Cognitive vascular impairment: An overview of clinical, diagnosis and treatment

Abstract

Although Alzheimer´s disease (AD) is the most commonly diagnosed cause of cognitive impairment among the aged, clinically apparent and subclinical forms of vascular disease including stroke are important as independent causes and contributors to cognitive dysfunction. Current estimates of the effect of different vascular risk factors on cognition in the elderly vary greatly between studies. There are differences in nosology, criteria, and measurement issues. Understanding the interaction between vascular disease and cognition represents an evolving challenge. Vascular cognitive impairment (VCI) is a heterogeneous group of cognitive disorders that share a presumed vascular cause [1]. This construct has evolved to describe a continuum of cognitive disorders in which vascular brain injury plays a role, ranging from mild cognitive impairment (MCI) to dementia [2]. The emphasis on VCI rather than vascular dementia (VaD) is deliberately intended to focus attention on earlier prevention and treatment. There is substantial evidence from observational studies and clinical trials that conventional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and atrial fibrillation play a role in the development of VCI [3]. Furthermore, concurrent vascular risk factors and vascular brain injury are often seen in older dementia patients, even though they may have a slowly progressive dementing illness most consistent with AD [4]. Of practical significance is that many of these morbidities are modifiable and should be the focus of interventions to minimize the burden of VCI, to ameliorate the course of cognitive decline, to improve quality of life, and to decrease mortality in our aging population.