Vascular Dementia


Case Discussion
80 yo with 12 mos of becoming more sedentary, slowed movement, unsteady gait, 2 falls, no injury. Stepwise progression of deficits. Uses walker. Speech diminished in volume, less distinct. Can’t manage finances. No change in mood or personality. Diabetic, smoker, hypertensive. Flat affect. Muscle tone increased, right grip weak, asymmetric reflexes, no tremor. 23/30 on MMSE (deficits in memory and calculations).

The most likely diagnosis is?

A. Alzheimer’s disease
B. Pick’s disease
C. Huntington’s disease
D. Parkinson’s disease
E. Vascular dementia

 
Characteristics
  • Subcortical or mixed dementia
  • Stepwise progression, prior strokes, focal neuro symptoms/signs
  • Preserved personality but “emotional incontinence” or apathy common
  • Definitive diagnosis difficult

 
Dementia Alzheimer's Dementia
Minor Neuro-cognitive Disorder
“Pseudodementia” (Dementia Syndrome of Depression)
Vascular Dementia
Diffuse Lewy Body Dementia
Frontotemporal Dementia
Normal Pressure Hydrocephalus
Creutzfeldt-Jakob Disease