Mind and Brain pp 119-127 | Cite as

Vascular Cognitive Impairment

  • Petra Črnac Žuna
  • Hrvoje BudinčevićEmail author
  • Tena Sučić Radovanović
  • Milija Mijajlović
  • Natan Bornstein


Dementia represents a significant public health issue, as it is a leading cause of disability and the requirement of personal care assistance, particularly in the elderly. The second most common etiological factor contributing to dementia is a cerebrovascular disease, as it is the cause of vascular cognitive impairment and vascular dementia. We can recognize the full spectrum of cognition, from vascular mild cognitive impairment to vascular dementia. There are two forms of vascular cognitive impairment: post-stroke and non-stroke related. The diagnosis of probable vascular cognitive impairment requires confirmation of cognitive impairment, cerebrovascular disease, and a clear relationship between the two conditions. A combination of history, examination, and neuroimaging are fundamental for the assessment of the presence of cerebrovascular disease. The role of neuroimaging is particularly important in the diagnosis of vascular cognitive impairment, to confirm the presence, location, and severity of the cerebrovascular disease. Treatment of vascular cognitive impairment should be aimed at treating vascular risk factors and lifestyle modification.


Vascular cognitive impairment Vascular dementia Cerebrovascular disease Vascular risk factor Cognitive screening Cognitive rehabilitation Secondary prevention 


  1. 1.
    Bowler JV. Vascular cognitive impairment. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 5):v35–44. Epub 2005/11/18.CrossRefGoogle Scholar
  2. 2.
    Yoshida D, Ninomiya T, Doi Y, Hata J, Fukuhara M, Ikeda F, et al. Prevalence and causes of functional disability in an elderly general population of Japanese: the Hisayama study. J Epidemiol. 2012;22(3):222–9. Epub 2012/02/22.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987;76(5):465–79. Epub 1987/11/01.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Patterson C, Gauthier S, Bergman H, Cohen C, Feightner JW, Feldman H, et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Can J Neurol Sci. 2001;28 Suppl 1:S3–16. Epub 2001/03/10.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Bowler JV. Modern concept of vascular cognitive impairment. Br Med Bull. 2007;83:291–305. Epub 2007/08/07.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Salihovic D, Smajlovic D, Mijajlovic M, Zoletic E, Ibrahimagic OC. Cognitive syndromes after the first stroke. Neurol Sci: Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2018;39(8):1445–51. Epub 2018/05/21.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Lee AY. Vascular dementia. Chonnam Med J. 2011;47(2):66–71. Epub 2011/11/24.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Cunningham EL, McGuinness B, Herron B, Passmore AP. Dementia. Ulst Med J. 2015;84(2):79–87. Epub 2015/07/15.Google Scholar
  9. 9.
    Petersen RC. Early diagnosis of Alzheimer’s disease: is MCI too late? Curr Alzheimer Res. 2009;6(4):324–30. Epub 2009/08/20.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Kalaria RN. Neuropathological diagnosis of vascular cognitive impairment and vascular dementia with implications for Alzheimer’s disease. Acta Neuropathol. 2016;131(5):659–85. Epub 2016/04/12.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Iadecola C. The pathobiology of vascular dementia. Neuron. 2013;80(4):844–66. Epub 2013/11/26.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Ruitenberg A, Ott A, van Swieten JC, Hofman A, Breteler MM. Incidence of dementia: does gender make a difference? Neurobiol Aging. 2001;22(4):575–80. Epub 2001/07/11.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Casolla B, Leys D. Stroke and dementia. In: Brainin M, Heiss W-D, editors. Textbook of stroke medicine, 2nd ed. Cambridge University Press; 2014. p. 255–65.Google Scholar
  14. 14.
    Mijajlovic MD, Pavlovic A, Brainin M, Heiss WD, Quinn TJ, Ihle-Hansen HB, et al. Post-stroke dementia—a comprehensive review. BMC Med. 2017;15(1):11. Epub 2017/01/18.Google Scholar
  15. 15.
    Demarin V, Basic Kes V, Trkanjec Z, Budisic M, Bosnjak Pasic M, Crnac P, et al. Efficacy and safety of Ginkgo biloba standardized extract in the treatment of vascular cognitive impairment: a randomized, double-blind, placebo-controlled clinical trial. Neuropsychiatr Dis Treat. 2017;13:483–90. Epub 2017/03/01.Google Scholar
  16. 16.
    Roman GC. Vascular dementia may be the most common form of dementia in the elderly. J Neurol Sci. 2002;203–204:7–10. Epub 2002/11/06.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Hachinski V, Einhaupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, et al. Preventing dementia by preventing stroke: The Berlin Manifesto. Alzheimer’s Dement J Alzheimer’s Assoc. 2019;15(7):961–84. Epub 2019/07/23.CrossRefGoogle Scholar
  18. 18.
    Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology. 2007;69(24):2197–204. Epub 2007/06/15.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Kalaria RN. The pathology and pathophysiology of vascular dementia. Neuropharmacology. 2018;134(Pt B):226–39. Epub 2017/12/24.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Niwa K, Porter VA, Kazama K, Cornfield D, Carlson GA, Iadecola C. A beta-peptides enhance vasoconstriction in cerebral circulation. Am J Physiol Heart Circ Physiol. 2001;281(6):H2417–24. Epub 2001/11/16.Google Scholar
  21. 21.
    Olsson B, Hertze J, Lautner R, Zetterberg H, Nagga K, Hoglund K, et al. Microglial markers are elevated in the prodromal phase of Alzheimer’s disease and vascular dementia. J Alzheimer’s Dis: JAD. 2013;33(1):45–53. Epub 2012/08/15.CrossRefGoogle Scholar
  22. 22.
    Iadecola C. The overlap between neurodegenerative and vascular factors in the pathogenesis of dementia. Acta Neuropathol. 2010;120(3):287–96. Epub 2010/07/14.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Trapp BD, Stys PK. Virtual hypoxia and chronic necrosis of demyelinated axons in multiple sclerosis. Lancet Neurol. 2009;8(3):280–91. Epub 2009/02/24.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Zhang F, Eckman C, Younkin S, Hsiao KK, Iadecola C. Increased susceptibility to ischemic brain damage in transgenic mice overexpressing the amyloid precursor protein. J Neurosci: Off J Soc Neurosci. 1997;17(20):7655–61. Epub 1997/10/07.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Koike MA, Green KN, Blurton-Jones M, Laferla FM. Oligemic hypoperfusion differentially affects tau and amyloid-{beta}. Am J Pathol. 2010;177(1):300–10. Epub 2010/05/18.Google Scholar
  26. 26.
    Gorelick PB, Nyenhuis D. Understanding and treating vascular cognitive impairment. Continuum (Minneap Minn). 2013;19(2 Dementia):425–37. Epub 2013/04/06.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Farooq MU, Gorelick PB. Vascular cognitive impairment. Current atherosclerosis reports. 2013;15(6):330. Epub 2013/04/25.Google Scholar
  28. 28.
    Smith E. Vascular cognitive impairment. Continuum (Minneap Minn). 2016;22(2 Dementia):490–509. Epub 2016/04/05.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Leys D, Erkinjuntti T, Desmond DW, Schmidt R, Englund E, Pasquier F, et al. Vascular dementia: the role of cerebral infarcts. Alzheimer Dis Assoc Disord. 1999;13(Suppl 3):S38–48. Epub 1999/12/28.CrossRefGoogle Scholar
  30. 30.
    McKay E, Counts SE. Multi-infarct dementia: a historical perspective. Dement Geriatr Cogn Disord Extra. 2017;7(1):160–71. Epub 2017/06/20.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Sachdev P, Kalaria R, O’Brien J, Skoog I, Alladi S, Black SE, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206–18. Epub 2014/03/19.CrossRefGoogle Scholar
  32. 32.
    Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43(2):250–60. Epub 1993/02/01.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42(9):2672–713. Epub 2011/07/23.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Association AP. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC; 2013.Google Scholar
  35. 35.
    Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centers. Neurology. 1992;42(3 Pt 1):473–80. Epub 1992/03/01.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Organization WH. The ICD-10classification of mental and behavioural disorders. Switzerland: Diagnostic criteria for research Geneva; 1993.Google Scholar
  37. 37.
    Longstreth WT Jr. Brain vascular disease overt and covert. Stroke. 2005;36(10):2062–3. Epub 2005/09/30.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975;12(3):189–98. Epub 1975/11/01.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. Epub 2005/04/09.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The clock drawing test: a review of its accuracy in screening for dementia. Dement Neuropsycholo. 2009;3(2):74–81. Epub 2009/04/01.CrossRefGoogle Scholar
  41. 41.
    Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia. A cause of mental deterioration in the elderly. Lancet. 1974;2(7874):207–10. Epub 1974/07/27.CrossRefGoogle Scholar
  42. 42.
    Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010;41(6):1290–3. Epub 2010/04/10.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–38. Epub 2013/07/23.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Smith EE, Schneider JA, Wardlaw JM, Greenberg SM. Cerebral microinfarcts: the invisible lesions. Lancet Neurol. 2012;11(3):272–82. Epub 2012/02/22.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Haridimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry. 2012;83(2):124–37. Epub 2011/11/08.Google Scholar
  46. 46.
    Federico A, Di Donato I, Bianchi S, Di Palma C, Taglia I, Dotti MT. Hereditary cerebral small vessel diseases: a review. J Neurol Sci. 2012;322(1–2):25–30. Epub 2012/08/08.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Black SE. Vascular cognitive impairment: epidemiology, subtypes, diagnosis and management. J R Coll Physicians Edinb. 2011;41(1):49–56. Epub 2011/03/03.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017;120(3):472–95. Epub 2017/02/06.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701. Epub 2010/07/09.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Dufouil C, Chalmers J, Coskun O, Besancon V, Bousser MG, Guillon P, et al. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril protection against recurrent stroke study) magnetic resonance imaging substudy. Circulation. 2005;112(11):1644–50. Epub 2005/09/08.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R, et al. The Finnish geriatric intervention study to prevent cognitive impairment and disability (FINGER): study design and progress. Alzheimer’s Dement J Alzheimer’s Assoc. 2013;9(6):657–65. Epub 2013/01/22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Petra Črnac Žuna
    • 1
  • Hrvoje Budinčević
    • 1
    • 2
    Email author
  • Tena Sučić Radovanović
    • 3
  • Milija Mijajlović
    • 4
  • Natan Bornstein
    • 5
  1. 1.Department of NeurologySveti Duh University HospitalZagrebCroatia
  2. 2.Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
  3. 3.Department of RadiologySveti Duh University HospitalZagrebCroatia
  4. 4.Clinical Center of Serbia and School of Medicine University of Belgrade, Neurology ClinicBelgradeSerbia
  5. 5.Brain DivisionShaare Zedek Medical CenterJerusalemIsrael

Personalised recommendations