial FLAIR MR demonstrates only mild white matter hyperintensity, as well as a very small cortical/subcortical infarct <img src='img/arrows/WS.png'/> in a patient with vascular dementia.*
![Axial FLAIR MR in the same patient shows changes of late acute/early subacute infarction in the right hemisphere <img src='img/arrows/WS.png'/>, old focal cortical infarcts in the left hemisphere <img src='img/arrows/WC.png'/>, and diffuse confluent white matter disease <img src='img/arrows/WO.png'/> (arteriolosclerosis).](images/app.statdx.com_image_thumbnail_dfb45971-adaf-4592-9a3a-b4593447a816_size_168_quality_85_7626aa94_20251014T185347Z.jpg)
*Axial FLAIR MR in the same patient shows changes of late acute/early subacute infarction in the right hemisphere <img src='img/arrows/WS.png'/>, old focal cortical infarcts in the left hemisphere <img src='img/arrows/WC.png'/>, and diffuse confluent white matter disease <img src='img/arrows/WO.png'/> (arteriolosclerosis).*
![Axial FLAIR MR in the same patient shows changes of late acute/early subacute infarction in the right hemisphere <img src='img/arrows/WS.png'/>, old focal cortical infarcts in the left hemisphere <img src='img/arrows/WC.png'/>, and diffuse confluent white matter disease <img src='img/arrows/WO.png'/> (arteriolosclerosis).](images/app.statdx.com_image_thumbnail_dfb45971-adaf-4592-9a3a-b4593447a816_size_168_quality_85_e46dbbd9_20251014T204618Z.jpg)
*Axial FLAIR MR in the same patient shows changes of late acute/early subacute infarction in the right hemisphere <img src='img/arrows/WS.png'/>, old focal cortical infarcts in the left hemisphere <img src='img/arrows/WC.png'/>, and diffuse confluent white matter disease <img src='img/arrows/WO.png'/> (arteriolosclerosis).*
![Axial NECT in a patient with multi-infarct dementia and a history of numerous strokes shows diffuse atrophy with multiple old focal cortical infarcts <img src='img/arrows/WS.png'/> and confluent periventricular white matter hypodensities <img src='img/arrows/WO.png'/>, consistent with arteriolosclerosis and lipohyalinosis.](images/app.statdx.com_image_thumbnail_e5cc03d5-d635-4a94-9520-b90c3c9d99ba_size_168_quality_85_39619cb4_20251014T204618Z.jpg)
*Axial NECT in a patient with multi-infarct dementia and a history of numerous strokes shows diffuse atrophy with multiple old focal cortical infarcts <img src='img/arrows/WS.png'/> and confluent periventricular white matter hypodensities <img src='img/arrows/WO.png'/>, consistent with arteriolosclerosis and lipohyalinosis.*
![Axial NECT in a patient with multi-infarct dementia and a history of numerous strokes shows diffuse atrophy with multiple old focal cortical infarcts <img src='img/arrows/WS.png'/> and confluent periventricular white matter hypodensities <img src='img/arrows/WO.png'/>, consistent with arteriolosclerosis and lipohyalinosis.](images/app.statdx.com_image_thumbnail_e5cc03d5-d635-4a94-9520-b90c3c9d99ba_size_168_quality_85_ac4c4cb1_20251014T185346Z.jpg)
*Axial NECT in a patient with multi-infarct dementia and a history of numerous strokes shows diffuse atrophy with multiple old focal cortical infarcts <img src='img/arrows/WS.png'/> and confluent periventricular white matter hypodensities <img src='img/arrows/WO.png'/>, consistent with arteriolosclerosis and lipohyalinosis.*
![Axial T2WI MR in an 82-year-old woman with clinical vascular dementia shows age-appropriate sulcal prominence, enlarged ventricles, and a focal right parietal lacunar infarct <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_02090a1b-f70b-4982-a0c5-5f28e46813bd_size_168_quality_85_0ce2f6a9_20251014T185346Z.jpg)
*Axial T2WI MR in an 82-year-old woman with clinical vascular dementia shows age-appropriate sulcal prominence, enlarged ventricles, and a focal right parietal lacunar infarct <img src='img/arrows/WS.png'/>.*
![Axial T2WI MR in an 82-year-old woman with clinical vascular dementia shows age-appropriate sulcal prominence, enlarged ventricles, and a focal right parietal lacunar infarct <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_02090a1b-f70b-4982-a0c5-5f28e46813bd_size_168_quality_85_c5738e15_20251014T204618Z.jpg)
*Axial T2WI MR in an 82-year-old woman with clinical vascular dementia shows age-appropriate sulcal prominence, enlarged ventricles, and a focal right parietal lacunar infarct <img src='img/arrows/WS.png'/>.*
![Axial FLAIR MR in the same patient shows another lacunar infarct in the right deep hemispheric white matter <img src='img/arrows/BS.png'/>. A few scattered white matter hyperintensities are present <img src='img/arrows/WS.png'/> but within normal limits for the patient's age. MR images do not explain fully the extent of the patient's cognitive impairment.](images/app.statdx.com_image_thumbnail_169a5f97-4f4d-448f-92f8-9d8dff55ce58_size_168_quality_85_437e1a25_20251014T185347Z.jpg)
*Axial FLAIR MR in the same patient shows another lacunar infarct in the right deep hemispheric white matter <img src='img/arrows/BS.png'/>. A few scattered white matter hyperintensities are present <img src='img/arrows/WS.png'/> but within normal limits for the patient's age. MR images do not explain fully the extent of the patient's cognitive impairment.*
![Axial FLAIR MR in the same patient shows another lacunar infarct in the right deep hemispheric white matter <img src='img/arrows/BS.png'/>. A few scattered white matter hyperintensities are present <img src='img/arrows/WS.png'/> but within normal limits for the patient's age. MR images do not explain fully the extent of the patient's cognitive impairment.](images/app.statdx.com_image_thumbnail_169a5f97-4f4d-448f-92f8-9d8dff55ce58_size_168_quality_85_a22c4b2f_20251014T204618Z.jpg)
*Axial FLAIR MR in the same patient shows another lacunar infarct in the right deep hemispheric white matter <img src='img/arrows/BS.png'/>. A few scattered white matter hyperintensities are present <img src='img/arrows/WS.png'/> but within normal limits for the patient's age. MR images do not explain fully the extent of the patient's cognitive impairment.*
![PET scan in the same patient was performed. Stereotaxic surface projections show normal glucose metabolism in age-matched controls (2nd row). The patient's scan (3rd row) shows multifocal cortical areas of decreased glucose metabolism. Z-scores are shown on the bottom row. (Courtesy N. Foster, MD.)](images/app.statdx.com_image_thumbnail_101e6924-c1ad-4147-8a1c-451187d37e27_size_168_quality_85_602f803d_20251014T204618Z.jpg)
*PET scan in the same patient was performed. Stereotaxic surface projections show normal glucose metabolism in age-matched controls (2nd row). The patient's scan (3rd row) shows multifocal cortical areas of decreased glucose metabolism. Z-scores are shown on the bottom row. (Courtesy N. Foster, MD.)*
![PET scan in the same patient was performed. Stereotaxic surface projections show normal glucose metabolism in age-matched controls (2nd row). The patient's scan (3rd row) shows multifocal cortical areas of decreased glucose metabolism. Z-scores are shown on the bottom row. (Courtesy N. Foster, MD.)](images/app.statdx.com_image_thumbnail_101e6924-c1ad-4147-8a1c-451187d37e27_size_168_quality_85_c5a3ce63_20251014T185346Z.jpg)
*PET scan in the same patient was performed. Stereotaxic surface projections show normal glucose metabolism in age-matched controls (2nd row). The patient's scan (3rd row) shows multifocal cortical areas of decreased glucose metabolism. Z-scores are shown on the bottom row. (Courtesy N. Foster, MD.)*
![Axial FLAIR MR in a patient with vascular dementia shows confluent periventricular white matter hyperintensities <img src='img/arrows/CC.png'/> with volume loss.](images/app.statdx.com_image_thumbnail_f71ee720-633b-41b3-aa14-32309cc29827_size_168_quality_85_8f0cf6f4_20251014T204618Z.jpg)
*Axial FLAIR MR in a patient with vascular dementia shows confluent periventricular white matter hyperintensities <img src='img/arrows/CC.png'/> with volume loss.*
![Axial FLAIR MR in a patient with vascular dementia shows confluent periventricular white matter hyperintensities <img src='img/arrows/CC.png'/> with volume loss.](images/app.statdx.com_image_thumbnail_f71ee720-633b-41b3-aa14-32309cc29827_size_168_quality_85_c4f3f2c5_20251014T185346Z.jpg)
*Axial FLAIR MR in a patient with vascular dementia shows confluent periventricular white matter hyperintensities <img src='img/arrows/CC.png'/> with volume loss.*
![Axial SWI in the same patient shows multiple &quot;blooming&quot; hypointense foci due to remote microhemorrhages in the basal ganglia <img src='img/arrows/CS.png'/>, thalami <img src='img/arrows/CO.png'/>, and cerebral cortex <img src='img/arrows/CC.png'/>. This patient had long-standing uncontrolled hypertension and the distribution of the microhemorrhages predominantly in the deep gray nuclei supports that.](images/app.statdx.com_image_thumbnail_824e9cc0-778c-4363-a555-e40706315897_size_168_quality_85_7150ab9c_20251014T204618Z.jpg)
*Axial SWI in the same patient shows multiple &quot;blooming&quot; hypointense foci due to remote microhemorrhages in the basal ganglia <img src='img/arrows/CS.png'/>, thalami <img src='img/arrows/CO.png'/>, and cerebral cortex <img src='img/arrows/CC.png'/>. This patient had long-standing uncontrolled hypertension and the distribution of the microhemorrhages predominantly in the deep gray nuclei supports that.*
![Axial SWI in the same patient shows multiple &quot;blooming&quot; hypointense foci due to remote microhemorrhages in the basal ganglia <img src='img/arrows/CS.png'/>, thalami <img src='img/arrows/CO.png'/>, and cerebral cortex <img src='img/arrows/CC.png'/>. This patient had long-standing uncontrolled hypertension and the distribution of the microhemorrhages predominantly in the deep gray nuclei supports that.](images/app.statdx.com_image_thumbnail_824e9cc0-778c-4363-a555-e40706315897_size_168_quality_85_aef04cd6_20251014T185346Z.jpg)
*Axial SWI in the same patient shows multiple &quot;blooming&quot; hypointense foci due to remote microhemorrhages in the basal ganglia <img src='img/arrows/CS.png'/>, thalami <img src='img/arrows/CO.png'/>, and cerebral cortex <img src='img/arrows/CC.png'/>. This patient had long-standing uncontrolled hypertension and the distribution of the microhemorrhages predominantly in the deep gray nuclei supports that.*
![Axial NECT in a 81-year-old woman with multi-infarct dementia shows cystic encephalomalacia in the right parietal lobe <img src='img/arrows/CC.png'/> due to an old infarct. There is marked volume loss with ventricular enlargement. There are confluent white matter hypodensities <img src='img/arrows/CS.png'/> consistent with arteriolosclerosis and lipohyalinosis.](images/app.statdx.com_image_thumbnail_9986a3dc-fbd7-4d67-813c-20e46b6299f0_size_168_quality_85_3cdb7fb6_20251014T185346Z.jpg)
*Axial NECT in a 81-year-old woman with multi-infarct dementia shows cystic encephalomalacia in the right parietal lobe <img src='img/arrows/CC.png'/> due to an old infarct. There is marked volume loss with ventricular enlargement. There are confluent white matter hypodensities <img src='img/arrows/CS.png'/> consistent with arteriolosclerosis and lipohyalinosis.*
![Axial NECT in a 81-year-old woman with multi-infarct dementia shows cystic encephalomalacia in the right parietal lobe <img src='img/arrows/CC.png'/> due to an old infarct. There is marked volume loss with ventricular enlargement. There are confluent white matter hypodensities <img src='img/arrows/CS.png'/> consistent with arteriolosclerosis and lipohyalinosis.](images/app.statdx.com_image_thumbnail_9986a3dc-fbd7-4d67-813c-20e46b6299f0_size_168_quality_85_89a58246_20251014T204618Z.jpg)
*Axial NECT in a 81-year-old woman with multi-infarct dementia shows cystic encephalomalacia in the right parietal lobe <img src='img/arrows/CC.png'/> due to an old infarct. There is marked volume loss with ventricular enlargement. There are confluent white matter hypodensities <img src='img/arrows/CS.png'/> consistent with arteriolosclerosis and lipohyalinosis.*
![Axial FLAIR MR in a 72-year-old man with chronic hypertension and diabetes presenting with mood and behavioral changes shows confluent white matter hyperintensities <img src='img/arrows/CC.png'/> in the periventricular regions. Note the multiple chronic lacunar infarcts in the basal ganglia <img src='img/arrows/CS.png'/> as well as enlargement of the ventricles and cortical sulci.](images/app.statdx.com_image_thumbnail_76df02d9-4377-43f5-ab94-37ac9a94299b_size_168_quality_85_526d1d7d_20251014T185347Z.jpg)
*Axial FLAIR MR in a 72-year-old man with chronic hypertension and diabetes presenting with mood and behavioral changes shows confluent white matter hyperintensities <img src='img/arrows/CC.png'/> in the periventricular regions. Note the multiple chronic lacunar infarcts in the basal ganglia <img src='img/arrows/CS.png'/> as well as enlargement of the ventricles and cortical sulci.*
![Axial FLAIR MR in a 72-year-old man with chronic hypertension and diabetes presenting with mood and behavioral changes shows confluent white matter hyperintensities <img src='img/arrows/CC.png'/> in the periventricular regions. Note the multiple chronic lacunar infarcts in the basal ganglia <img src='img/arrows/CS.png'/> as well as enlargement of the ventricles and cortical sulci.](images/app.statdx.com_image_thumbnail_76df02d9-4377-43f5-ab94-37ac9a94299b_size_168_quality_85_d1174d73_20251014T204618Z.jpg)
*Axial FLAIR MR in a 72-year-old man with chronic hypertension and diabetes presenting with mood and behavioral changes shows confluent white matter hyperintensities <img src='img/arrows/CC.png'/> in the periventricular regions. Note the multiple chronic lacunar infarcts in the basal ganglia <img src='img/arrows/CS.png'/> as well as enlargement of the ventricles and cortical sulci.*
![Axial FLAIR MR shows multiple subcortical hyperintensities <img src='img/arrows/CS.png'/> in a 76-year-old normotensive man with clinical diagnosis of vascular dementia. No focal infarcts are seen.](images/app.statdx.com_image_thumbnail_af172ede-fc9e-4e51-afc1-b46ff28dfaa8_size_168_quality_85_4230ab7f_20251014T204618Z.jpg)
*Axial FLAIR MR shows multiple subcortical hyperintensities <img src='img/arrows/CS.png'/> in a 76-year-old normotensive man with clinical diagnosis of vascular dementia. No focal infarcts are seen.*
![Axial FLAIR MR shows multiple subcortical hyperintensities <img src='img/arrows/CS.png'/> in a 76-year-old normotensive man with clinical diagnosis of vascular dementia. No focal infarcts are seen.](images/app.statdx.com_image_thumbnail_af172ede-fc9e-4e51-afc1-b46ff28dfaa8_size_168_quality_85_d17ad18b_20251014T185346Z.jpg)
*Axial FLAIR MR shows multiple subcortical hyperintensities <img src='img/arrows/CS.png'/> in a 76-year-old normotensive man with clinical diagnosis of vascular dementia. No focal infarcts are seen.*
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