Abstract
The term vascular cognitive impairment (VCI) has been proposed to encompass all people with cognitive impairment of cerebrovascular origin. VCI is not a single condition, but has several clinical presentations, etiologies, and treatment. VCI forms a spectrum that includes vascular dementia, mixed Alzheimer's disease with a vascular component, and VCI that does not meet dementia criteria. Multiple pathophysiological mechanisms contribute to VCI, accounting for its heterogeneity. Although main changes in the brain in VCI include cerebral infarcts, vascular cognitive impairment is thought to be due to factors beyond acute infarcts. Cerebral white matter lesions and silent brain infarcts are considered to be risk factors for VCI. The prevalence of VCI is high and this entity is poised to become the silent epidemic of the 21st century. Cognitive impairment due to cerebrovascular disease can to some extent be improved, and VCI prevented, if vascular risk factors are brought under control and strokes do not recur. Therefore, strategies that focus on the prevention and treatment of the cognitive impairment associated with cerebrovascular disease are high priority healthcare objectives.
Highlights
The role of systemic vascular disease in the development and manifestation of dementing illnesses is becoming increasingly important. Both epidemiologic and histopathologic studies have emphasized the role of vascular risk factors in the development of cognitive impairment and dementia, and in the cognitive dysfunction that may result in the presence of both vascular and neurodegenerative disease
Because vascular risk factors can be identified, can be followed, and in theory, are treatable, management of vascular disease is one area of interest that might prevent cognitive impairment and dementia, studies to date have not proven this in actual practice
Alzheimer’s disease (AD) is the most common type of dementia identified in a clinical setting, many individuals diagnosed with AD have cerebrovascular lesions identified at autopsy
Summary
Both epidemiologic and histopathologic studies have emphasized the role of vascular risk factors in the development of cognitive impairment and dementia, and in the cognitive dysfunction that may result in the presence of both vascular and neurodegenerative disease. Because vascular risk factors can be identified, can be followed, and in theory, are treatable, management of vascular disease is one area of interest that might prevent cognitive impairment and dementia, studies to date have not proven this in actual practice. Alzheimer’s disease (AD) is the most common type of dementia identified in a clinical setting, many individuals diagnosed with AD have cerebrovascular lesions identified at autopsy.
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