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Vascular — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryVascularMRCPsych Paper B

A 76-year-old man has developed increasing difficulty planning household tasks and managing his finances over 18 months. His wife describes periods of stability interrupted by abrupt deterioration after two transient ischaemic attacks. He has hypertension and type 2 diabetes, and examination shows left-sided hyperreflexia. MRI demonstrates multiple cortical and subcortical infarcts. Which dementia subtype is most likely?

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Correct answer: D — Vascular dementia

The correct answer is D, vascular dementia. The strongest discriminators are periods of stability followed by abrupt deterioration after cerebrovascular events, prominent executive dysfunction, vascular risk factors, focal neurological signs and multiple infarcts on MRI. Alzheimer's disease more typically begins with insidious episodic-memory impairment and progresses gradually, although mixed pathology is common. Frontotemporal dementia usually presents earlier with prominent behavioural, personality or language change. Dementia with Lewy bodies is suggested by recurrent visual hallucinations, cognitive fluctuations, REM sleep behaviour disorder and spontaneous parkinsonism. Normal-pressure hydrocephalus causes gait impairment, urinary dysfunction and cognitive decline with ventriculomegaly, rather than an infarct-associated stepwise course.

Reference: NHS. Symptoms of vascular dementia. Page last reviewed 8 June 2023. https://www.nhs.uk/conditions/vascular-dementia/symptoms/