An 82-year-old hypertensive man is brought by his son for evaluation of cognitive decline. The son reports that memory worsened in distinct steps over 18 months, each decline occurring abruptly and followed by partial stabilization. On examination there are focal neurological signs including an asymmetric grasp reflex and gait apraxia. MRI shows multiple lacunar infarcts. What is the most likely diagnosis?

• A Alzheimer disease
• B Vascular dementia ✓
• C Dementia with Lewy bodies
• D Frontotemporal dementia

Explanation

Stepwise deterioration with abrupt declines and plateau periods, focal neurological signs, gait disturbance and imaging evidence of lacunar infarcts in a hypertensive patient define multi-infarct vascular dementia. This contrasts with the insidious, slowly progressive course of Alzheimer disease. Dementia with Lewy bodies is distinguished by early visual hallucinations, parkinsonism and fluctuating cognition rather than stepwise deficits, while frontotemporal dementia presents early with personality change and language decline without focal strokes.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.