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Vascular cognitive impairment

Nature Reviews Disease Primers volume 4, Article number: 18003 (2018) Cite this article

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Abstract

The term vascular cognitive impairment (VCI) was introduced around the start of the new millennium and refers to the contribution of vascular pathology to any severity of cognitive impairment, ranging from subjective cognitive decline and mild cognitive impairment to dementia. Although vascular pathology is common in elderly individuals with cognitive decline, pure vascular dementia (that is, dementia caused solely by vascular pathology) is uncommon. Indeed, most patients with vascular dementia also have other types of pathology, the most common of which is Alzheimer disease (specifically, the diffuse accumulation of amyloid-β plaques and neurofibrillary tangles composed of tau). At present, the main treatment for VCI is prevention by treating vascular diseases and other risk factors for VCI, such as hypertension and diabetes mellitus. Despite the current paucity of disease-modifying pharmacological treatments, we foresee that eventually, we might be able to target specific brain diseases to prevent cognitive decline and dementia.

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Figure 1: Relationship between VCI and vascular dementia.
Figure 2: Mechanisms of VCI.
Figure 3: Macroscopic and microscopic vascular pathology at autopsy.
Figure 4: MRI manifestations of cerebrovascular disease.

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Author information

Affiliations

  1. Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, Netherlands

    Wiesje M. van der Flier & Philip Scheltens

  2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands

    Wiesje M. van der Flier

  3. Center for Ageing and Health, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Ingmar Skoog

  4. Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA

    Julie A. Schneider

  5. L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

    Leonardo Pantoni

  6. Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Center for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Gerald Choa Neuroscience Center, The Chinese University of Hong Kong, Hong Kong

    Vincent Mok

  7. Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Memory Aging and Cognition Centre, National University Health System, Singapore

    Christopher L. H. Chen

Authors
  1. Wiesje M. van der Flier
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  2. Ingmar Skoog
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  3. Julie A. Schneider
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  4. Leonardo Pantoni
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  5. Vincent Mok
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  6. Christopher L. H. Chen
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  7. Philip Scheltens
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Contributions

Introduction (W.M.v.d.F.); Epidemiology (I.S.); Mechanisms/pathophysiology (J.A.S.); Diagnosis, screening and prevention (L.P. and P.S.); Management (V.M.); Quality of life (C.L.H.C.); Outlook (All); Overview of Primer (W.M.v.d.F. and P.S.).

Corresponding author

Correspondence to Wiesje M. van der Flier.

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Competing interests

W.M.v.d.F. has been an invited speaker at Boehringer Ingelheim and has received grant support from Boehringer Ingelheim, Biogen MA Inc, Piramal Neuroimaging, Roche BV, Janssen Stellar and Combinostics. All funding is paid to her institution. I.S. has been a consultant for Takeda and has given paid lectures for Takeda in relation to vascular dementia. J.A.S. has been on the scientific advisory boards of Genentech, Eli Lilly and Grifols and has received consultancy fees from Navidea Biopharmaceuticals and the Michael J. Fox Foundation. C.L.H.C. has received research support from Moleac, Nutricia, Lundbeck, Eisai, GlaxoSmithKline and Merck. All funding is paid to his institution. P.S. has acquired grant support from GE Healthcare, Danone Research, Piramal and Merck and, in the past 2 years, has received consultancy and speaker fees from GE Healthcare, Novartis, Nutricia, Probiodrug, Biogen, Lundbeck, Roche and EIP Pharma. All funding is paid to his institution. All other authors declare no competing interests.

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van der Flier, W., Skoog, I., Schneider, J. et al. Vascular cognitive impairment. Nat Rev Dis Primers 4, 18003 (2018). https://doi.org/10.1038/nrdp.2018.3

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