Knopman reported the Index of Cerebrovascular Disease (CVD) to help identify a patient with vascular dementia. Cerebrovascular disease is a heterogenous disorder that can produce any pattern of cognitive deficits and evolve in complex ways. The author is from the Mayo Clinic.



(1) history of stroke

(2) number of focal signs

(3) white matter hyperintensities on imaging studies

(4) lacunae on imaging studies

(5) cortical infarcts

(6) involvement of critical regions


Low Risk

Moderate Risk

High Risk

history of stroke


any stroke above midbrain with no apparent impact on cognition

stroke temporally related to onset or worsening of impaired cognition

focal signs suggestive of CVD

0 or 1

2 or 3

>= 4

white matter hyperintensity

none or minimal

mild to moderate



0 or 1

2 or 3

>= 4

cortical infarcts

none or 1 small one

single large

multiple large

involvement of critical regions


lacunae or small infarcts in a critical region

larger infarcts in hippocampus, caudate, and/or thalamus



• Focal signs may include an asymmetrical reflex or an unexplained extensor toe sign.



• The presence of multiple high risk features favors vascular dementia.

• The presence of multiple low risk features suggests another cause for any cognitive impairment.


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