Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects

Abstract

Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or “hidden” in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.

MCT2 overexpression promotes recovery of cognitive function by increasing mitochondrial biogenesis in a rat model of stroke

“…Stroke survivors are at high risk of cognitive impairment within 3 months of the stroke (Nakling et al 2017 ). The risk factors for cognitive impairment include age, smoking, hyperlipidemia, hypertension, and diabetes mellitus (Kim et al 2017 ; Koyanagi et al 2018 ; Meguro and Dodge 2019 ; Wong et al 2019 ; Xiu et al 2019 ); however, the precise mechanism underlying post-stroke cognitive impairment remains unclear. Vascular cognitive impairment and Alzheimer’s disease (AD) are the main causes of post-stroke cognitive decline (Bordet et al 2017 ).…”

Baseline White Matter Is Associated With Physical Fitness Change in Preclinical Alzheimer’s Disease

“…The detrimental effects of vascular risk factors on WMM have also been shown to be exacerbated among APOE ε4 carriers (Power et al, 2017). Vascular risk factors such as arterial hypertension, blood pressure, and elevated total cholesterol level have shown to play significant roles in the development of vascular MCI (Stephan et al, 2009;Meguro and Dodge, 2019). Accumulation of multiple vascular risk factors has shown to affect longitudinal WMM integrity in patients with MCI and dementia (Maillard et al, 2015).…”

Exploring the Potential of Mesenchymal Stem Cell-Based Therapy in Mouse Models of Vascular Cognitive Impairment

“…While such coexistence is difficult to observe naturally in animal models, this overlap is commonly observed clinically in the aged [4]. Similar to AD, the etiology of VCI is known to be complex and heterogeneous [5]. Chronic hypoperfusion is considered to be one of the major pathogenic mechanisms underlying VCI [6][7][8].…”