A 73-year-old man with a history of multiple lacunar infarcts presents with stepwise cognitive decline, prominent executive dysfunction, and gait apraxia. His MMSE is 22/30. What type of dementia does this MOST likely represent, and which neuroimaging finding would be MOST supportive?
- A Alzheimer's disease; hippocampal atrophy on MRI
- B Frontotemporal dementia; frontal lobe atrophy on MRI
- C Dementia with Lewy bodies; reduced dopamine transporter scan (DaTscan)
- D Vascular dementia; periventricular white matter hyperintensities and lacunar infarcts on MRI ✓
Explanation
Vascular dementia (VaD) is characterized by stepwise deterioration (following discrete vascular events), focal neurological signs, executive dysfunction, and gait disturbances. It is strongly associated with cardiovascular risk factors. Neuroimaging shows strategic infarcts, periventricular white matter hyperintensities (leukoaraiosis), and lacunar infarcts on MRI—the hallmark supporting findings. Alzheimer's shows medial temporal/hippocampal atrophy. Frontotemporal dementia shows frontal/anterior temporal atrophy and hypometabolism. DaTscan is reduced in Parkinson's disease and DLB (dopaminergic system involvement).
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.