American Board of Internal Medicine (ABIM) Certification Practice Exam

Which clinical evidence is required for diagnosing vascular neurocognitive disorder?

1. Neuropsychological deficits

2. Neuroimaging evidence of tumor

3. A previous stroke or cerebrovascular disease

4. Genetic testing results

The correct answer is: A previous stroke or cerebrovascular disease

To diagnose vascular neurocognitive disorder, the presence of a previous stroke or cerebrovascular disease is essential. This condition is considered to be caused by conditions that impair blood flow to the brain, such as strokes and other forms of cerebrovascular disease, leading to the development of cognitive deficits. In vascular neurocognitive disorder, patients often experience a decline in cognitive function that can correlate clinically with a history of vascular issues. While neuropsychological deficits are indeed seen in these patients, they alone do not confirm the existence of the vascular causes without the contextual evidence of previous cerebrovascular incidents. Neuroimaging may reveal evidence of prior strokes or other cerebrovascular damage, but it is the history of these events that directly ties the cognitive impairment to the underlying vascular pathology. Therefore, understanding the relationship between strokes or cerebrovascular disease and cognitive decline is crucial in establishing the diagnosis of vascular neurocognitive disorder. Genetic testing is not relevant in this context, as this disorder is primarily associated with acquired vascular damage rather than inherited genetic conditions.