Alzheimer Disease vs Vascular Dementia
Alzheimer Disease and Vascular Dementia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Alzheimer Disease vs Vascular Dementia at a glance
- Alzheimer Disease: Most common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology.
- Vascular Dementia: Cognitive impairment due to cerebrovascular disease; second most common dementia cause.
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Side-by-side comparison
| Feature | Alzheimer Disease | Vascular Dementia |
|---|---|---|
| At a glance | Most common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology. | Cognitive impairment due to cerebrovascular disease; second most common dementia cause. |
| Classic presentation | Profound short-term memory loss with relatively preserved older memories and intact remote procedural memory; hippocampal/medial temporal atrophy on MRI.; Insidious onset, gradual progression over years; Early: episodic short-term memory loss (forgetting recent conversations, repeating questions, misplacing items), word-finding… | Stepwise decline + focal neurologic findings + extensive white matter disease/lacunes on MRI.; Stepwise decline temporally related to vascular events (classic but not universal); subcortical VaD may progress gradually; Executive dysfunction (planning, multitasking, attention) and slowed processing — prominent early features; Memory… |
| Workup / key labs | NIA-AA: probable AD dementia = insidious onset, progressive cognitive decline, predominant memory or non-amnestic syndrome, exclusion of other causes. Biomarker-supported (CSF or imaging) AD if available.; Reversible-cause screen: CBC, BMP, calcium, LFTs, TSH, B12, folate; consider HIV, RPR, heavy metals if risk factors; Depression… | NINDS-AIREN or VASCOG criteria: cognitive decline + cerebrovascular disease on imaging + temporal/causal relationship. Probable VaD when both are clear; possible when imaging-clinical relationship less certain.; Stroke risk factor workup: lipid panel, A1c, fasting glucose, BMP, TSH, B12; Hypercoagulable workup only if young or recurrent… |
| Imaging | MRI brain (or CT if MRI contraindicated): generalized and disproportionate medial temporal/hippocampal atrophy; excludes vascular disease, NPH, masses, subdural; FDG-PET: temporoparietal hypometabolism; Amyloid PET (florbetapir, florbetaben, flutemetamol): positive cortical amyloid; required for anti-amyloid therapy candidacy; Tau PET… | MRI brain (preferred): cortical/subcortical infarcts, lacunes, confluent white matter hyperintensities (leukoaraiosis), microbleeds (susceptibility-weighted imaging) suggesting cerebral amyloid angiopathy; CT acceptable if MRI contraindicated; Carotid duplex, echocardiogram (TTE/TEE) if embolic source suspected; Holter or extended… |
| First-line treatment | Cholinesterase inhibitor (AChE inhibitor) — donepezil, rivastigmine (oral or transdermal patch), galantamine; modest symptomatic benefit for mild-to-moderate AD; rivastigmine and galantamine require BID dosing; side effects include nausea, diarrhea, anorexia, bradycardia, vivid dreams, urinary urgency; NMDA receptor antagonist —… | Aggressive cardiovascular risk-factor control (the only intervention that slows progression):; Antihypertensive therapy targeting individualized BP goal (typically <130/80 mmHg if tolerated); Statin therapy (high-intensity for established atherosclerotic disease); Antiplatelet (aspirin 81 mg, clopidogrel) for non-cardioembolic;… |
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