Vascular Cognitive Impairment (VCI)

Abstract

Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.

Relationship Between Hypertension and Cognitive Function in an Elderly Population: A Population-Based Study in Rural Northern China

“…Hypertension is a major risk factor for vascular dementia ( 37 , 38 ). Previous studies have shown that changes in blood pressure are associated with changes in cerebral perfusion and metabolism ( 5 , 39 , 40 ).…”

Sirtuins and cognition: implications for learning and memory in neurological disorders

“…VCI may be used to describe any cognitive impairments that are associated with cerebrovascular disease, and hypoperfusion has been identified as one of the main culprits of VCI. VCI ranges from mild cognitive impairments to vascular dementia that is caused by ischemic or hemorrhagic stroke and vascular factors alone or in a combination with neurodegeneration such as that from AD (Roman, 2002;Rundek et al, 2021). Cerebral hypoperfusion will lead to blood-barrier disruption, microglial activation, matrix metalloproteinase activation, white matter lesions, and ultimately, cognitive impairment due to chronic glucose and oxygen deficiency in parenchymal tissue (Swartz et al, 2003;Kitamura et al, 2012;Liu and Zhang, 2012;Zietemann et al, 2016;Duncombe et al, 2017;Zilberter and Zilberter, 2017).…”

Blood–Brain Barrier Dysfunction and the Potential Mechanisms in Chronic Cerebral Hypoperfusion Induced Cognitive Impairment

“…A growing amount of evidence from animal models and epidemiological investigations in humans suggests that chronic cerebral hypoperfusion (CCH) is one of the major pathophysiological hallmarks of cognitive decline ( Washida et al, 2019 ; Zlokovic et al, 2020 ; Rundek et al, 2021 ). CCH, despite without a clear definition, is implicated in multiple morbid conditions like heart failure, hypotension, and carotid stenosis ( Iturria-Medina et al, 2016 ; Ciacciarelli et al, 2020 ), whose relationships to cognitive function have been verified in previous research.…”