Vascular Dementia
A 74-year-old woman with type 2 diabetes and long-standing hypertension has cognitive decline that has worsened in a stepwise fashion over 2 years, with prominent slowing of thinking and difficulty planning and organizing. On examination she has a shuffling gait and brisk reflexes. MRI shows multiple lacunar infarcts and extensive white matter ischemic changes. What is the most likely diagnosis?
- A.Vascular dementiaCorrect
- B.Alzheimer disease
- C.Frontotemporal dementia
- D.Vitamin B12 deficiency
Explanation
Stepwise cognitive decline with prominent executive dysfunction and slowed processing, focal neurologic signs (gait disturbance, brisk reflexes), and imaging showing lacunar infarcts and white matter ischemic change in a patient with diabetes and hypertension defines vascular dementia. This contrasts with the insidious, memory-predominant, gradually progressive course of Alzheimer disease.
Why each option
- A.
- Correct: stepwise course, executive and processing slowing, focal signs, and infarcts with white matter disease on imaging indicate vascular dementia.
- B.
- Alzheimer disease is gradually progressive and memory-predominant, without stepwise decline or infarcts.
- C.
- Frontotemporal dementia begins with early personality or behavior change or aphasia and frontotemporal atrophy.
- D.
- Vitamin B12 deficiency causes neuropathy and subacute combined degeneration with megaloblastic anemia and is reversible.
Reference: DSM-5-TR, 2022
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