Synopsis
Recognise cognitive and functional impairment caused by cerebrovascular injury, distinguish acute stroke and mixed dementia, use imaging and collateral chronology coherently, and prevent further vascular harm without prescribing dementia drugs outside supported indications.
- Vascular dementia requires cognitive decline interfering with function plus cerebrovascular disease judged sufficient to explain it; imaging lesions alone are not diagnosis.
- The phenotype often emphasises slowed processing, attention, executive function, gait and focal findings more than isolated early amnesia.
- Decline may be stepwise after strokes, but small-vessel disease can progress gradually; absence of obvious steps does not exclude it.
Key red flags
A new focal deficit or sudden step requires stroke or intracranial haemorrhage assessment rather than a routine memory appointment.
Sudden focal or cognitive deficit remains an emergency regardless of established dementia.
Investigation priorities
Connect vascular events to acquired decline.
Management branches
Persistent cognitive decline occurs with stroke or vascular disease.
- Exclude acute stroke and delirium and obtain a dated collateral cognitive and functional trajectory.
- Complete executive, focal, mood and gait assessment with MRI or CT and vascular risk evaluation.
A cerebrovascular mechanism and modifiable risks are present.
Key medicines
Antiplatelet therapyUse the agent and dose specified by the person's TIA or non-cardioembolic stroke pathway, commonly clopidogrel 75 mg orally once daily for long-term secondary prevention.
AtorvastatinAfter ischaemic stroke or TIA, NICE commonly recommends atorvastatin 80 mg orally once daily unless interactions, adverse-effect risk or preference require a lower dose.