stroke, with cognitive decline temporally assoc iated with the event, or physical signs con-
sistent with stroke (e.g., hemi paresis; pseudobulbar syndrome , visual field defect). Neuro-
imaging (magnetic resonance imaging [MRI] or computed tomography [CT]) evidence of
cerebrovascular disease comprises one or more of the following: one or more large vessel
infarcts or hemorrhages, a strategically placed  single infarct or hemorrhage (e.g., in angu-
lar gyrus, thalamus, basal forebrain), two or mo re lacunar infarcts outside the brain stem,
or extensive and confluent white matter lesions. The latter is often termed small vessel dis-
ease or subcortical ischemic changes  on clinical neuroimaging evaluations.
For mild vascular NCD, history of a single stroke or extensive white matter disease is gen-
erally sufficient. For major vascular NCD, two or more strokes, a strate gically placed stroke,
or a combination of white matter disease and one or more lacunes is  generally necessary.
The disorder must not be better explained by another disorder. For example, promi-
nent memory deficit early in the course mi ght suggest Alzheimer' s disease, early and
prominent parkinsonian features would suggest Parkinson's disease, and a close associa-
tion between onset and depression would suggest depression.
Associated Features Supporting Diagnosis
A neurological assessmen t often reveals history of stroke  and/or transient ischemic epi-
sodes, and signs indicative of brain infarctions. Also commonly associated are personality
and mood changes, abulia, depression, and emotional lability. The development of late-
onset depressive symptoms accompanied by psychomotor slowing and executive dys-