Neuropsychiatric disturbances along the continuum of cognitive disturbances in ischaemic cerebrovascular disease are reviewed and their neuroanatomic correspondences are explored. Depression, apathy, disinhibition, and delusions are common in ischaemic, cerebrovascular disease. Delirium, hallucinations, confabulations, akinesia, pathological affect, anxiety, and catastrophic reaction are less common, while manic syndromes appear rarely. Many of these neuropsychiatric syndromes remain poorly delineated. The presence of neuropsychiatric disturbance may not be correlated with the degree of cognitive disturbance. The implications of this finding for the concept of dementia are explored. The authors conclude that neuropsychiatric disturbances should be considered essential features of dementia.