An 85-year-old woman with hypertension and hyperlipidemia presented with gradual and progressive cognitive impairment for more than 2 years, involving cognitive domains of memory, executive function, visuospatial and mood. She has short-term memory loss such as forgetting whether she has eaten or showered. She will also ask the same questions repeatedly. However, her long-term memory remains intact. She has forgotten how to cook and has recently burnt the pot while cooking on the stove. She is also unable to manage finances and often gives the wrong change while buying her usual groceries. She has lost her way a few times in places where she is familiar with. In addition, she started having mood swings, low mood, and poor sleep. Physical examination reveals mild bilateral bradykinesia, absence of postural or rest tremors, normal limb power, tone and tendon reflexes. She has lower limb apraxia and mild postural instability. Her Mini-Mental State Examination (MMSE) was 16. While she scored 0 for delayed recall, she was able to recall all 3 objects with either category or lexical cueing.

A 71-year-old man was admitted for gradually difficult walking for 3 years along with memory impairment and urinary incontinence for 1 year. At first, this patient just complained of weakness while walking and dizziness. He was treated for arterial hypertension; however, no relief was obtained. He experienced more difficulties in walking and initiating steps. Besides these symptoms, his memory and thinking ability declined. His wife found that he responded slowly with personality change from a talkative and considerative gentleman to a silent man with apathy. The patient often felt urinary urgency, sometimes with incontinence. It was considered as symptoms of prostate hypertrophy. He was referred to a neurologist and MRI reported some lacunar infarctions and brain atrophy (retrospectively, lateral ventricles enlargement already existed). His Mini-Mental State Examination (MMSE) score was 18 points. Lumbar puncture (LP) was performed and cerebrospinal fluid (CSF) results were normal. The patient was diagnosed as having vascular dementia, hypertension and treated with neuroprotective agents and antihypertensives. After hospitalization, his symptoms were temporarily and partially relieved. His MMSE score was improved to 24 points when he was discharged.