Vascular dementia

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Vascular dementia

Nervous system


Vascular dementia


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USMLE® Step 1 questions

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Vascular dementia

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USMLE® Step 1 style questions USMLE

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A 63-year-old man is brought to the office by his partner for evaluation of impaired memory. About three-months ago, the patient started frequently misplacing objects and having difficulty performing his responsibilities as an accountant. His symptoms worsened two weeks ago, when he developed difficulty walking and frequently tripped over himself. The patient still enjoys playing poker with his friends weekly, but he has found it increasingly difficult to remain competitive. Past medical history is significant for type II diabetes mellitus and hypertension, for which he takes daily medications. His last HbA1c from one month ago was 9.6%. He drinks 3-4 glasses of wine per week, and he does not consume tobacco or illicit substances. In the office, temperature is 37.0°C (98.6°F), pulse is 88/min, respirations are 15/min, and blood pressure is 145/94 mmHg. Physical exam reveals no abnormalities. Head CT shows multiple hypodense lesions. Which of the following is the most likely cause of this patient’s condition?  

Memory Anchors and Partner Content


With vascular dementia, vascular refers to the blood flow to the brain, and dementia refers to problems like poor memory, difficulty communicating, and difficulty learning new information.

Vascular dementia is also known as multi-infarct dementia, and it’s a progressive loss of brain function caused by long term poor blood flow to the brain, typically because of a series of strokes.

OK, let’s start with some basic brain anatomy. The brain has a few regions - the most obvious is the cerebrum, which is divided into two cerebral hemispheres, each of which is divided into four lobes: the frontal, parietal, temporal, and occipital lobe.

The frontal lobe controls movement, and our personalities, it also handles our ability to count and spell, and make decisions.

The parietal lobe processes sensory information, which lets us locate exactly where we are physically and guides movements in a three dimensional space.

The temporal lobe plays a role in hearing, smell, and memory, as well as visual recognition of faces and languages.

Finally there’s the occipital lobe which is primarily responsible for processing visual information.

All the cells in the body need oxygen - and that’s particularly relevant for neurons, which can only function in aerobic conditions, meaning with constant supply of oxygen.

Neurons also don’t have long term energy stores, so they need a constant supply of glucose to keep working.

Each time the heart beats, about a quarter of the blood pumped out goes directly to your brain, via the internal carotid arteries and the vertebral arteries in the neck.

Once they reach the base of the brain, these arteries join to form a ring, called the circle of Willis, which then branches off into smaller and smaller arteries, the smallest being the perforating arteries, that eventually supply the entire brain with oxygen and glucose.


Vascular dementia is a progressive loss of brain function caused by multiple strokes, or infarcts, which in turn are caused by atherosclerosis of the vessels supplying the brain. Symptoms can vary depending on the affected regions of that brain but may include problems with memory, thinking, and judgment, as well as difficulty with daily tasks and changes in mood or personality. Treatment for vascular dementia may include medications to manage symptoms and lifestyle changes to reduce risk factors for stroke, such as high blood pressure, high cholesterol, and smoking.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Management of Behavioral and Psychological Symptoms of Dementia" Noro Psikiyatri Arsivi (2014)
  5. "Distinguishing Alzheimer’s disease from other major forms of dementia" Expert Review of Neurotherapeutics (2011)
  6. "Comparison of Different Diagnostic Criteria for Vascular Dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN)" Stroke (1996)

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