Vascular Dementia

The early cognitive syndrome of subcortical VaD is characterized by (1) dysexecutive syndrome including slowed information processing, (2) memory deficit (may be mild), and (3) behavioral and psychological symptoms. The dysexecutive syndrome in subcortical VaD includes impairment in goal formulation, initiation, planning, organising, sequencing, executing, setsifting and set-maintenance, as well as in abstracting. The memory deficit in subcortical VaD is often mild. Sometimes it is manifested by impaired recall but relatively intact recognition. In consequence, patients often benefit from cues. Mild disorders are also commonly seen in subcortical VaD as is incontinence.

Clinical neurological findings especially early in the course of subcortical VaD include mild upper motor neuron signs, gait disorder, imbalance and falls. Often, however, these focal neurological signs are subtle or even transient.

By contrast, patients with cortical VaD, more commonly exhibit the neurological signs classically associated with stroke.

Onset and course. In subcortical VaD, the onset is variable, whereas in cortical VaD, it is typically sudden, with a step-wise deterioration following.