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Understanding and Treating Vascular Cognitive Impairment

Gorelick, Philip B. MD, MPH, FAAN;; Nyenhuis, David PhD, ABPP

CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000429174.29601.de
Review Articles
Abstract

Purpose of Review: It is estimated that one in three people will experience a stroke, dementia, or both during their lifetime. The goal of this article is to assist clinicians in the identification and treatment of patients with vascular cognitive impairment (VCI). To that end, we will discuss the scope and definition of VCI; how this definition can be applied in clinical practice; VCI epidemiology and pathogenesis, its clinical features, and assessment; and prevention and treatment of this disorder.

Recent Findings: During the past decade, we have gained a more complete understanding of clinical manifestations of VCI (eg, the importance of executive function and memory), what it looks like pathologically (eg, the role of cerebral amyloid angiopathy, microinfarcts, and “silent” strokes), and how VCI relates to other disease processes (eg, co-occurrence with Alzheimer disease). A recent American Heart Association and American Stroke Association guidance statement clarified the construct of VCI, including the severity of cognitive and behavioral dysfunction contained under the definition of VCI and the presence of both “pure” and “mixed” VCI forms. VCI treatments approved by the US Food and Drug Administration are still lacking, and challenges remain regarding how to convert promising observational study findings that link stroke and coronary heart disease risk factors to cognitive impairment and dementia into evidence-based preventive methods.

Summary: VCI is a common contributor to cognitive impairment in later life. Because the risk of Alzheimer disease may be heightened by the same risk factors that make us susceptible to stroke and coronary heart disease, these borderlands merit careful consideration as we strive to preserve cognitive function throughout the aging process.

Author Information

Address correspondence to Dr Philip B. Gorelick, Saint Mary’s Health Care, 220 Cherry Street SE, H3037, Grand Rapids, MI 49503, pgorelic@trinity-health.org.

Relationship Disclosure: Dr Gorelick has received personal compensation for activities with AstraZeneca/Quinteles; BrainsGate; Dendreon Corporation; Daiichi Sanko Co., Ltd; F. Hoffmann-La Roche Ltd./PAREXEL International Corporation; Forest Laboratories, Inc./Watermark Medical; Takeda Pharmaceutical Company Limited. Dr Gorelick’s employer receives compensation for Dr Gorelick’s research work from Lundbeck and for Dr Gorelick’s service on the speakers’ bureau of Boehringer Ingelheim. Dr Nyenhuis reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gorelick discusses the unlabeled use of treatment of cardiovascular risk factors in the prevention of cognitive impairment and the unlabeled use of cholinesterase inhibitors for the treatment of vascular cognitive impairment. Dr Nyenhuis reports no disclosure.

© 2013 American Academy of Neurology