Background: Several sets of diagnostic criteria have been published for vascular dementia since the 1960s. The continuing ambiguity in vascular dementia definition warrants a critical reexamination.
Methods: Participants at a special symposium of the International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2009 critiqued the current criteria. They drafted a proposal for a new set of criteria, later reviewed through multiple drafts by the group, including additional experts and the members of the Neurocognitive Disorders Work Group of the fifth revision of Diagnostic and Statistical Manual (DSM-5) Task Force.
Results: Cognitive disorders of vascular etiology are a heterogeneous group of disorders with diverse pathologies and clinical manifestations, discussed broadly under the rubric of vascular cognitive disorders (VCD). The continuum of vascular cognitive impairment is recognized by the categories of Mild Vascular Cognitive Disorder, and Vascular Dementia or Major Vascular Cognitive Disorder. Diagnostic thresholds are defined. Clinical and neuroimaging criteria are proposed for establishing vascular etiology. Subtypes of VCD are described, and the frequent cooccurrence of Alzheimer disease pathology emphasized.
Conclusions: The proposed criteria for VCD provide a coherent approach to the diagnosis of this diverse group of disorders, with a view to stimulating clinical and pathologic validation studies. These criteria can be harmonized with the DSM-5 criteria such that an international consensus on the criteria for VCD may be achieved.
*Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales
†Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
‡Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear
§Department of Psychiatry, University of Cambridge, Cambridge, UK
∥Department of Psychiatry and Neurochemistry, University of Gothenburg, Göteborg, Sweden
¶Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
#University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON
§§§Dalhousie University, Halifax, NS, Canada
**Departments of Epidemiology, Harvard Medical School, Boston, MA
††Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
‡‡Memory Aging and Cognition Centre, National University Health System, Singapore
§§Department of Neurology, University of Southern California and Keck School of Medicine, Los Angeles, CA
∥∥University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA
¶¶Institute of Clinical Neurobiology, Vienna, Austria
##Department of Psychiatry, University of California, San Diego, CA
***University Lille Nord de France UDSL and Memory Clinic, CHU, Lille, France
†††The Carver College of Medicine, The University of Iowa, Iowa City, IA
‡‡‡Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
∥∥∥Methodist Neurological Institute, Houston, TX
P.S.: initiated the project, summarized results of the discussions, wrote the first draft, and finalized the manuscript. R.J., J.O.B., I.S., S.A., S.E.B., D. Blacker, D. Blazer, C.C., H.C., M.G., K.J., D.V.J., F.P., J.P., N.P., K.R., G.R., and P.S.: reviewed the literature, made substantive contributions to the content, and provided comments on multiple drafts of the manuscript.
The International Society for Vascular Behavioural and Cognitive Disorders (VASCOG) provided support for the conferences from which this manuscript emanated.
Reprints: Perminder Sachdev, MD, PhD, Centre for Healthy Brain Ageing, UNSW Australia and the Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW 2031, Australia (e-mail: email@example.com).
Received September 5, 2013
Accepted February 5, 2014