Vascular dementia is diagnosed from cognitive decline together with evidence of cerebrovascular disease, where the two are plausibly linked. Imaging is central, and the pattern often features executive dysfunction and slowed processing more than memory loss. Gait disturbance and urinary urgency also tend to appear earlier in the course than they would in Alzheimer's disease.
Vascular dementia is diagnosed from cognitive decline together with evidence of cerebrovascular disease, where the two are plausibly linked. Imaging is central, and the pattern often features executive dysfunction and slowed processing more than memory loss. Gait disturbance and urinary urgency also tend to appear earlier in the course than they would in Alzheimer's disease.
Where Alzheimer's disease typically leads with memory, vascular cognitive impairment often leads with executive function: planning, sequencing, multitasking, and mental flexibility. Processing speed slows noticeably. Attention fluctuates. Memory may be relatively preserved early, and prompting often helps recall in a way it does not in Alzheimer's disease. Gait disturbance and urinary urgency frequently appear earlier in the course than they would otherwise.
The classic description is stepwise decline, with abrupt worsening after a stroke followed by partial recovery and a plateau. That does happen, but small-vessel disease produces a gradual decline indistinguishable in tempo from Alzheimer's disease, so a smooth course does not exclude a vascular cause. Mixed pathology is genuinely common, particularly in older adults, and a diagnosis of mixed dementia is often the most accurate one.
Imaging is essential rather than optional here, because the diagnosis depends on demonstrating cerebrovascular disease: infarcts, extensive small-vessel change, or strategically placed lesions. It is arranged externally since these offices have no imaging suite. Vascular risk factors are assessed and treated, which is the part that can influence the trajectory: blood pressure, atrial fibrillation, diabetes, cholesterol and smoking. Neuropsychological testing profiles the deficits and is available within the practice.
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: Alzheimer disease; National Institute of Neurological Disorders and Stroke; MedlinePlus: memory.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.