Laboratory Studies

Laboratory tests should be performed to rule out other causes of dementia. These tests should routinely include a CBC count, erythrocyte sedimentation rate, glucose level, renal and liver function tests, serologic tests for syphilis, vitamin B-12 and red blood cell folate levels, and thyroid function tests.

In selected patients, optional tests include HIV serology testing, lupus anticoagulant testing, antiphospholipid antibody testing, antinuclear antibody testing, and antineutrophil cytoplasmic antibody testing.

Imaging Studies

Neuroimaging studies may include CT brain scanning and MRI of the brain. The absence of cerebrovascular lesions on CT scanning or MRI is evidence against vascular etiology. The features on CT scanning or MRI that are suggestive of vascular dementia are bilateral multiple infarcts located in the dominant hemisphere and limbic structures, multiple lacunar strokes, or periventricular white matter lesions extending into the deep white matter.

Patients with vascular mild cognitive impairment (MCI), which is a prodromal stage for subcortical vascular dementia, have MRI features that differ from patients with amnestic MCI, which is the prodromal stage for AD. Vascular MCI shows more extensive white matter lacunar infarcts and leukoaraiosis and minimal hippocampal and entorhinal cortical atrophies, whereas the opposite is true for amnestic MCI.

Functional imaging may also be used for diagnosis. According to a 2000 study by Nagata et al,^[21]positron emission tomography may be useful for differentiating vascular dementia from AD. Hypoperfusion and hypometabolism can be observed in the frontal lobe, including the cingulate and superior frontal gyri, in patients with vascular dementia; a parietotemporal pattern is observed in patients with AD. Starkstein et al in 1996^[22]and other authors have demonstrated that single-photon emission CT scanning produce similar findings.

Cerebral angiography is not performed routinely during the evaluation of vascular dementia, but it is performed before carotid artery surgery. It also is useful in cases of possible cerebral vasculitis; cerebral vessels can demonstrate beading.

Other Tests

Tests that may be useful for evaluation of stroke and in certain cases of vascular dementia include the following:

Echocardiography
Holter monitoring
Carotid duplex Doppler scanning

Treatment & Management

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