Chapter 11 Vascular Cognitive Impairment

Abstract

Publisher Summary This chapter offers information on vascular cognitive impairment. Vascular cognitive impairment (VCI) is currently considered as the most recent modification of the terminology to reflect the encompassing effects of vascular disease or lesions on cognition, and incorporates the complex interactions among vascular etiologies, risk factors, and cellular changes within the brain and cognition. The term includes those patients with vascular disease sufficient to cause a dementia syndrome or vascular dementia (VaD). Ischemic brain lesions are considered to be the primary cause of the cognitive impairment. The dementia resulting from cerebrovascular disease (CVD) involves multiple causes, several risk factors, and variable clinical manifestations, and as such, it is a challenge for clinical trials and research. The Hachinski Ischemic Score (HIS) has been widely used as an initial screen to differentiate patients with VaD and AD. The burden of VCI can be reduced by preventing and controlling vascular risk factors. The two main subtypes of the VaD syndrome include large cortical infarction or multi-infarct dementia (MID) and small vessel disease–related dementia or subcortical ischemic vascular disease and dementia (SIVD), which is increasingly common in the oldest patients. Focal clinical signs, neuroimaging, and neuropsychological findings may be reliably used to predict the neuropathologic diagnosis of VaD.