Vascular Disease Is a Significant Contributor To This Patient’s Cognitive Impairment

The Case A 75-year-old woman is evaluated for difficulties with memory and daily function. Over the past 2 years, she has had progressively worsening short-term memory and difficulties paying bills accurately or cooking complex meals. Her medical history is positive for hypertension and coronary artery disease with no recent cardiac symptoms and no history of transient ischemic attack or stroke. Her neurological examination is notable for a mini-mental state examination score of 24. Magnetic resonance imaging scan shows mild-to-moderate cortical atrophy, mild-to-moderate white matter hyperintensities, and a chronic lacunar infarct in the left thalamus.