Vascular Cognitive Impairment in Clinical Practice

Abstract

Why do we use the term “vascular cognitive impairment” (VCI)? This term has a fairly recent history. Although it was long held that “senility” arose from cerebral arteriosclerosis, this view began to be undermined about 30 years ago, with the promulgation of the doctrine that dementia in the setting of cerebrovascular illness was a matter of small or large cerebral infarcts (1,2). With this view of vascular dementia (VaD) being a matter of strokes large and small, the term multi-infarct dementia (MID) became synonymous with VaD. In the early 1990s, however, the term MID was seen as inadequate. Specifically, it did not include many patients with clinically important cognitive impairment, especially those who, while impaired, did not meet traditional criteria for dementia (3). The latter, modeled on the dementia of Alzheimer’s disease (AD), excluded, for example, patients in whom memory complaint was not dominant, or in whom functional impairment might be due simply to the motoric effects of stroke. Initially, MID was replaced with VaD, which was conceptualized in two widely promulgated sets of consensus-based criteria (4,5).