Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel

Costantino Iadecola1, Marco Duering2, Vladimir Hachinski3

  • 1Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.

Insights

Vascular cognitive impairment and dementia (VCID) is a significant public health concern, particularly in East Asia. This review critically appraises VCID epidemiology, pathology, and treatment, highlighting research needs.

Area of Science:

  • Neurology
  • Public Health
  • Gerontology

Background:

  • Cognitive impairment in aging is a growing global challenge.
  • While Alzheimer's disease is common in the West, vascular cognitive impairment and dementia (VCID) is the second leading cause and may be predominant in East Asia.
  • Cerebral vascular changes, including microcirculation, significantly contribute to cognitive dysfunction, even in Alzheimer's disease.

Purpose of the Study:

  • To provide a critical review of vascular cognitive impairment and dementia (VCID).
  • To examine the epidemiology, pathobiology, neuropathology, and neuroimaging of VCID.
  • To assess current diagnostic and therapeutic strategies and identify research gaps.

Main Methods:

  • Expert panel review and critical appraisal of existing literature.
  • Synthesis of data on epidemiology, pathobiology, neuropathology, and neuroimaging.
  • Analysis of current diagnostic and therapeutic approaches.

Main Results:

  • Vascular factors are crucial in cognitive impairment, irrespective of underlying pathology like Alzheimer's disease.
  • VCID presents a significant challenge, with regional variations in prevalence (e.g., East Asia).
  • Current understanding highlights the need for integrated approaches considering both vascular and other pathologies.

Conclusions:

  • VCID is a major contributor to dementia, necessitating focused research and clinical attention.
  • Further research into epidemiology, pathobiology, and neuroimaging is essential for improved diagnostics and therapeutics.
  • Addressing unresolved issues in VCID research is critical for mitigating this devastating condition.

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