Neurological Manifestations of Vascular Dementia Clinical Presentation
- Author: Jasvinder Chawla, MD, MBA; Chief Editor: Niranjan N Singh, MD, DM more...
Criteria for the diagnosis of dementia require impairment in memory and at least 1 other cognitive domain (eg, orientation, language, praxis, executive functions, visuospatial abilities). These should be serious enough to affect activities of daily living and be consistently present to distinguish dementia from episodic impairments of consciousness such as delirium.
Currently, several sets of diagnostic criteria for vascular dementia exist. This list summarizes the main common criteria.
Vascular risk factors such as hypertension, coronary disease, and diabetes mellitus 
Specific evidence of cerebrovascular disease, eg, strokes and transient ischemic attacks: The cerebrovascular insult should precede (by no more than 3 months) or coincide with the onset or worsening of cognitive abnormalities.
Neuroimaging evidence of strokes
Lateralizing neurologic signs
Psychiatric disturbances (eg, emotional lability, depression, apathy)
Depression is a common comorbidity in patients with cerebrovascular disease and vascular dementia.
Medications should be reviewed because of the potential of drugs to interfere with alertness and cognition.
Differences between the cognitive disturbances in vascular dementia and Alzheimer disease are of limited value in discriminating vascular dementia from Alzheimer disease in a clinical setting.
Vascular dementia is thought to be associated with less significant memory dysfunction than Alzheimer disease. 
Frontal dysfunction due to widespread involvement of subcortical structures in vascular dementia is thought to lead to a dysexecutive syndrome with abulia and apathy.
A cognitively impaired patient with vascular risks factors but no history of cerebrovascular disease is most likely to have Alzheimer disease. Patients with dementia and vascular disease frequently have mixed pathology (ie, both Alzheimer disease and vascular dementia).
The physical examination should be focused on the cardiovascular system and neurologic localizing signs.
The temporal arteries may show decreased pulsatility, local tenderness, and thickening associated with giant cell arteritis. 
Funduscopic examination provides important information regarding end-organ effects of hypertension and diabetes mellitus.
Cardiac auscultation may detect rhythmic and valvular abnormalities.
Low scores on a standardized instrument (eg, Mini Mental Status Examination, Short Blessed questionnaire) can provide corroborating evidence of a cognitive disturbance.
Spasticity, hemiparesis, visual field defects, pseudobulbar palsy, and extrapyramidal signs confirm focal pathology.
Vascular dementia and cerebrovascular disease share risk factors, including age, male sex, diabetes mellitus, hypertension, cardiomyopathy, and possibly homocysteine levels.
So far, no relationship between cholesterol, serum lipoproteins, and the risk of vascular dementia is clearly indicated.
Evidence for tobacco consumption as a risk factor for vascular dementia is conflicting. However, a multiethnic, population-based study published in 2010 suggested that the brain is not immune to long-term consequences of heavy smoking. In fact, 21,123 heavy midlife smokers were followed for a mean of 23 years and were found more than 2 decades later to have a greater than 100% increased risk of dementia, Alzheimer disease, and vascular dementia. 
Limited alcohol consumption may be protective. 
Jellinger KA. Morphologic diagnosis of "vascular dementia" - a critical update. J Neurol Sci. 2008 Jul 15. 270(1-2):1-12. [Medline].
Jellinger KA. The pathology of "vascular dementia": a critical update. J Alzheimers Dis. 2008 May. 14(1):107-23. [Medline].
Schneck MJ. Vascular dementia. Top Stroke Rehabil. 2008 Jan-Feb. 15(1):22-6. [Medline].
Srinivasan V, Braidy N, Chan EK, Xu YH, Chan DK. Genetic and Environmental Factors in Vascular Dementia: an update of blood brain barrier dysfunction. Clin Exp Pharmacol Physiol. 2016 Feb 9. [Medline].
Solans-Laque R, Bosch-Gil JA, Molina-Catenario CA, Ortega-Aznar A, Alvarez-Sabin J, Vilardell-Tarres M. Stroke and multi-infarct dementia as presenting symptoms of giant cell arteritis: report of 7 cases and review of the literature. Medicine (Baltimore). 2008 Nov. 87(6):335-44. [Medline].
Anderson P. 6 Steps to nondrug management of dementia. Medscape Medical News. December 27, 2012. [Full Text].
Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA. 2012 Nov 21. 308(19):2020-9. [Medline].
Bousser MG. Stroke prevention: an update. Front Med. 2012 Mar. 6(1):22-34. [Medline].
Ancelin ML, Carrière I, Barberger-Gateau P, Auriacombe S, Rouaud O, Fourlanos S, et al. Lipid Lowering Agents, Cognitive Decline, and Dementia: The Three-City Study. J Alzheimers Dis. 2012 Mar 26. [Medline].
Fischer P, Krampla W, Mostafaie N, Zehetmayer S, Rainer M, Jungwirth S, et al. VITA study: white matter hyperintensities of vascular and degenerative origin in the elderly. J Neural Transm Suppl. 2007. 181-8. [Medline].
Chen C, Homma A, Mok VC, Krishnamoorthy E, Alladi S, Meguro K, et al. Alzheimer's disease with cerebrovascular disease: current status in the Asia-Pacific region. J Intern Med. 2016 Mar 16. [Medline].
Roach GW, Kanchuger M, Mangano CM. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996 Dec 19. 335(25):1857-63. [Medline].
Ruchoux MM, Brulin P, Brillault J. Lessons from CADASIL. Ann N Y Acad Sci. 2002 Nov. 977:224-31. [Medline].
Qian L, Ding L, Cheng L, Zhu X, Zhao H, Jin J, et al. Early biomarkers for post-stroke cognitive impairment. J Neurol. 2012 Mar 10. [Medline].
Perrotta M, Lembo G, Carnevale D. Hypertension and Dementia: Epidemiological and Experimental Evidence Revealing a Detrimental Relationship. Int J Mol Sci. 2016 Mar 8. 17 (3):[Medline].
Knopman DS, Rocca WA, Cha RH. Incidence of vascular dementia in Rochester, Minn, 1985-1989. Arch Neurol. 2002 Oct. 59(10):1605-10. [Medline].
Erkinjuntti T. Vascular cognitive deterioration and stroke. Cerebrovasc Dis. 2007. 24 Suppl 1:189-94. [Medline].
Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, Whitmer RA. Heavy Smoking in Midlife and Long-term Risk of Alzheimer Disease and Vascular Dementia. Arch Intern Med. 2010 Oct 25. [Medline].
Mukamal KJ, Kuller LH, Fitzpatrick AL. Prospective study of alcohol consumption and risk of dementia in older adults. JAMA. 2003 Mar 19. 289(11):1405-13. [Medline].
Smith E. Vascular Cognitive Impairment. Continuum (Minneap Minn). 2016 Apr. 22 (2 Dementia):490-509. [Medline].
Bowler JV. Acetylcholinesterase inhibitors for vascular dementia and Alzheimer's disease combined with cerebrovascular disease. Stroke. 2003 Feb. 34(2):584-6. [Medline].
Bowler JV. Modern concept of vascular cognitive impairment. Br Med Bull. 2007. 83:291-305. [Medline].
de Groot JC, de Leeuw FE, Oudkerk M. Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol. 2000 Feb. 47(2):145-51. [Medline].
Deramecourt V, Slade JY, Oakley AE, Perry RH, Ince PG, Maurage CA, et al. Staging and natural history of cerebrovascular pathology in dementia. Neurology. 2012 Feb 29. [Medline].
Engelhart MJ, Geerlings MI, Ruitenberg A. Diet and risk of dementia: Does fat matter?: The Rotterdam Study. Neurology. 2002 Dec 24. 59(12):1915-21. [Medline].
Freels S, Nyenhuis DL, Gorelick PB. Predictors of survival in African American patients with AD, VaD, or stroke without dementia. Neurology. 2002 Oct 22. 59(8):1146-53. [Medline].
Iadecola C, Gorelick PB. Converging pathogenic mechanisms in vascular and neurodegenerative dementia. Stroke. 2003 Feb. 34(2):335-7. [Medline].
Knopman DS. Cerebrovascular pathology in cognitive impairment: New (in)sights. Neurology. 2012 Feb 29. [Medline].
Knopman DS, Rocca WA, Cha RH. Survival study of vascular dementia in Rochester, Minnesota. Arch Neurol. 2003 Jan. 60(1):85-90. [Medline].
Meguro K, Ishii H, Yamaguchi S. Prevalence of dementia and dementing diseases in Japan: the Tajiri project. Arch Neurol. 2002 Jul. 59(7):1109-14. [Medline].
Mok VC, Liu T, Lam WW, Wong A, Hu X, Guo L, et al. Neuroimaging predictors of cognitive impairment in confluent white matter lesion: volumetric analyses of 99 brain regions. Dement Geriatr Cogn Disord. 2008. 25(1):67-73. [Medline].
Mok VC, Wong A, Lam WW. Cognitive impairment and functional outcome after stroke associated with small vessel disease. J Neurol Neurosurg Psychiatry. 2004 Apr. 75(4):560-6. [Medline].
Moretti R, Torre P, Antonello RM, Cazzato G, Pizzolato G. Different responses to rivastigmine in subcortical vascular dementia and multi-infarct dementia. Am J Alzheimers Dis Other Demen. 2008 Apr-May. 23(2):167-76. [Medline].
Morris JC. The nosology of dementia. Neurol Clin. 2000 Nov. 18(4):773-88. [Medline].
Orgogozo JM, Rigaud AS, Stoffler A. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke. 2002 Jul. 33(7):1834-9. [Medline].
Polidori MC, Pientka L. A brief update on dementia prevention. Z Gerontol Geriatr. 2012 Jan. 45(1):7-10. [Medline].
Quinn J. Vascular dementia. J Am Med Dir Assoc. 2003 Nov-Dec. 4(6 Suppl):S155-61. [Medline].
Rao R. The role of carotid stenosis in vascular cognitive impairment. J Neurol Sci. 2002 Nov 15. 203-204:103-7. [Medline].
Roman GC, Tatemichi TK, Erkinjuntti T. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993 Feb. 43(2):250-60. [Medline].
Sha MC, Callahan CM. The efficacy of pentoxifylline in the treatment of vascular dementia: a systematic review. Alzheimer Dis Assoc Disord. 2003 Jan-Mar. 17(1):46-54. [Medline].
Vermeer SE, Prins ND, den Heijer T. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27. 348(13):1215-22. [Medline].