Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (original) (raw)

Vascular Contributions to Cognitive Impairment and Dementia

Stroke, 2011

Background and Purpose— This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. Methods— Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic lit...

Vascular aspects of cognitive impairment and dementia

Journal of Cerebral Blood Flow & Metabolism, 2013

Hypertension and stroke are highly prevalent risk factors for cognitive impairment and dementia. Alzheimer's disease (AD) and vascular dementia (VaD) are the most common forms of dementia, and both conditions are preceded by a stage of cognitive impairment. Stroke is a major risk factor for the development of vascular cognitive impairment (VCI) and VaD; however, stroke may also predispose to AD. Hypertension is a major risk factor for stroke, thus linking hypertension to VCI and VaD, but hypertension is also an important risk factor for AD. Reducing these two major, but modifiable, risk factors—hypertension and stroke—could be a successful strategy for reducing the public health burden of cognitive impairment and dementia. Intake of long-chain omega-3 polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the renin-angiotensin system (e.g. angiotensin II or angiotensin-converting enzyme) have been shown to reduce the risk of developing hypertension an...

Vascular cognitive impairment and vascular dementia

Journal of the Neurological Sciences, 2002

The criteria for vascular dementia (VaD) depend on first diagnosing dementia using Alzheimer-type criteria, upon which are superimposed vascular events, usually following a stroke model. This if often inappropriate, however, as memory loss is not always prominent in VaD. Alzheimer-type criteria will not detect these patients, and much brain injury can occur without resulting in classical features of stroke. VaD is often only diagnosed when dementia is clinically manifest, already too late to influence the early progression of the disease. Moreover, the predominating consensus-based criteria have demonstrably poor reliability. These shortcomings in the diagnosis of VaD have led to the development of the concept of vascular cognitive impairment (VCI), a broader term that is intended to detect cognitive loss before the dementia advances beyond effective treatment. Criteria for VCI are in the early stages of development. A lack of data on the beginnings of cognitive loss has inhibited their formalization, but it appears that the level of cognition should be set at a sensitive rather than a specific level. Similarly, for routine purposes, neuroimaging evidence of any cerebrovascular disease may be sufficient to document VCI and specific localization is not required. The current clinical criteria for VaD are probably not applicable for the diagnosis of VCI since the presence of focal signs is inappropriate, and stepwise progression is more supportive than diagnostic of VCI. The purpose of defining the new concept of VCI is to identify preventable risk factors. Importantly, not only physical health but also mental health should be monitored and treated.

Vascular Contribution to Cognition in Stroke and Alzheimer's Disease

Brain Science Advances, 2018

Vascular factors to cognitive impairment in degenerative on non-degenerative diseases have been reported, examined, and debated for several decades. The various definitions of cognitive impairment due to vascular origins will make these results diverse. During this review, we are going to report currently update information of vascular contributions to cognitive function, in clinical or neuroimaging findings. Risks factors and their managements also will be discussed and reported to have a comprehensive review.

Pathophysiology of vascular dementia

Immunity & Ageing, 2009

The concept of Vascular Dementia (VaD) has been recognized for over a century, but its definition and diagnostic criteria remain unclear.

Vascular cognitive impairment: Epidemiology, subtypes, diagnosis and management

2011

Vascular cognitive impairment (VCI) often refers to cognitive impairment related to cerebrovascular disease (CVD) that is not severe enough to interfere with autonomy in activities of daily living (ADLs). Just as mild cognitive impairment may be a precursor of Alzheimer's dementia (AD), VCI may represent an 'at risk' state for decline to vascular dementia (VaD), which may be preventable or delayed by aggressive management of vascular risk factors. 1 However, VCI has also been used to embrace any cognitive impairment in which vascular disease is a contributing factor. This would include vascular cognitive impairment-not dementia (VCIND), vascular dementia (VaD) and mixed VaD and AD. 2 If one adopts this comprehensive concept, VCI would have comparable prevalence and mortality to so-called 'pure' AD. 3 The Canadian Study of Health and Aging suggested that, for those over the age of 65, VaD causes 19% of dementia cases. 4 However, this was based on history, physical and cognitive testing without the benefit of imaging, and likely overestimated pure VaD, while underestimating mixed AD and VaD. Other epidemiological studies from Western countries suggest that VaD is the second most common cause of dementia after AD, but in Asia it may be the primary aetiology. Like AD, VaD increases with age, with prevalence estimates in people in their 70s ranging from 1.5% to 4.8%. 5 US estimates vary more widely, from 9% to 39% of those aged over 65. 6 Whatever the point estimates, however, clearly all dementias are a major growing health problem as they increase exponentially with age over 65, and it is projected that two billion of the world's population will be over 65 in a generation. By general consensus, dementia has usually required a memory deficit plus impairment in at least one other cognitive domain (e.g. language, praxis, visuospatial or executive abilities) that causes loss of autonomy in instrumental and self-care ADLs. 7 The new Diagnostic and Statistical Manual of Mental Disorders (DSM-V) currently under review suggests the terms 'major neurocognitive disorders' (for dementia) and 'minor neurocognitive disorders' (for CIND or mild cognitive Vascular cognitive impairment: epidemiology, subtypes, diagnosis and management This review is based on a presentation given by Professor Black at the RCPE Care of the Elderly Symposium on

The many faces of vascular cognitive impairment

Journal of neurochemistry, 2018

This Preface introduces the articles of the special issue on "Vascular Dementia" in which several recognized experts provide an overview of this research field. The brain is a highly vascularized organ and consequently, vascular dysfunction and related pathways affect cognitive performance and memory. Vascular dementia or vascular cognitive impairment is the second most common type of dementia after Alzheimer's disease, and both disorders often occur in parallel. With this special issue, we hope to provide insight and a stimulating discussion for the future development of this research field. This article is part of the Special Issue "Vascular Dementia".

Vascular risk factors as treatment target to prevent cognitive decline

Journal of Alzheimer's disease : JAD, 2012

Epidemiological studies have consistently shown that vascular risk factors including hypertension, diabetes, obesity, hypercholesterolemia, smoking, and lack of physical exercise are associated with an increased risk of cognitive decline and dementia. Neuroradiological and neuropathological studies have confirmed the importance of cerebrovascular lesions in the etiology of late onset dementia. We have reviewed the literature and conclude that up until now randomized controlled clinical trials targeting individual risk factors and assessing cognitive decline or dementia as an outcome have not convincingly shown that treatment of vascular risk factors can actually prevent or postpone cognitive decline and dementia. New studies targeting several vascular risk factors at the same time and using cognitive decline or dementia as primary outcome might answer the question whether cognitive decline can really be postponed or even prevented. The design of such studies is not straightforward a...