How can I differentiate between vascular dementia and other types of dementia during a patient assessment?

To differentiate vascular dementia from other types of dementia during a patient assessment:

• Refer the patient to a specialist dementia diagnostic service (e.g., memory clinic or community old age psychiatry) after reversible causes of cognitive decline have been excluded, as specialist assessment is essential for subtype diagnosis ¹.
• Use validated diagnostic criteria such as the NINDS-AIREN criteria specifically for vascular dementia, alongside criteria for other dementia subtypes, to guide clinical judgement ¹.
• Perform structural brain imaging (preferably MRI; if unavailable or contraindicated, CT) to identify vascular lesions and rule out reversible causes; however, do not diagnose vascular dementia solely based on vascular lesion burden seen on imaging ¹.
• Consider the clinical presentation and cognitive testing results: vascular dementia often presents with a stepwise cognitive decline and focal neurological signs, whereas Alzheimer's disease typically shows progressive memory impairment; verbal episodic memory testing is useful when Alzheimer's is suspected ¹.
• Use neuropsychological testing if the subtype diagnosis is unclear, to differentiate vascular dementia from other dementias ¹.
• Do not rely solely on imaging or cognitive scores but integrate clinical history, examination, imaging, and specialist assessment to reach a diagnosis ¹.