Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report

Area of Science:

• Neurology
• Vascular Dementia Research
• Cognitive Decline Studies

Background:

• Vascular cognitive impairment (VCI) encompasses post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment.
• VCI presents a significant and growing health, social, and economic burden.
• Currently, no specific treatments exist for VCI, highlighting the need for disease modifiers.

Purpose of the Study:

• To propose the development of a disease-modifying strategy for VCI and PSCI.
• To outline a consensus for future treatment approaches.

Main Methods:

• Integration of pharmacological and non-pharmacological multimodal approaches.
• Targeting key pathological mechanisms including endothelial dysfunction, neuronal loss, cerebral plasticity, and protein misfolding.
• Emphasis on robust study designs with clear methodological definitions for participant stratification, outcome measures, and statistical analysis.

Main Results:

• A consensus was reached on the necessity of disease-modifying strategies for VCI and PSCI.
• Proposed strategies should be pleiotropic, addressing multiple disease pathways.
• Future research requires well-defined methodologies for clinical trials.

Conclusions:

• A consensus supports the development of disease-modifying strategies for VCI and PSCI.
• These strategies should employ pleiotropic pharmacological and non-pharmacological approaches.
• Standardized research methodologies are essential for effective VCI and PSCI treatment development.