2nd M/C cause of cognitive impairment and dementia in the elderly (after Alzheimer’s disease (AD))
The concept of VCI, was proposed by Sachdev in 1999 to describe the cognitive deficit of vascular origin severe enough to meet the criteria for a diagnosable disorder. It was initially ascribed to cognitive impairment of vascular origin not significant enough to impair activities of daily living (ADL), i.e., cognitive impairment that does not meet the requirements for dementia. The term now however refers to a broad spectrum of cognitive and behavioural changes associated with cerebral vascular pathology, characterized by attention and executive impairment ranging from early cognitive decline to dementia. VCI therefore encompasses all the cognitive disorders associated with cerebrovascular disease.
The risk factors for dementia overlap with those for stroke supporting the concept of a shared susceptibility, as also suggested by the epidemiological relationship between these 2 disorders
Increasing age (biggest risk factor)
Apolipoprotein E4 (strong risk factor especially in women)
Cerebrovascular cells are closely related to brain cells, and their interaction plays a critical role in brain development, maintenance, and function, both in health and disease
Leukoaraiosis: thinning of the white matter
the earliest changes are usually those of small vessel disease producing white matter changes.
Sites associated with dementia include basal forebrain, medial temporal, thalamic or parieto-occipital infarcts.
Vascular Impairment of Cognition Classification Consensus Study (VICCCS) classification:
4 major subtypes
Post-stroke dementia (PSD): Dementia manifesting within 6 months after a stroke
Subcortical ischemic vascular dementia (SIVaD)
Multi-infarct (cortical) dementia
VCI is not a single disorder, rather it is a spectrum of conditions with heterogeneous clinical presentations, aetiologies and treatment. VCI is characterized by deficit in executive functioning (planning, task flexibility, problem solving, etc.)
Multi infarct dementia:
Characterised by recurrent stroke, stepwise course, focal neurological symptoms and signs, and multiple cerebral infarcts on brain imaging.
Strategic infarct dementia:
Characterized by an abrupt onset of memory impairment or behavioural change in association with a single, strategically placed infarct.
Subcortical vascular dementia:
Subcortical vascular dementia encompasses the earlier entities, Binswanger’s disease and lacunar state and is characterised by a dysexecutive syndrome with mild memory loss, early gait disorder, Parkinsonian features, behavioral, and urinary symptoms.
For a diagnosis of VaD or mild VCI, the new VICCCS guideline generally requires magnetic resonance imaging (MRI) and evidence of vascular lesions that qualify for one of the major diagnostic subtypes
The main management strategy for VCI is the symptomatic treatment of VaD, management of risk factors as well non-pharmacological approaches aimed at preventing progression to VaD.