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Vascular dementia (VD) or multi-infarct dementia (MID) involves the presence of multiple ischemic brain lesions, without other changes known to cause dementia. The onset of cognitive symptoms may be abrupt, coincident with the vascular injury. There is stepwise deterioration of cognitive symptoms as ischemic events recur. Usually, there are accompanying focal neurologic signs or symptoms, depending on the location of the lesions. Infarcts occur in the cortical or subcortical areas of the brain, and may be large or small. Symptoms depend on the location and extent of the lesions. CT or MRI scans may confirm findings. The clinical history is usually significant for vascular disorders such as heart disease, myocardial infarction, hypertension, atrial fibrillation, claudication, or cerebrovascular disease.