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.

中文翻译：

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与缺血性血管疾病和相关皮质下神经病理学相关的执行障碍综合征：波士顿过程方法。

血管性痴呆诊断标准的引入有助于重新定义各种皮层下神经病变对衰老的影响；然而，最先进的神经影像技术和尸检研究表明，并非所有与血管性痴呆相关的大脑结构改变都与这种神经退行性过程有关。因此，详细分析与缺血性血管疾病相关的认知表型是我们理解皮层下神经病理学及其相关行为的关键。在过去的二十年里，我们使用波士顿过程方法进行神经心理学评估，在操作上定义了这种认知表型。这导致了两个经验性的，以及对与影响脑室周围和深部白质以及连接这些区域与前额叶皮层的皮层下结构的缺血性血管疾病相关的执行不良综合征相关的三个核心结构的理论理解。因此，心理设置、认知控制和心理操纵方面的困难会对执行功能产生负面影响。本综述将概述这种前额叶功能障碍背后的微妙标志，即与缺血性血管疾病相关的执行不良表型，并将其与各种痴呆综合征内和跨各种痴呆综合征的基底神经节-丘脑通路所支持的门控的基本损伤相关联。思维定势、认知控制和心理操纵的困难会对执行功能产生负面影响。本综述将概述这种前额叶功能障碍背后的微妙标志，即与缺血性血管疾病相关的执行不良表型，并将其与各种痴呆综合征内和跨各种痴呆综合征的基底神经节-丘脑通路所支持的门控的基本损伤相关联。思维定势、认知控制和心理操纵的困难会对执行功能产生负面影响。本综述将概述这种前额叶功能障碍背后的微妙标志，即与缺血性血管疾病相关的执行不良表型，并将其与各种痴呆综合征内和跨各种痴呆综合征的基底神经节-丘脑通路所支持的门控的基本损伤相关联。