Patient handout

Vascular dementia

PRODUCTION

1. Your condition

This handout is for vascular dementia. Your care team identified this based on: step-wise or fluctuating cognitive decline with prominent executive/processing-speed slowing (informant-corroborated).

Other reasons your team may use this plan: post-stroke / post-tia cognitive impairment on surveillance (multi-infarct or strategic infarct); heavy vascular-risk burden (htn/dm/af/carotid disease/smoking) with new cognitive concern + gait change/early incontinence; mri showing significant infarcts / confluent white-matter hyperintensities / lacunes / microbleeds with temporal/topographic link to cognition.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
reversible_cause_workup	—	—	—	VASCOG — B12, TSH, depression (GDS-15), medication/anticholinergic burble, and structural MRI (NPH/subdural/tumor) excluded or treated before attributing decline to cerebrovascular disease
cerebrovascular_imaging_confirmation	—	—	—	NINDS-AIREN — significant CVD on MRI (infarcts, lacunes, confluent white-matter hyperintensities/Fazekas, microbleeds) with a temporal/topographic link to cognition is a diagnostic requirement; assess mixed AD with biomarkers when an amnestic/insidious component coexists

Plan: Vascular cognitive impairment care ladder — exclude reversible/confirm vascular → AGGRESSIVE secondary vascular prevention (cornerstone) → ChEI/memantine modest/uncertain → depression/PBA/apathy → non-pharm/caregiver/ACP → BPSD non-pharm-first → deprescribe + rehab/falls

3. When to call your provider

Contact your care team if any of the following happen:

Acute new focal deficit / suspected acute stroke or TIA → acute stroke pathway, not chronic VaD (AHA/ASA Stroke)
Superimposed delirium or acute deterioration → inpatient workup (NICE NG97)
BPSD with danger to self/others not controllable in clinic → inpatient/urgent (NICE NG97)
Rapid progression (<1-2y) → rapid-dementia workup (CJD/autoimmune/paraneoplastic) (VASCOG)
NPH triad with ventriculomegaly → neurosurgical evaluation (AHA/ASA VCID)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Acute new focal neurologic deficit or suspected acute stroke/TIA superimposed on baseline vascular dementia (AHA/ASA Stroke)(life-threatening)
Cognitive decline progressing to dementia over <1-2 years (or weeks-months) — atypical for typical VaD trajectory (VASCOG)
Acute fluctuating inattention/altered consciousness superimposed on baseline vascular dementia (NICE NG97)(life-threatening)
Behavioral & psychological symptoms with danger to self/others or severe unrelievable distress (NICE NG97)

5. Follow-up

Reinforce and re-titrate secondary prevention at each visit (BP/LDL/HbA1c/anticoagulation/smoking); advance care planning revisited at each transition; driving/finances/capacity reviewed; caregiver respite and support referral; rehab continuity and falls prevention; palliative/end-of-life planning and ChEI/memantine deprescribing decision in advanced (severe) disease (VASCOG)

6. Sources

Guideline: AHA/ASA Scientific Statement — Vascular Contributions to Cognitive Impairment and Dementia (VCID) + 2024-2025 vascular cognitive impairment reviews; NINDS-AIREN and VASCOG diagnostic criteria; DSM-5 vascular neurocognitive disorder; NICE NG97 Dementia; AGS Beers 2023