Clinical Features

Cognitive. In patients with VaD, cognitive impairment often begins abruptly and progresses in a stepwise fashion, as would be expected in an illness caused by discrete stroke events. Some VaD patients, though, have an insidious onset and a slow progression of their illness like patients with AD and other degenerative dementias.

Attempts to characterize the neuropsychological profile in VaD have been complicated by the fact that VaD is commonly comorbid with AD. In addition, the neuropsychological presentation of VaD in patients depends on the areas of the brain affected by vascular disease, which by its nature is quite variable from patient to patient. Thus, it is not possible to provide a cognitive description of VaD that is valid for the entire population of persons who present with this disease.

As would also be expected in an illness affecting discrete areas of the brain, the cognitive deficits of VaD patients are often referred to as "patchy." Comparisons of VaD with AD have often focused on deficient executive functioning and psychomotor slowing as being more typical of the former disease than the latter (Knopman and Selnes, 2003; Looi and Sachdev, 1999). A frontal-subcortical cognitive pattern is often reported with recognition memory being less affected than recall (Knopman and Selnes, 2003). Other cognitive deficits, including visuoconstructive and language problems have been reported but likely depend on the specific populations under study.

Neuropsychiatric. Several forms of psychopathology can accompany VaD. Personality changes ranging from lability to apathy are common. Depression is more common, more severe, and more persistent in VaD than in AD. Mania can also be caused by cerebrovascular disease but is rarer than depression. Psychosis can also be seen in VaD patients. Hallucinations are more common in VaD than in AD. Delusions are seen in 40 to 50 percent of VaD patients (Cummings et al., 1987). Affective blunting and pseudobulbar affective changes (disinhibited laughing and crying in the absence of, or out of proportion to, an emotional stimulus) can be noted in VaD patients; these facts should be kept in mind when evaluating VaD patients for mood disorders. The severity of neuropsychiatric symptoms in patients with VaD does not correlate with the severity of cognitive impairment (Sultzer et al., 1993).

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