When atrophy is seen on imaging in adult patients, it does not necessarily represent Alzheimer disease. Many cases of dementia or cognitive decline could be caused by reversible or preventable diseases, such as vascular dementia. This article familiarizes the physician with various types of vascular lesions leading to dementia and cognitive decline and their imaging appearances. Neuroimaging plays an important role in identifying vascular lesions of the brain early, even before the clinical manifestation of the cognitive decline symptoms and, thus, can help to prevent or delay the symptoms related to the various vascular pathologic conditions.
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