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I. The criteria for the clinical diagnosis of subcortical vascular dementia include all of the following:
A. COGNITIVE SYNDROME including both:
dysexecutive syndrome: impairment in goal formulation, initiation, planning, organizing, sequencing, executing, set-shifting and -maintenace, abstracting,
and
memory deficit (may be mild): impaired recall, relative intact recognition, less severe forgetting, benefit from cues.
Which indicate deterioration from a previous higher level of functioning, and are interfering with complex (executive) occupational and social activities not due to physical effects of cerebrovascular disease alone.
B. CEREBROVASCULAR DISEASE including both:
evidence of relevant cerebrovascular disease by brain imaging
and
presence or a history of neurologic signs as evidence for cerebrovascular disease such as hemiparesis, lower facial weakness, Babinski sign, sensory deficit, dysarthria, gait disorder, extrapyramidal signs consistent with subcortical brain lesion (s).
II. Clinical features supporting the diagnosis of subcortical vascular dementia include the following:
a. episodes of mild upper motor neuron involvement such as drift, reflex asymmetry, incordination
b. early presence of a gait disturbance (small-step gait or marche a petits-pa magnetic, apraxic-ataxic or Parkinsonian gait).
c. History of unsteadiness and frequent, unprovoked falls.
d. Early urinary frequency, urgency, and other urinary symptoms not explained by urologic disease.
e. Dysarthria, dysphagia, extrapyramidal signs (hypokinesia, rigidity).
f. Behavioral and psychological symptoms such as depression, personality change, emotional incontinence, psychomotor retardation.
III. Features that make the diagnosis of subcortical vascular dementia uncertain or unlikely include:
a. Early onset of memory deficit and progressive worsening of memory and other cognitive functions such as language (transcortical sensory aphasia), motor skills (apraxia), and perception (agnosia), in the absence of corresponding focal lesions on brain imaging.
b. Absence of relevant cerebrovascular disease lesions on brain CT or MRI.
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