Effects of White Matter Lesions and Lacunes on Cortical Function

Abstract
Current conceptual models of ischemic vascular dementia (IVD) derive from the concept of multi-infarct dementia1 and emphasize the role of lacunes and cortical strokes. There is little controversy about the idea that cortical stroke may cause dementia. However, in the absence of frank cortical lesions, the pathogenesis of cognitive failure in cerebrovascular disease (CVD) is less clear.2 Relationships of diffuse white matter changes and lacunes to cortical dysfunction are not well defined. Case studies have correlated cognitive impairment with the presence3 or emergence4 of lacunes, particularly in “strategic” locations3 such as head of the caudate5 or thalamus.6,7