Vascular dementia

Last reviewed: 3 Sep 2022
Last updated: 26 Aug 2021



History and exam

Key diagnostic factors

  • history of stroke(s)
  • difficulty solving problems
  • apathy
  • disinhibition
  • slowed processing of information
  • poor attention
  • retrieval memory deficit
  • frontal release reflexes
  • focal neurological signs
  • impaired gait and balance
More key diagnostic factors

Risk factors

  • age >60 years
  • obesity
  • hypertension
  • cigarette smoking
  • diabetes mellitus
  • hypercholesterolaemia
  • alcohol misuse
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • erythrocyte sedimentation rate
  • blood glucose level
  • renal and liver function tests
  • vitamin B12
  • folate
  • thyroid function
  • CT or MRI brain
  • ECG
More 1st investigations to order

Investigations to consider

  • syphilis serology
  • lupus anticoagulant, antiphospholipid, and antinuclear testing
  • neuropsychological testing
  • carotid duplex ultrasound
  • echocardiogram
More investigations to consider

Treatment algorithm


atherosclerotic ischaemic disease

cardioembolic disease



Peter Passmore, BSc, MB, BCh, BAO, MD, FRCP (Lond, Glasg), FRCPI

Professor of Ageing and Geriatric Medicine

Queen's University Belfast




PP declares that he has no competing interests.


Dr Peter Passmore would like to gratefully acknowledge Dr David Wilson, Dr Grant Bateman, and Dr Velandai Srikanth, previous contributors to this topic. DW has received educational grants from Shire. GB and VS declare that they have no competing interests.

Peer reviewers

Roy J. Goldberg, MD, FACP, AGSF, CMD

Medical Director

Kings Harbor Multicare Center

New York



RJG declares that he has no competing interests.

Craig N. Sawchuk, PhD

Affiliate Assistant Professor

Department of Psychiatry and Behavioral Sciences

University of Washington Medical Center




CNS declares that he has no competing interests.

Bryan Bernard, PhD

Assistant Professor and Clinical Neuropsychologist

Department of Neurological Sciences

Rush University Medical Center




BB declares that he has no competing interests.

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