Abstract
Introduction. Vascular cognitive impairment is a common yet preventable cause for dementia. It needs high degree of suspicion and appropriate designing of investigatory tools to confirm diagnosis, identify comorbidities, and ascertain the areas of impairment. Commonly DSM-IV criterion is applied for diagnosis and detailed clinical and neuropsychological examination for identifying the specific phenotype is used. Early diagnosis using the mandatory criteria will help in early initiation of disease modifying treatment strategies which can result in partial reversal of vascular changes and arrest of progression. Patients with young onset disease might require genetic characterization for designing more aggressive treatment. Discussion and Conclusion. Dementias as such carry poor course and prognosis resulting in severe Disability Adjusted Life Years (DALYs) for patients and caregivers. Therefore, it is mandatory to identify treatable and preventable causes so that man power loss can be reduced.
Highlights
Vascular cognitive impairment is a common yet preventable cause for dementia
The term vascular cognitive impairment was proposed by Sachdev [2] as an umbrella term to denote cognitive disorders due to cerebrovascular cause ranging from Mild Cognitive Impairment stage (MCI) to vascular dementia and cerebral small vessel disease (SVD) is an important and major contributor to the same [1, 3]
Since cerebral SVD is difficult to detect in vivo, we have to rely on radiological markers for the same and predominantly the triad of Periventricular white matter hyperintensities, lacunes, and microbleeds constitute the continuum of SVD [3, 4]
Summary
Cerebral small vessel disease (SVD) is characterized by disease of the small perforating arteries which are defined as “vessels with a diameter less than 50 μm” and “all the vessels within the brain parenchyma plus the vessels with a diameter less than 500 μm in the leptomeningeal space” supplying the deep brain structures [1]. Cerebral SVD is a neuroimaging defined concept and there has been a unified approach to the neuroimaging standards for research in SVD under the acronym STRIVE (STandards for ReportIng Vascular changes on nEuroimaging) which has resulted in the adaptation of major four conclusions which include the following: (A) the number of SVD lesion subtypes was broadened to include six types of neuroimaging lesions: (1) recent small subcortical infarcts; (2) lacunes of presumed vascular origin; (3) white matter hyperintensity of presumed vascular origin; (4) perivascular spaces; (5) cerebral microbleeds; and (6) brain atrophy based on the association between subcortical lesions and brain atrophy; (B) the establishment of a common language about terms and definitions for SVD features visible on magnetic resonance imaging (MRI); (C) maintenance of minimum standards for image acquisition and analysis; (D) agreement on standards for scientific reporting of changes related to SVD on neuroimaging along with review of the newer imaging techniques for the detection and quantification of preclinical manifestations of SVD [1, 3]. This review article deals with pure vascular dementias and other dementias associated with vascular changes and mixed dementias have not been considered
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