Small vessel diseases of the brain -: Is there any chance to treat?

One third of the cerebrovascular diseases is caused by small vessel disease. Behind the leading clinical symptoms such as focal deficits and subcortical dementia complex serious histopathological changes can be found. Lipohyalinosis and less frequently amyloidosis of the arterioles was recognised as vascular factor of the lacunar infarcts and white matter degeneration (leukoaraiosis, LA). In most cases of vascular dementia (VaD) mental symptoms appear as a composite of various particular deficits which can be derived from focal and diffuse lesion of the brain parenchyma. Several questions are unsolved in VaD: specificity of diagnostic criteria, pathomechanism of white matter disease, relationship between vascular and Alzheimer pathology, clinical relevance of silent infarcts leading to VaD. Due to the multicausal character of VaD the therapeutic implications are not yet elaborated.