neurologic disorders
Vascular Cognitive Impairment and Dementia
Symptoms and Signs of Vascular Cognitive Impairment and Dementia
Symptoms and signs of vascular cognitive impairment and dementia are similar to those of other Symptoms and Signs (eg, memory loss, impaired executive function, difficulty initiating actions or tasks, slowed thinking, personality and mood changes, language deficits). However, compared with Alzheimer disease, vascular cognitive impairment and dementia tends to cause memory loss later and to affect executive function earlier. Also, symptoms can vary depending on where the infarcts occur. Unlike other dementias, multiple-infarct dementia tends to progress in discrete steps; each episode is accompanied by intellectual decline, sometimes followed by modest recovery. Subcortical vascular cognitive impairment and dementia caused by small-vessel ischemic damage (which includes multiple lacunar infarction and Binswanger dementia) tends to cause small, incremental deficits; thus, the decline appears to be gradual. As the disease progresses, focal neurologic deficits often develop: Exaggeration of deep tendon reflexes Extensor plantar response Gait abnormalities Weakness of an extremity Hemiplegias Pseudobulbar palsy with pathologic laughing and crying Other signs of extrapyramidal dysfunction Aphasias Cognitive loss may be focal. For example, short-term memory may be less affected than in other dementias. Because loss may be focal, patients may retain more aspects of mental function. Thus, they may be more aware of their deficits, and depression may be more common than in other dementias. Patients with CADASIL commonly present with cognitive impairment, migraine headaches, and/or stroke. CARASIL can cause alopecia and spondylosis. Age at onset varies. 