Neuroimaging criteria and cognitive performance in vascular mild cognitive impairment: A systematic review.

Felipe Kenji Sudo,Chan Tiel,Jerson Laks,Eliasz Engelhardt,Letice Ericeira-Valente,Gilberto Sousa Alves,Denise Madeira Moreira

doi:10.1590/1980-57642015dn94000394

Felipe Kenji Sudo, Chan Tiel + Show 5 more

Open Access

https://doi.org/10.1590/1980-57642015dn94000394

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Abstract

The recognition of Cerebrovascular Disease (CVD) at earlier clinical stages may favor the control of vascular risk factors and prevention of dementia. However, operational criteria for symptomatic phases at non-dementia stages are often difficult, as the current criteria normally require the evidence of extensive subcortical disease.ObjectiveTo identify the neuroimaging profile of Vascular Mild Cognitive Impairment (VaMCI), the impact of those aspects over cognition and the neuropsychological tests that distinguished VaMCI from other groups.MethodsSearches were performed in Scopus, ISI and PsycINFO, using the following key terms: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular cognitive impairment not demented" OR "subcortical mild cognitive impairment".ResultsOf 249 papers, 20 studies were selected. Ten of those included only patients with severe White Matter Hyperintensities (WMH), whereas 10 others admitted subjects with moderate-to-severe WMH. Both groups showed poor performances in Executive Function (EF) tasks in comparison to normal controls and other diagnostic groups. Among EF tests, those assessing "complex" EF abilities consistently distinguished VaMCI from other groups, regardless of the severity of WMH. VaMCI subjects with severe or moderate-to-severe WMH showed cognitive deficits in comparison with other groups. "Complex" EF tests were the most useful in differentiating those patients from the other groups.ConclusionThe occurrence of VaMCI may be associated with the presence of CVD at moderate levels; the detection of vascular damage at earlier stages may allow the adoption of therapeutic actions with significant effect-sizes.

Highlights

Vascular Cognitive Impairment (VCI) is an umbrella concept which comprises a continuum of vascularrelated cognitive impairment, from high-risk preclinical conditions (“brain-at-risk”) to Vascular Dementia (VaD)
Intermediate stages are commonly referred as Vascular Mild Cognitive Impairment (VaMCI) or Vascular Cognitive Impairment No-Dementia (Va-CIND).[1]
The idea that VCI comprises a spectrum of different stages of vascular-related cognitive impairment may suggest that dementia can be preceded by subtle cognitive changes associated with Cerebrovascular Disease (CVD).[41]

Summary

Introduction

Vascular Cognitive Impairment (VCI) is an umbrella concept which comprises a continuum of vascularrelated cognitive impairment, from high-risk preclinical conditions (“brain-at-risk”) to Vascular Dementia (VaD). The VASCOG statement represented a more comprehensive neuroimaging criterion in comparison to the AHA/ASA recommendations and a substantial change in relation to the Erkinjuntti’s neuroimaging criteria for Subcortical Ischemic VaD (2000), in which extensive and confluent WMH or moderate WMH combined with at least 5 lacunes was required to characterize CVD.[4] the persistence in the new criteria of the need for extensive and confluent WMH contrasted with some studies, which have suggested that moderate WMH with less than 5 lacunes could account for cognitive impairments.[5] As indicated by several studies, mild WMH is highly prevalent among normal elderly individuals and has not been significantly associated with cognitive changes.[6]

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