Snapshot A 68-year-old man presents to his neurologist for a follow-up visit. He experienced his second ischemic stroke approximately 6 months ago and has minimal neurological deficits. He continues to take his aspirin, maximum intensity statin, and lisinopril. He is accompanied by his wife, who said he has been having trouble with planning or solving complex tasks. Physical examination is notable for impaired executive functioning. An MRI brain demonstrates cortical ischemic changes. Introduction Definition dementia caused primarily by cerebrovascular disease Associated conditions Alzheimer disease depression Epidemiology Incidence second most common cause of dementia Alzheimer disease is the most common cause Etiology Cerebrovascular disease Impaired cerebral blood flow Pathogenesis Cerebral infarction results in improper brain functioning Presentation Symptoms cognitive decline impaired executive function (most prominent finding) "stepwise cognitive decline" Imaging MRI brain indication more sensitive for detecting ischemic changes Studies Cognitive screening tests e.g., Montreal cognitive assessment (MoCA) Differential Alzheimer disease differentiating factor episodic memory is prominently found impaired recollection of previous experiences Dementia with Lewy bodies differentiating factors fluctuating cognition visuospatial dysfunction (prominent finding) REM sleep behavior disorder visual hallucinations Treatment Risk factor management is also important in managing vascular dementia Medical acetylcholinesterase inhibitors indication recommended for vascular dementia medications donepezil galantamine rivastigmine Complications Depression Impaired activities of daily living