Vascular Cognitive Impairment

  • David J. Libon
  • Catherine C. Price
  • Rodney A. Swenson
  • Dana Penney
  • Bret Haake
  • Alfio Pennisi


Vascular Cognitive Impairment or VCI can be compared to the proverbial blind men palpating the elephant. Sometimes the “parts” appear to be diverse and disparate. Thus, VCI tends to mean different things to different people. Despite this diversity of opinions, the study of vascular brain disease has a long and quite distinguished history in neurology.

A fundamental issue regarding mild cognitive impairment associated with vascular disease is the ultimate relationship of VCI to vascular dementia (VaD). Here is when a simple palpation of the “parts” may cause confusion. In this chapter we do not necessarily draw a definitive line that separates VCI from VaD. The exact relationship between these entities is a work in progress. Nonetheless, it is very clear that VCI and VaD are opposite sides of the same coin.

This chapter will be divided into five parts. First, we present a short historical perspective of vascular disease as related to VCI. The second part of this chapter...


Pulse Wave Velocity Executive Control Carotid Stenosis Vascular Cognitive Impairment Information Processing Speed 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bowler, J. V. (2004). Vascular cognitive impairment. Stroke, 35, 386–388.PubMedCrossRefGoogle Scholar
  2. Bowler, J. V. (2005). Vascular cognitive impairment. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 35–44.CrossRefGoogle Scholar
  3. Bowler, J. V., & Hachinski, V. (1995). Vascular cognitive impairment: A new approach to vascular dementia. In Bailliere’s clinical neurology, 4, 357–376.Google Scholar
  4. Canning, S. J., Leach, L., Stuss, D., Ngo, L., & Black, S. E. (2004). Diagnostic utility of abbreviated fluency measures in Alzheimer disease and vascular dementia. Neurology, 62, 556–562.PubMedGoogle Scholar
  5. Carew, T. G., Lamar, M., Cloud, B. S., & Libon, D. J. (1997).Impairment in category fluency in ischaemic vascular dementia. Neuropsychology, 11, 400–412.PubMedCrossRefGoogle Scholar
  6. Davis, H.S., & Rockwood, K. (2004). Conceptualization of mild cognitive impairment: a review. International Journal of Geriatric Psychiatry, 19, 313–319.PubMedCrossRefGoogle Scholar
  7. de Leeuw, F., Richard, F., de Groot, J. C, van Duijn, C. M., Hofman, A., van Gijn, J., et al. (2004). Interaction between hypertension, apoE, and cerebral white matter lesions. Stroke, 35, 1057–1060.PubMedCrossRefGoogle Scholar
  8. De Jager, C. A., Hogervorst, E., Combrinck, M., & Budge, M. M. (2003). Sensitivity and specificity of neuropsychological tests for mild cognitive impairment, vascular cognitive impairment, and Alzheimer’s disease. Psychological Medicine, 33,1039–1050.PubMedCrossRefGoogle Scholar
  9. Devasenapathy, A., & Hachinski, V. C. (2000).Vascular cognitive impairment. Current Treatment Options in Neurology, 2,61–71.PubMedCrossRefGoogle Scholar
  10. Di Carlo, A., Baldereschi, M., Amaducci, L., Maggi, S., Grigoletto, F., Scarlato, G., et al. (2000). Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian longitudinal study on aging.Journal of the American Geriatrics Society, 48, 775–782.PubMedGoogle Scholar
  11. Erkinjuntti, T., & Rockwood, K. (2003). Vascular dementia.Seminars in Clinical Neuropsychiatry, 8, 37–45.PubMedCrossRefGoogle Scholar
  12. Frisoni, G. B., Galluzzi, S., Bresciani, L., Zanetti, O., & Geroldi, C. (2002). Mild cognitive impairment with subcoritcal vascular features: clinical characteristics and outcome.Journal of Neurology, 249, 1423–1432.PubMedCrossRefGoogle Scholar
  13. Galluzzi, S., Sheu, C. F., Zanetti, O., & Frisoni, G. B. (2005). Distinctive clinical features of mild cognitive impairment with subcortical cerebrovascular disease. Dementia and Geriatric Cognitive Disorders, 19, 196–203.PubMedCrossRefGoogle Scholar
  14. Garrett K. D., Browndyke J. N., Whelihan W., Paul R. H., DiCarlo M., Moser D. J., et al. (2004). The neuropsychological profile of vascular cognitive impairment – no dementia: Comparisons to patients at risk for cerebrovascular disease and vascular dementia. Archives of Clinical Neuropsychology, 19, 745–757.PubMedCrossRefGoogle Scholar
  15. Guidi, I., Galimberti, D., Lonati, S., Novembrino, C., Bamonti, F., Tiriticco, M., et al. (2006). Oxidative imbalance in patients with mild cognitive impairment and Alzheimer’s disease.Neurobiology of Aging, 27, 262–269.PubMedCrossRefGoogle Scholar
  16. Hachinski, V. C. (1994). Vascular dementia: a radical definition.Dementia, 5, 130–132.PubMedGoogle Scholar
  17. Hachinski, V. C., Potter, P., & Merskey, H. (1987).Leuko-araiosis.Archives of Neurology, 44, 21–23.PubMedCrossRefGoogle Scholar
  18. Hanon, O., Haulon, S., Lenoir, H., Seux, M. L., Rigaud, A. S., Safar, M., et al. (2005). Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss. Stroke, 36, 2193–2197.PubMedCrossRefGoogle Scholar
  19. Hauw, J. J. (1995). The history of lacunes. In G. A. Donnan, B. Norrving, J. M. Bamford, & J. Bogousslavsky (Eds.), Lacunar and other subcortical infarctions (pp.3–15).New York, NY: Oxford University Press.Google Scholar
  20. Hill, J., Fillit, H., Shah, S. N., del Valle, M. C., & Futterman, R. (2005). Patterns of healthcare utilization costs for vascular dementia in a community-dwelling population.Journal of Alzheimer’s Disease, 8, 43–50.PubMedGoogle Scholar
  21. Hofman, A., Ott, A., Breteler, M. M. B., Bots, M. L., Slooter, A. J. C., van Harskamp, F., et al. (1997). Atherosclerosis, apolipoprotein E and the prevalence of dementia and Alzheimer's disease in a population based study: The Rotterdam Study. The Lancet, 349, 151–154.CrossRefGoogle Scholar
  22. Huang, J., Meyer, J. S., Zhang, Z., Wei, J., Hong, X., Wang, J., et al. (2005). Progression of mild cognitive impairment to Alzheimer’s or vascular dementia versus normative aging among elderly Chinese. Current Alzheimer Research, 2, 571–578.PubMedCrossRefGoogle Scholar
  23. Ingles, J. L., Wentzel, C., Fisk, J. D., & Rockwood, K. (2002). Neuropsychological predictors of incident dementia in patients with vascular cognitive impairment, without dementia. Stroke, 33, 1999–2002.PubMedCrossRefGoogle Scholar
  24. Ishii, N., Nishihara, Y., & Imamura, T. (1986). Why do frontal lobe symptoms predominate in vascular dementia with lacunes? Neurology, 36, 340–345.PubMedGoogle Scholar
  25. Johnston, S. C., O’Meara, E. S., Manolio, T. A., Lefkowitz, D., O’Leary, D. H., Goldstein, S., et al. (2004). Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Annals of Internal Medicine, 140, 237–247.PubMedGoogle Scholar
  26. Jokinen, H., Kalska, H., Mantyla, R., Pohjasvaara, T., Ylikoski, R., Hietanen, M., et al. (2006). Cognitive profile of subcortical ischaemic vascular disease.Journal of Neurology, Neurosurgery, and Psychiatry, 77, 28–33.PubMedCrossRefGoogle Scholar
  27. Jones, S., Jonsson Laukka, E., Small, B. J., Fratiglioni, L., & Backman, L. (2004). A preclinical phase in vascular dementia: cognitive impairment three years before diagnosis. Dementia and Geriatric Cognitive Disorders, 18, 233–239.PubMedCrossRefGoogle Scholar
  28. Kramer, J. H., Reed, B. R., Mungas, D., Weiner, M. W., & Chui, H. C. (2002).Executive dysfunction in subcortical ischaemic vascular disease.Journal of Neurology, Neurosurgery, and Psychiatry, 72, 217–220.PubMedCrossRefGoogle Scholar
  29. Lamar, M., Price, C. C., Libon, D. J., Penney, D. L., Kaplan, E., Grossman, M. et al. (2007). Alterations in working memory as a function of leukoaraiosis in dementia. Neuropsychologia, 45, 245–254.Google Scholar
  30. Lamar, M., Price, C. C., Davis, K. L., Kaplan, E., & Libon, D. J. (2002). Capacity to maintain a mental set in dementia.Neuropsychologia, 40, 435–445.PubMedCrossRefGoogle Scholar
  31. Lawton, M. P., & Brody, E. M. (1969).Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.PubMedCrossRefGoogle Scholar
  32. Libon, D. J., Price, C. C., Heilman, K. M., & Grossman, M. (2006).Alzheimer’s “other dementia”. Cog Behav Neurol, 19, 112–116.CrossRefGoogle Scholar
  33. Libon, D. J., Price, C. C., Garrett, K. D., & Giovannetti, T. (2004). From Binswanger’s disease to Leukoaraiosis: What we have learned about subcortical vascular dementia.The Clinical Neuropsychologist, 18, 83–100.PubMedCrossRefGoogle Scholar
  34. Libon, D. J., Bogdanoff, B., Cloud, B. S., Skalina, S., Carew, T. G., Gitlin, H. L. et al. (1998). Motor learning and qualitative measures of the hippocampus and subcortical white alterations in Alzheimer’s disease and ischemic vascular dementia. Journal of Clinical and Experimental Neuropsychology, 20, 30–41.PubMedCrossRefGoogle Scholar
  35. Luis, C. A., Barker, W. W., Loewenstein, D. A., Crum, T. A, Rogaeva, E., Kawarai, T., et al. (2004). Conversion to dementia among two groups with cognitive impairment. Dementia and Geriatric Cognitive Disorders, 18, 307–313.PubMedCrossRefGoogle Scholar
  36. Maxwell, C. J., Hicks, M. S., Hogan, D. B., Basran, J., & Elby, E. M. (2005) Supplemental use of antioxidant vitamins and subsequent risk of cognitive decline and dementia.Dementia and Geriatric Cognitive Disorders, 20, 45–51.PubMedCrossRefGoogle Scholar
  37. Meyer, J., Xu, G., Thomby, J., Chowdhury, M., & Quach, M. (2002). Longitudinal analysis of abnormal domains comprising mild cognitive impairment (MCI) during aging. Journal of Neuroscience, 201, 19–25.Google Scholar
  38. Nagai, K., Akishita, M., Machida, A., Sonohara, K., Ohni, M., & Toba, K. (2004).Correlation between pulse wave velocity and cognitive function in nonvascular dementia.Journal of the American Geriatric Society, 52, 1037–1038.CrossRefGoogle Scholar
  39. Nyenhuis, D. L., Gorelick, P. B., Geenen, E. J., Smith, C. A., Gencheva, E., Freels, S. et al. (2004). The pattern of neuropsychological deficits in vascular cognitive impairment – no dementia (vascular CIND). The Clinical Neuropsychologist, 18, 41–49.PubMedCrossRefGoogle Scholar
  40. Panza, F., Solfrizzi, V., Colacicco, A. M., D’Intorno, A., Capurso, C., Torres, F., et al. (2004). Mediterranean diet and cognitive decline.Public Health Nutrition, 7, 959–963.PubMedCrossRefGoogle Scholar
  41. Pedelty, L., & Nyenhuis, D. L. (2006).Vascular cognitive impairment.Current Treament Options in Cardiovascular Medicine, 8, 243–250.CrossRefGoogle Scholar
  42. Prencipe, M., Santini, M., Casini, A. R., Pezzella, F. R., Scaldaferri, N., & Culasso, F. (2003). Prevalence of non-dementing cognitive disturbances and their association with vascular risk factors in an elderly population. Journal of Neurology, 250, 907–912.PubMedCrossRefGoogle Scholar
  43. Price, C. C., Jefferson, A. L., Merino, J., Heilman, K., & Libon, D.J. (2005). Towards an operational definition of the ‘Research Criteria for Subcortical Vascular Dementia’: integrating neuroradiological and neuropsychological data. Neurology, 65, 376–382.PubMedCrossRefGoogle Scholar
  44. Quadri, P., Fragiacomo, C., Pezzati, R., Zanda, E., Forloni, G., Tettemanti, M. et al. (2004). Homocysteine, folate, and vitamin B-12 in mild cognitive impairment, Alzheimer disease, and vascular dementia.American Journal of Clinical Nutrition, 80, 114–122.PubMedGoogle Scholar
  45. Ravaglia, G., Forti, P., Maioli, F., Scali, R. C., Saccheitti, L., Talerico, T., et al. (2004). Homocysteine and cognitive performance in healthy elderly subjects. Arch Gerontol Geriatr, 9, 349–357.CrossRefGoogle Scholar
  46. Reed, B. R., Eberling, J. L., Mungas, D., Weiner, M., Kramer, J. H., & Jagust, W. J. (2004).Effects of white matter lesions and lacunes on cortical function.Archives of Neurology, 61, 1545–1550.PubMedCrossRefGoogle Scholar
  47. Rockwood, K., Black, S. E., Song, X., Hogan, D. B., Gauthier, S., MacKnight, C., et al. (2006). Clinical and radiographic subtypes of vascular cognitive impairment in a clinic-based cohort study.Journal of Neurological of the Sciences, 240, 7–14.CrossRefGoogle Scholar
  48. Rockwood, K., Davis, H., MacKnight, C., Vandorpe, R., Gauthier, S., Guzman, A., et al. (2004). The consortium to investigate vascular impairment of cognition: methods and first findings. Canadian Journal of Neurological Sciences, 30, 237–243.Google Scholar
  49. Rockwood, K., Brown, M., Merry, H., Sketris, I., Fisk, J., & Wolfson C.(2002). Societal Costs of Vascular Cognitive Impairment in Older Adults. Stroke, 33, 1605–1609.PubMedCrossRefGoogle Scholar
  50. Roman, G. C. (2004).Vascular dementia: advances in nosology, diagnosis, treatment and prevention. Panminerva Medical, 46, 207–215.Google Scholar
  51. Roman, G. C., Sachdev, P., Royall, D. R., Bullock, R. A., Orgogozo, J. M., Lopez-Pousa, S., et al. (2004). Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia.Journal of the Neurological Sciences, 226, 81–87.PubMedCrossRefGoogle Scholar
  52. Sachdev, P. S., Brodaty, H., Valenzuela, M. J., Lorentz, L., Looi, J. C., Wen, W. et al. (2004).The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients.Neurology, 62, 912–919.PubMedGoogle Scholar
  53. Sacuiu, S. Sjogren, M., Johansson, B., Gustafson, D., & Skoog, I. (2005). Prodromal cognitive signs of dementia in 85-year-olds using four sources of information. Neurology, 65, 1894–1900.Google Scholar
  54. Scuteri, A., Brancati, A. M., Gianni, W., Assisi, A., & Volpe, M. (2005). Arterial stiffness is an independent risk factor for cognitive impairment in the elderly: a pilot study. Journal of Hypertension, 23, 1211–1216.PubMedCrossRefGoogle Scholar
  55. Sicras, A, Rejas, J., Arco, S., Flores, E., Ortega, G., Esparcia, A., et al. (2005). Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer’s disease in a population setting. Dementia and Geriatric Cognitive Disorders, 19, 305–315.PubMedCrossRefGoogle Scholar
  56. Solfrizzi, V., Panza, F., Colacicco, A. M., D’Introno, A., Capurso, C., Torres, F., et al. (2004). Vascular risk factors, incidence of MCI, and rates of progression to dementia.Neurology, 63, 1882–1891.PubMedGoogle Scholar
  57. Song, X., Mitnitski, A., & Rockwood, K. (2005).Index variables for studying outcomes in vascular cognitive impairment.Neuroepidemiology, 25, 196–204.PubMedCrossRefGoogle Scholar
  58. Stephens, S., Kenny, R. A., Rowan, E., Allan, L., Kalaria, R. N., Bradbury, M., et al. (2004). Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke.International Journal of Geriatric Psychiatry, 19, 1053–1057.PubMedCrossRefGoogle Scholar
  59. Stephens, S., Kenny, R. A., Rowan, E., Kalaria, R. N., Bradbury, M., Pearce, R., et al. (2005). Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia. Journal of the American Geriatric Society, 53, 103–107.CrossRefGoogle Scholar
  60. Talelli, P., Ellul, J., Terzis, G., Lekka, N. P., Gioldasis, G., Chrysanthopoulou, A. et al. (2004). Common carotid artery intima media thickness and post-stroke cognitive impairment. Journal of the Neurological Sciences, 223, 129–134.PubMedCrossRefGoogle Scholar
  61. Tervo, S., Kivipelto, M., Hanninen, T., Vanhanen, M., Hallikainen, M., Mannermaa, A. et al. (2004). Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dementia and Geriatric Cognitive Disorders, 17, 196–203.PubMedCrossRefGoogle Scholar
  62. Thomas, D. A., Libon, D. J., & Ledakis, G. (2005).Treating dementia patients with vascular lesions with donepezil: a preliminary analysis. Applied Neuropsychology, 12, 12–18.PubMedCrossRefGoogle Scholar
  63. van Harten, B., Laman, D. M., van Duijn, H., Knol, D. L., Stam, C. J., Scheltens, P. et al. (2006). The auditory oddball paradigm in patients with vascular cognitive impairment: a prolonged latency of the N2 complex. Dementia and Geriatric Cognitive Disorders, 21, 322–327.PubMedCrossRefGoogle Scholar
  64. van den Heuvel, D. M. J., ten Dam, V. H., de Craen, A. J. M., Admiraal-Behloul, F., Olofsen, H., Bollen, E. L. E. M., et al. (2006). Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 149–153.PubMedCrossRefGoogle Scholar
  65. Waite, L. M., Grayson, D. A., Piguet, O., Creasey, H., Bennett, H. P., & Broe, G. A. (2005). Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. Journal of the Neurological Sciences, 229–230, 89–93.Google Scholar
  66. Wolfe, N., Linn, R., Babikian, V. L., Knoefel, J. E., & Albert, M. (1990). Frontal systems impairment following multiple lacunar infarcts.Archives of Neurology, 47, 129–132,PubMedCrossRefGoogle Scholar
  67. Xu, G., Meyer, J. S., Huang, Y., Chen, G., Chowdhury, M., & Quach, M. (2004). Cross-cultural comparison of mild cognitive impairment between China and USA. Current Alzheimer Research, 1, 55–61.PubMedCrossRefGoogle Scholar
  68. Yip, A. G., McKee, A. C., Green, R. C., Wells, J., Young, H., Cupples, L. al. (2005). APOE, vascular pathology, and the AD brain.Neurology, 65, 259–265.PubMedCrossRefGoogle Scholar
  69. Zanetti, M., Ballabio, C., Abbate, C., Cutaia, C., Vergani, C., & Bergamaschini, L. (2006).Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study. Journal of the American Geriatric Society, 54, 580–586.CrossRefGoogle Scholar
  70. Zhang, Z., Zahner, G. E. P., Roman, G. C., Lui, J., Hong, Z., Qu, Q., et al. (2005). Dementia subtypes in China: prevalence in Beijing, Xian, Shanghai, and Chengdu.Archives of Neurology, 62, 447–453.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • David J. Libon
    • 1
  • Catherine C. Price
    • 1
  • Rodney A. Swenson
    • 1
  • Dana Penney
    • 1
  • Bret Haake
    • 1
  • Alfio Pennisi
    • 1
  1. 1.Department of Neurology, Drexel Medical College

Personalised recommendations