Diagnostic Criteria for Vascular Cognitive Disorders

Sachdev, Perminder S.; Kalaria, Raj N.; O’Brien, John T.; Skoog, Ingmar; Alladi, Suvarna; Black, Sandra E.; Blacker, Deborah; Blazer, Dan G.; Chen, Christopher; Chui, Helena C.; Ganguli, Mary; Jellinger, K. A.; Jeste, Dilip V.; Pasquier, Florence; Paulsen, Jane S.; Prins, Niels D.; Rockwood, Kenneth; Román, Gustavo C.; Scheltens, Philip

doi:10.1097/wad.0000000000000034

Cited by 628 publications

(555 citation statements)

References 75 publications

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“…Cognitive changes in VCI/VaD are more variable than in AD and are dependent on the particular neuronal substrates related to the vascular pathology, while other functions such as memory, language, executive functions and non-cognitive features, depression and apathy are much more affected; delusions and hallucinations are less frequent [6,7].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The limitations of current clinical diagnostic criteria sets for VCI/VaD that poorly refl ect the underlying pathology, have been critically discussed recently [6,17].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Currently, several sets of criteria for the clinical diagnosis of VCI/VaD are used (see [8]): the NINDS-AIREN criteria [9], the ADDTC criteria [10], the DSM-V criteria (APA), distinguishing possible, probable and proven VaD (with pathologically proven multiple cerebrovascular lesions/CVLs) [11]; the NINDS-CSN criteria [12], the EFNS guidelines [13], the consensus statement of the American Stroke Association [14], and the VASCOG criteria [6]. Vascular cognitive impairment no dementia (VCIND) describes a condition related to vascular disease, in which cognitive impairment is not severe enough to fi t the criteria of dementia [15].…”

Section: Clinical Featuresmentioning

confidence: 99%

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Current Pathogenetic Concepts of Vascular Cognitive Impairment

Jellinger¹

2016

J Neurol Neurol Sci Disord

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The term vascular cognitive impairment designates a heterogenous group of disorders ranging from mild cognitive impairment to full-blown dementia -vascular dementia -resulting from cerebrovascular lesions involving various brain areas. Current clinical criteria show moderate sensitivity (50-56%) and variable specifi city (range 64-98%). The prevalence in autopsy series ranges from 0.03 to 58% (mean 8-15% in Western series, 22-35% in Japan). Major morphological types -multi-infarct and subcortical vascular encephalopathy, strategic infarct dementia, lacunar state, cortical granular atrophy (rare), and ischemic encephalopathy -are caused by atherosclerosis of major cerebral arteries and small vessel disease, resulting from systemic, cardiac and local vascular disease or cerebral amyloid angiopathy. Pathogenesis of vascular dementia is multifactorial, and pathophysiology affects brain areas and neurological networks involved in cognition, memory, behavior, and executive functions. Vascular brain injury in elderly persons often coexists with Alzheimer-type lesions and other pathologies resulting in mixed dementia. However, these lesions are also present in many non-demented elderly subjects. The heterogeneity of clinical manifestations, cerebrovascular pathology and their pathogenic factors result in limitations of the accuracy of diagnostic criteria for vascular dementia. Therefore, standardized and reproducible neuropathological criteria for the assessment of cerebrovascular lesions associated with cognitive impairment in order to elucidate contribution of cerebrovascular disease to cognitive impairment are urgently needed.

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Section: Clinical Featuresmentioning

confidence: 99%

“…The limitations of current clinical diagnostic criteria sets for VCI/VaD that poorly refl ect the underlying pathology, have been critically discussed recently [6,17].…”

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

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Current Pathogenetic Concepts of Vascular Cognitive Impairment

Jellinger¹

2016

J Neurol Neurol Sci Disord

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“…It has been recognized that vascular cognitive impairment (VCI) is correlated with disability worldwide and is the most common manifestation of severe cerebrovascular disease (Hachinski, 2007; Kearney‐Schwartz et al., 2009; Sachdev et al., 2014). Notably, stroke may happen with risk factors of vascular disease and cause decline of cognitive function (Dempsey, Vemuganti, Varghese, & Hermann, 2010; Elias et al., 2004).…”

Section: Introductionmentioning

confidence: 99%

Severe carotid artery stenosis evaluated by ultrasound is associated with post stroke vascular cognitive impairment

Lin

et al. 2016

Brain and Behavior

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BackgroundAcute ischemic stroke has been recognized as one key cause of vascular cognitive impairment (VCI). The purpose of this study was to evaluate the correlation between carotid artery stenosis and post VCI in acute ischemic stroke patients.MethodsIn this study, B‐mode ultrasound was applied to measure the degree of carotid artery stenosis. After 1 year, the stroke patients’ cognitive function was assessed by the mini‐mental state examination (MMSE) score. The relationship between the VCI and degree of carotid artery stenosis was evaluated by multivariate regression analysis.Results VCI was observed in 136 (37.2%) of the 365 participants. High degree of carotid artery stenosis was significantly correlated with VCI (p < .01), and this correlation remained unchanged even adjustment for age, gender, education level, stroke features, and vascular risk factors.ConclusionsThese findings indicate that high‐grade stenosis of carotid artery is positively correlated with post stroke VCI in patients with acute ischemic stroke. The evaluation of 1 year post stroke cognitive function may be a potential tool for screening stroke patients at risk of VCI.

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“…The neuropsychological evaluation must include memory, visuospatial, language, and executive domains . The most recent diagnostic criteria divides VCI into mild cognitive disorder and dementia or major cognitive disorder; there is a recommendation to evaluate praxis-gnosis-body schema, and social cognition, besides previous cognitive domains 2 . In both of them there are no concerns about cognitive evaluation in aphasic patients, which could be unsuitable in most studies.…”

mentioning

confidence: 99%

Cognitive deficit and aphasia – a challenging diagnosis

Brucki

2015

Arq. Neuro-Psiquiatr.

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O ne of the greatest challenges in cognitive neurology is to determine severity of cognitive impairment in patients with aphasia. Most of the cognitive evaluation is performed through language assessment; lesions causing aphasia can be spread in some different brain areas by committing different networks and, consequently, different cognitive domains. Otherwise, verbal based evaluations could show a false positive impairment.One of the vascular cognitive impairment (VCI) criteria classified it into vascular mild cognitive impairment and vascular dementia, based on functional impairment and number of evaluated cognitive domains. The neuropsychological evaluation must include memory, visuospatial, language, and executive domains 1 . The most recent diagnostic criteria divides VCI into mild cognitive disorder and dementia or major cognitive disorder; there is a recommendation to evaluate praxis-gnosis-body schema, and social cognition, besides previous cognitive domains 2 . In both of them there are no concerns about cognitive evaluation in aphasic patients, which could be unsuitable in most studies.Stud ies in tertiary outpatient clinics report a prevalence of vascular dementia between 24.9 and 32.25%; and among presenile dementia there was a prevalence of 36.9% 3,4,5. There are a few considerations regarding aphasia in these studies. In a prospective study, that have also included aphasics, frequency of VCI was 16.8% in 12-month follow-up 6 . In the majority of the studies, aphasic patients have shown poor performance in attention, executive functions, working memory, and short-term memory 7,8,9 . The study published in this number of Arq Neuropsiquiatr tries to fulfill a gap in this issue in Brazil, characterizing cognitive deficit in a sample of first-stroke patients. Bonini and Radanovic have evaluated 47 stroke patients without depression (non-aphasics: left hemisphere lesion: 17, right hemisphere lesion: 9; and 21 aphasics) with a comprehensive neuropsychological battery; functional activities and quality of life were measured, as well. Aphasics presented a poorer performance on digit span, verbal and visual memory, constructional praxis recall, clock design test, and phonemic verbal fluency. Quality of life was better in right hemisphere lesion and non-aphasic patients 10 . Aphasia severity correlated with scores in the Trail Making Test (TMT) part B, Digit Span forwards and backwards, and Gesture Praxis in this study. In another report, only attention was correlated with aphasia severity 9 .Although this study has limitations as a small number of patients with heterogeneous vascular lesions, it is needed to highlight the importance of the development of specific batteries for evaluating cognition in aphasic patients.Difficulties on interpretation of cognitive deficit in aphasics are relatively common, according to different lesioned topographies, involvement of cortical and subcortical areas, and white matter tracts, near common language areas 11 . More studies must be performed in Brazil to evaluate cogni...

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Diagnostic Criteria for Vascular Cognitive Disorders

Cited by 628 publications

References 75 publications

Current Pathogenetic Concepts of Vascular Cognitive Impairment

Current Pathogenetic Concepts of Vascular Cognitive Impairment

Severe carotid artery stenosis evaluated by ultrasound is associated with post stroke vascular cognitive impairment

Cognitive deficit and aphasia – a challenging diagnosis

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