Investigations in primary care

Vascular cognitive impairment relates to subjects who have a broad spectrum of cognitive deficits,including all forms of mild to severe cognitive impairment associated with and presumed to be caused by cerebrovascular diseases. The latter may be represented by multiple cortical infarcts, multiple subcortical infarcts, or both, silent infarcts, strategic infarcts, small-vessel disease with white matter lesions, and lacunes, all more or less related to stroke. Some authors also include in the category of vascular cognitive impairment Alzheimer's disease patients with evidence of additional vascular lesions. The recognition of early cognitive decline in the primary care setting is an important step as it may allow an early referral of patients to the specialist level, thus permitting a correct diagnosis of the etiologic subtype and the best treatment approach for that particular patient. The aim of this chapter is to provide an overview of the role of the primary care physician in the screening of patients with suspected vascular cognitive decline. Patients in whom screening for cognitive decline could be of clinical relevance are depicted, and a brief overview of investigations and diagnostic tests in the primary care setting is outlined. This specific diagnostic approach includes suggestions on how to take the clinical history, how to perform the physical examination, and on how to choose the appropriate tools for the cognitive and non-cognitive screening; finally, the role of neuroimaging in the primary care setting is illustrated.