7th June 2023

A 55-year-old woman is seen in memory clinic with cognitive decline. Her past medical history is significant for migraines

A 55-year-old woman is seen in memory clinic with cognitive decline. Her past medical history is significant for migraines with aura, depression, and hypertension. She did not grow up with her biological father but knows that he died of dementia aged 60 years old. She is a smoker with a 10-pack-year history and drinks approximately twenty units of alcohol per week. She has an MRI brain which shows deep white matter hyperintensities and subcortical infarcts in both hemispheres. On examination, she scores 18/30 on MoCA, with the lowest scores in tests of executive function.

Which of the following options is the most likely diagnosis?