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Vascular dementia

Last reviewed: 29 Nov 2025
Last updated: 17 Apr 2025

Summary

Definition

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 neurologic signs
  • impaired gait and balance
Full details

Risk factors

  • age >60 years
  • obesity
  • hypertension
  • cigarette smoking
  • diabetes mellitus
  • hypercholesterolemia
  • alcohol misuse
  • chronic kidney disease
Full details

Diagnostic tests

1st tests to order

  • CBC
  • erythrocyte sedimentation rate
  • blood glucose level
  • renal and liver function tests
  • vitamin B12
  • folate
  • thyroid function
  • MRI brain
  • ECG
  • neuropsychologic testing
Full details

Tests to consider

  • syphilis serology
  • lupus anticoagulant, antiphospholipid, and antinuclear testing
  • carotid duplex ultrasound
  • echocardiogram
Full details

Algoritmo de tratamento

CONTÍNUA

atherosclerotic ischemic disease

cardioembolic disease

Colaboradores

Autores

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

Professor of Ageing and Geriatric Medicine

Queen's University Belfast

Belfast

UK

Declarações

PP declares that he has no competing interests.

Agradecimentos

Dr Peter Passmore would like to gratefully acknowledge Dr David Wilson, Dr Grant Bateman, and Dr Velandai Srikanth, previous contributors to this topic.

Declarações

DW has received educational grants from Shire. GB and VS declare that they have no competing interests.

Revisores

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

Medical Director

Kings Harbor Multicare Center

New York

NY

Declarações

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

Seattle

WA

Declarações

CNS declares that he has no competing interests.

Bryan Bernard, PhD

Assistant Professor and Clinical Neuropsychologist

Department of Neurological Sciences

Rush University Medical Center

Chicago

IL

Declarações

BB declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke - Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006 Sep;37(9):2220-41.Texto completo  Resumo

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

American College of Radiology. ACR appropriateness criteria: dementia. 2024 [internet publication].Texto completo

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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