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From the Cognitive Neurology and Alzheimer’s Disease Center and the Departments of Neurology and Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL.
Address correspondence and reprint requests to Dr. M. Mesulam, 320 E. Superior St., Chicago, IL 60611; e-mail: mmesulam{at}northwestern.edu
Circumstantial evidence suggests that vascular dementia (VaD) may be associated with cholinergic denervation. The specificity of this association has been difficult to assess because many of the patients are elderly and have the additional cholinergic lesions of aging and AD. A patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) who died at age 36 showed that pure white matter infarcts, similar to those seen in VaD, can cause cortical cholinergic denervation, but in patterns that vary from those seen in AD.
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