Abstract
Cerebrovascular disease (CVD) is a universal aspect of the aging process. Nearly two thirds of individuals 70 years of age and older exhibit vascular lesions on structural brain scans. The neuropsychological phenotype of CVD can vary across individuals depending on the location and volume of the vascular damage, though most individuals exhibit impairment in executive function and psychomotor speed that ranges in severity from mild impairment to severe dementia. More than one third of individuals who survive a large vessel stroke exhibit dementia, with exponentially greater risk among those older than 65. In spite of the frequency and high individual, familial, and societal burden, progress in the field has been hampered by the application of inconsistent nomenclature, lack of objective and universal grading systems in radiology and neuropathology, and suboptimal sensitivity of clinical and research neuroimaging methods. These limitations underscore the value of clinical neuropsychology in the care and management of individuals with CVD. Through standardized methods, neuropsychological assessment provides the only means to evaluate functional brain integrity as it relates to performance. Further, neuropsychological assessment establishes a reference to determine the natural history of vascular cognitive impairment (VCI) over time and the potential benefit of therapeutic interventions. This chapter reviews the underlying biological features of VCI and related neuroimaging signatures. We review historic and contemporary perspectives on the neuropsychological phenotype of VCI, followed by recommendations to complete an evidence-based evaluation of neuropsychological status. We include a case example to illustrate the clinical application of the concepts reviewed in the chapter.
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Paul, R., Salminen, L. (2019). Vascular Cognitive Impairment. In: Ravdin, L.D., Katzen, H.L. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-93497-6_30
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DOI: https://doi.org/10.1007/978-3-319-93497-6_30
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