Which clinical pattern is most characteristic of vascular neurocognitive disorder rather than Alzheimer disease?
- A Stepwise deterioration with focal neurological signs and patchy cognitive deficits ✓
- B Insidious onset with early impairment of recent memory and language
- C Prominent visual hallucinations with fluctuating attention
- D Early personality change with preserved memory until late stages
Correct answer: A. Stepwise deterioration with focal neurological signs and patchy cognitive deficits
Explanation
Vascular dementia characteristically shows an abrupt or stepwise decline corresponding to successive ischemic events, with focal signs such as hemiparesis, reflex asymmetry, or gait change, and uneven deficits reflecting the territory of infarction. Option B describes the smooth insidious amnestic course of Alzheimer disease, option C describes dementia with Lewy bodies, and option D describes the behavioural variant of frontotemporal dementia.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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