Vascular Dementia

Vascular cognitive impairment is a spectrum ranging from mild cognitive impairment to overt dementia caused by cerebrovascular disease. It is the second most common cause of dementia after Alzheimer disease and frequently coexists with it as mixed dementia.

Subtypes include post-stroke dementia, multi-infarct dementia, strategic infarct dementia (e.g., thalamic stroke), subcortical ischemic vascular disease with lacunar infarcts and leukoaraiosis, and rarer inherited forms such as CADASIL.

Clinical presentation depends on the vascular territory and lesion burden. Executive dysfunction, slowed processing speed, and gait disturbance often predominate, with memory relatively preserved in early stages compared with Alzheimer disease.

Diagnosis combines neuropsychological testing, brain imaging (MRI showing infarcts and white-matter hyperintensities), and vascular work-up. Management focuses on prevention of further vascular injury.