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How is suspected vascular dementia diagnosed
What basic workup should be done when vascular dementia is suspected?
The standard workup for vascular dementia includes neuroimaging, laboratory assessment, and, if at all possible, neuropsychological testing.
Laboratory Evaluation
Laboratory assessmentshould include basic labs, such as a complete blood count and a comprehensive metabolic panel. Unless there is suspicion after a medical history review, there is no need to obtain testing for c-reactive protein, HIV, or treponemal antibodies. In addition to basic laboratory tests, obtaining vitamin B12 and homocysteine levels is recommended. Homocysteine, in particular, has been associated with an increased risk of vascular dementia.[15]
Neuroimaging
Neuroimaging is essential for making rigorous diagnoses of MND. MRI is the preferred imaging modality because its different sequences and orientations provide essential insights in evaluating cognitive impairment. Contrast is not necessary unless one is concerned about possible hemorrhage or infection.
The workup should begin with imaging studies and psychometric testing in addition to the history and physical examination.
In most cases, all tests recommended for the diagnosis of Alzheimers Disease should be pursued to rule out additional conditions that may cause or contribute to the dementia, including a lipid profile and blood homocysteine levels, which are risk factors for both Alzheimers Disease and vascular dementia.
Some patients, especially those with clear-cut strokes, may benefit from imaging of the carotid arteries, especially when high grade stenosis or ulcerated plaques are suspected.
An echocardiogram is indicated in patients who have a cardiac history or appear to have had embolic strokes.
Patients who have had strokes or transient ischemic attacks should be considered for antiplatelet therapies.
Sources
Sanders AE, Schoo C, Kalish VB. Vascular Dementia. [Updated 2023 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430817/
