Yes, but often in a different shape from Alzheimer's disease. Decline can be stepwise, with periods of relative stability interrupted by fairly abrupt drops, each usually corresponding to further vascular injury. Controlling vascular risk factors can genuinely influence that trajectory.
Yes, but often in a different shape from Alzheimer's disease. Decline can be stepwise, with periods of relative stability interrupted by fairly abrupt drops, each usually corresponding to further vascular injury. Controlling vascular risk factors can genuinely influence that trajectory.
The classic description is a staircase: a period of stability, then a distinct step down, then stability again at the lower level. That happens because the underlying injury arrives in discrete events rather than accumulating evenly. Not everyone follows it. Where the cause is diffuse small-vessel disease rather than larger strokes, the course can look gradual and be difficult to distinguish from Alzheimer's disease on the pattern alone. Slowed thinking, reduced attention and difficulty with planning are usually more prominent early than memory loss.
This is the practical difference from most other dementias, and it is worth emphasising because it gives something to act on. The injury is vascular, so the measures that reduce stroke risk also address the mechanism driving the decline: blood pressure control above all, then lipids, glucose, atrial fibrillation treatment, stopping smoking, and physical activity. None of this reverses damage already done. It is aimed at preventing the next step down, which is a realistic and worthwhile goal.
In practice most older people with dementia have more than one process at work, commonly Alzheimer's pathology together with cerebrovascular disease. That has two consequences. The clinical picture is often intermediate rather than textbook, so a confident single label is sometimes not achievable or useful. And it means the treatments used for Alzheimer's disease may still have a place alongside vascular risk management, which is a discussion rather than a rule.
Review covers cognition and function, mood, gait and falls, bladder symptoms, blood pressure, and the medication list. A distinct step down prompts a look for a new vascular event and also for the ordinary mimics - infection, dehydration, a new sedating medicine, delirium - which are far commoner and are treatable. MRI and CT are performed at an imaging centre or hospital and the report is reviewed with you here; there is no imaging suite at these offices.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: dementia; National Institute of Neurological Disorders and Stroke; National Institute on Aging.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.