PRIMEVIEW

VASCULAR COGNITIVE IMPAIRMENT

For the Primer, visit doi:10.1038/nrdp.2018.3

Many
Vascular cognitive impairment (VCI) risk factors MECHANISMS
EPIDEMIOLOGY
refers to any severity of cognitive for VCI have
impairment (from subjective complaints been identified,
some of which are The mechanisms of VCI are complex and are
only to dementia) caused by vascular
also risk factors for not fully understood. The best described
pathology. Patients with VCI typically
Low Alzheimer disease mechanism is direct tissue injury, such
have deficits in memory and executive
educational as macroscopic infarcts, microinfarcts,
function, mental slowness and
attainment microbleeds and white matter injury.
behavioural problems such as
This tissue injury can be caused by
anxiety and depression.
Advanced intracranial vessel diseases (such as
age atherosclerosis, arteriolosclerosis
Overweight Ischaemic and cerebral amyloid angiopathy).
DIAGNOSIS Smoking heart
failure In addition, intracranial vessel
diseases are independently
Several diagnostic criteria for associated with VCI when
VCI are available, each of which infarcts and vascular risk
has different levels of supporting Female factors are controlled,
evidence. The two most recent
sex suggesting that mechanisms
criteria are the Diagnosis and other than direct tissue
Stroke
Statistical Manual of Mental Diabetes injury are involved.
Depression
Disorders, Fifth edition (DSM-5) mellitus
Reduced
classification and the American physical
Heart Association/American Stroke activity
Association scientific statement on MANAGEMENT
Vascular Contributions to Cognitive
Impairment and Dementia. Both of these No symptomatic pharmacological
criteria require the presence of, Atrial treatments for VCI have been approved
and a temporal link between, fibrillation by the US FDA. In general, management
Pure vascular dementia
Hypercholesterolaemia
cognitive impairment and Hypertension includes improving control of vascular
(that is, dementia caused solely by
cerebrovascular disease for cerebrovascular pathology) is quite rare
risk factors and interventions to slow the
diagnosis. Diagnostic work-up and accounts for <10% of patients with progression of cognitive decline in individuals
of individuals with suspected dementia. Most patients also have other brain with vascular-related mild cognitive impairment.
VCI includes neuroimaging, pathologies, the most common of which is In patients with stroke, antihypertensive,
cognitive testing and laboratory Alzheimer disease. antithrombotic or lipid-lowering drugs, in
testing. Neuroimaging, addition to lifestyle modifications, should be
preferentially MRI, is used to prevent recurrent stroke. However,
essential and can be OUTLOOK although the prevention of recurrent stroke
used to identify should, in principle, prevent further cognitive
the type, severity The current sets of diagnostic mechanism-based specific brain defects, whether conventional therapies actually
and location of criteria for VCI or any other diagnosis. Identifying diseases should achieve this is controversial.
cerebrovascular type of dementia do not provide the exact combinations be able to be
pathology. guidelines for mixed pathology. of pathology will allow targeted to cure,
In the future, diagnosis should for precise or personalized stop or even prevent
change from a syndrome-based pharmacological cognitive decline
diagnosis to a more specific, treatments. In the future, and dementia.

Written by Louise Adams; designed by Laura Marshall Article number: 18004; doi:10.1038/nrdp.2018.4; published online 15 Feb 2018
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