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Vascular cognitive impairment — SCE Neurology MCQ

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HardCognitive NeurologyVascular cognitive impairmentSCE Neurology

A 70-year-old with hypertension and atrial fibrillation has stepwise cognitive decline after several small strokes. Examination shows slowed processing, brisk reflexes and gait impairment; MRI shows multiple lacunes and confluent white-matter disease. What is the diagnosis?

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Correct answer: DVascular cognitive impairment

The best answer is “Vascular cognitive impairment”. The temporal relation to strokes, stepwise course, executive slowing, gait signs and extensive cerebrovascular injury indicate vascular cognitive impairment, although mixed Alzheimer pathology remains possible in older people. “Behavioural-variant frontotemporal dementia” is less appropriate because frontotemporal dementia usually has early behavioural or language change and frontotemporal atrophy “Typical amnestic Alzheimer disease” is less appropriate because typical Alzheimer disease is predominantly amnestic and more steadily progressive “Dementia with Lewy bodies” is less appropriate because Lewy body disease needs core features such as fluctuations, hallucinations, REM-sleep behaviour disorder or parkinsonism “Normal ageing” is less appropriate because the functional decline and MRI burden are pathological

Reference: NICE NG97: Dementia — recommendations. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations