There has been a recent upsurge of interest in the clinical features of and risk factors for vascular dementia, and consensus is emerging on its diagnostic characteristics. We discuss these features and risk factors and the main intervention strategies, both for treatment and prevention.

Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.

To the Editor: Pradhan et al. 1 report five cases of Japanese encephalitis (JE) with typical parkinsonian features. Of 52 patients with JE, five were selected based on isolated lesions in the substantia nigra on MRI. We also reported a rat model of PD 2 induced by the JE virus, which revealed bradykinesia and predominant involvement of substantia nigra as the major pathologic changes. This parkinsonism model is made in rats infected with JE virus at 13 days after birth. We demonstrated that the susceptibility of the rat brain to JE virus infection was dependent on the age of animals at the time of infection, and this appeared to be related to the level of neuronal maturity in our other in vivo 3 and in vitro 4 study. The age at the JE infection of five cases with parkinsonian features reported by Pradhan et al., is between 7 and 16 years, and the average age is 12 years. The report that only patients infected with JE virus at the limited younger age manifest typical parkinsonism correlates with our parkinsonian model feature. These clinical findings are compatible with those of experimental models. We hope Pradhan et al. will examine whether the patients with parkinsonism at such young ages in India are infected with JE virus. Currently, we are investigating new antiparkinsonian treatments using this model. 5

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