Відмінності між судинними когнітивними порушеннями, деменцією та хворобою Альцгеймера

History of present illness

Stepwise progression in cognition after multiple infarcts

Subcortical ischemic vascular disease with slow progression

Slow deterioration of cognition

Past medical history/

Family history

Cerebrovascular risk factors or disease

Coronary artery disease

Peripheral vascular disease

Alzheimer disease

Mental status

Variable, depending on location of ischemic damage

Subtle decline in executive function due to subcortical ischemic vascular disease

Memory impairment typical of Alzheimer disease (eg, forgets rapidly, misses environmental and social  cues)

Neurologic findings

Focal deficits, gait disturbances

Impaired mental status; otherwise normal until disease progresses

Cardiovascular findings

Findings related to cardiovascular risk factors (eg, skin changes in the legs due to peripheral artery disease, pitting edema due to heart failure, irregular heart rhythm due to atrial fibrillation, hypertension)

Usually normal

Laboratory tests needed

Measurement of hemoglobin A1C and lipids, which are elevated

ECG to check for atrial fibrillation

Routine laboratory tests to check for reversible dementia (comprehensive metabolic panel, CBC,TSH,vitamin B12 level, fluorescent treponemal antibody absorption) to rule out other possible causes of cognitive impairment

MRI/CT

Focal infarcts in specific brain areas critical for cognition and behavior,, confluent white matter changes

In pure vascular cognitive impairment and dementia, relative preservation of hippocampal volume

Hippocampal, temporal, parietal, and frontal atrophy

FDG-PET

Multifocal hypometabolism varying by location of vascular brain damage

Hypometabolism in parietal, temporal, and later on in frontal lobes with sparing of primary motor-sensory cortex

Biomarkers

None

Amyloid-beta or phosphorylated tau detected in CSF or by PET