Neurological Manifestations of Vascular Dementia Workup

Updated: Nov 07, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Laboratory Studies

All patients with dementia should have laboratory testing to rule out reversible causes of dementia.

CBC, electrolytes, thyroid-stimulating hormone (TSH), folate, and vitamin B-12 levels should be obtained. The American Academy of Neurology no longer recommends syphilis screening in the routine evaluation of dementia if patients come from geographic regions with a very low base rate of syphilis. In specific cases, screening for syphilis is indicated.

If the clinician has reason to suspect an angiitis affecting cerebral vessels, then an erythrocyte sedimentation rate (ESR) and specific panels may be ordered.


Imaging Studies

Patients with newly diagnosed dementia undergo neuroimaging studies to rule out treatable causes of dementia and to aid the differential diagnosis.

Either CT scanning or MRI of the head should be performed.

In patients with vascular dementia, multiple cortical, and more commonly subcortical, infarcts or single strokes affecting the thalamus, angular gyrus, and the territory supplied by the anterior cerebral arteries are observed.

Decreased white matter density (on CT scanning) or decreased T1 or increased T2 signal intensities (on MRI) are associated with dementia. Multiple pathologies, including small vessel disease and decreased integrity of the blood-brain barrier, have been associated with these findings.

Measurement of cerebral blood flow using single photon emission computerized tomography (SPECT) or positron emission tomography (PET) scanning is not recommended for diagnostic purposes.