Affiliations: Department of Psychology, Section of Brain Maturation,
Institute of Psychiatry, King's College London, London, UK | Department of Clinical and Health Psychology,
University of Florida, Gainesville, FL, USA | Department of Psychology, Temple University,
Philadelphia, PA, USA | Department of Neuroscience, University of North Dakota
Medical School, Fargo, ND, USA | Department of Neurology, Drexel University,
Philadelphia, PA, USA
Note: [] Corresponding author: Dr. Melissa Lamar, Institute of
Psychiatry, King's College London, M6.01, P050, De Crespigny Park, London, SE5
8AF UK. Tel.: +44 (0)207 1880183; Fax: +44 (0)207 1880184; E-mail: m.lamar@iop.kcl.ac.uk
Abstract: The introduction of diagnostic criteria for vascular dementia has
helped to re-define the impact of various subcortical neuropathologies on
aging; however, state-of-the-art neuroimaging techniques and autopsy studies
suggest that not all structural brain alterations associated with vascular
dementia are exclusive to this neurodegenerative process alone. Thus, a
detailed analysis of the cognitive phenotype associated with ischaemic vascular
disease is key to our understanding of subcortical neuropathology and its
associated behaviors. Over the past twenty years, we have operationally defined
this cognitive phenotype using the Boston Process Approach to
neuropsychological assessment. This has led to both an empirical, as well as a
theoretical understanding of three core constructs related to the dysexecutive
syndrome associated with ischaemic vascular disease affecting periventricular
and deep white matter as well as subcortical structures connecting these
regions with the prefrontal cortex. Thus, difficulties with mental set,
cognitive control and mental manipulation negatively impact executive
functioning. This review will outline the subtle markers underlying this
prefrontal dysfunction, i.e., the dysexecutive phenotype, associated with
ischaemic vascular disease and relate it to fundamental impairments of gating
subserved by basal ganglia-thalamic pathways within and across various dementia
syndromes.
Keywords: Ischaemic vascular disease, white matter, dementia, aging, executive functioning
