Is the time ripe for new diagnostic criteria of cognitive impairment due to cerebrovascular disease? Consensus report of the International Congress on Vascular Dementia working group

Abstract

BackgroundLong before Alzheimer’s disease was established as the leading cause of dementia in old age, cerebrovascular lesions were known to cause cognitive deterioration and associated disability. Since the middle of the last century, different diagnostic concepts for vascular dementia and related syndromes were put forward, yet no widely accepted diagnostic consensus exists to date.DiscussionSeveral international efforts, reviewed herein, are ongoing to define cognitive impairment due to cerebrovascular disease in its different stages and subtypes. The role of biomarkers is also being discussed, including cerebrospinal fluid proteins, structural and functional brain imaging, and genetic markers. The influence of risk factors, such as diet, exercise and different comorbidities, is emphasised by population-based research, and lifestyle changes are considered for the treatment and prevention of dementia.ConclusionTo improve the diagnosis and management of vascular cognitive impairment, further progress has to be made in understanding the relevant pathomechanisms, including shared mechanisms with Alzheimer’s disease; bringing together fragmented research initiatives in coordinated international programs; testing if known risk factors are modifiable in prospective interventional studies; and defining the pre-dementia and pre-clinical stages in line with the concept of mild cognitive impairment due to Alzheimer’s disease.

Bilingualism Is Associated with a Delayed Onset of Dementia but Not with a Lower Risk of Developing it: a Systematic Review with Meta-Analyses

“…Increasing statistical power will enable partitioning of participants into different dementia etiologies (Nelson et al, 2019) and to conduct sub-group analyses. While categorizing participants into dementia subtypes poses several challenges (De Reuck et al, 2016), applying biomarkers could help researchers in classifying dementia subtypes (Jack et al, 2016;Perneczky et al, 2016). Future studies should consider adjusting for variables such as physical activity, which is associated with the risk of dementia (Brini et al, 2018b).…”

Cerebrospinal fluid lipocalin 2 as a novel biomarker for the differential diagnosis of vascular dementia

“…Despite the importance of the disease, diagnosis has been hampered by the lack of well-defined standardized criteria. Commonly used criteria 2 have suboptimal diagnostic accuracy 3,4 . Unified neuropathological criteria have not been available 5 in the past and recently published guidelines 6 have not yet been widely adopted.…”

What is new in vascular dementia?

“…Their aim was to produce consensus statements on some of the contentious topics within the field. Some of these teams have now been successful in formulating conclusions, which are now published in BMC Medicine [3–6]. …”

“…An attempt to clarify the confusion and delineate future solutions to existing needs was made by Perneczky et al [3]. Modern neuroimaging techniques using magnetic resonance imaging (MRI) are very sensitive for showing white matter changes, lacunes, and microbleeds, and their contribution is discussed by Heiss et al [4].…”