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Objective To survey causes of dementia were confirmed by autopsy among the elderly and to improve physicians recognizing various causes of senile dementia.Method A retrospective study on clinical and pathological diagnosis was carried out in 383 cases aged 60 and over which had been completed consecutive autopsy in 1981-2002.Clinical diagnosis of dementia based on the DSM-Ⅳ, NINCDS-ADRDA, NINCDS-AIREN criteria.In pathological diagnosis of neurodegenerative dementia, Gallyas-Braak staining, Tau and Ubiquitin Immunohistochemistry staining were adopted for distinguishing various degenerative diseases besides routine neuropathological methods.Result Among 383 old cases with consecutive autopsy,78 cases were found to have clinical features and brain pathologic change related to dementia.Incidence of dementia in the old patients with autopsy was 20.4%.Of all these eases, vascular dementia accounted for 38.4% (30 cases), and was primary cause; next were degenerative dementias including Alzheimers disease (Fig2) (11 cases) and non-Alzheimers degenerative dementia (9cases) including dementia with lewy bodies, corticobasal degeneration, progressive supranuclear palsy (Fig 3、 4、 5), Picks disease (Fig6、 7、 8) and idiopathic Parkinson disease, they all accounted for 25.3% (20 cases).Various medical disorders including hepatic encephalopathy, pulmonary encephalopathy, hypoglycemia causing recognitive impairement were also relatively common, they accounted for 20.7%(16 cases).The other less common causes included brain tumor, normal pressur hydrocephalus and subdural hematoma.Total agreement rate of clinical and pathologic diagnosis of senile dementia was 64.5%, the agreement rates of medical disorders such as hepatic encephalopathy, pulmonary encephalopathy and brain metastatic tumors all were 100%, the agreement rate of vascular dementia and degenerative dementia was 66.7% and 40% respectively.Conclusion Senile dementia is a clinical syndrome caused by multiple factors.Physician should think differential diagnosis of various probable causes of dementia, basing on clinical history and laboratory results of patient.Promoting autopsy and adopting new pathological techniques would increase the accuracy of degenerative dementia.