Consider referring a patient with suspected vascular dementia to a specialist dementia diagnostic service (such as a memory clinic or community old age psychiatry service) if reversible causes of cognitive decline have been investigated and dementia is still suspected. This includes ruling out delirium, depression, sensory impairments, and cognitive impairment from medicines with anticholinergic burden.
Use MRI to assist with diagnosis if the dementia subtype is uncertain and vascular dementia is suspected; if MRI is unavailable or contraindicated, use CT. However, do not diagnose vascular dementia based solely on vascular lesion burden.
Referral to a specialist is also important to confirm the diagnosis, perform appropriate neurological examination and cognitive testing, and to access post-diagnostic support and treatment.