Diagnosing vascular cognitive impairment: Current challenges and future perspectives.

Area of Science:

• Neurology
• Neuroscience
• Geriatrics

Background:

• Cerebrovascular disease is a primary driver of cognitive decline and dementia, termed vascular cognitive impairment (VCI).
• Accurate VCI diagnosis is vital for timely intervention and preventing progressive vascular brain injury.
• Existing diagnostic criteria for VCI have evolved, but clinical application remains challenging.

Purpose of the Study:

• To review the evolution of VCI diagnostic criteria.
• To identify current challenges in diagnosing VCI in clinical practice.
• To explore future directions for VCI diagnosis.

Main Methods:

• Narrative review of diagnostic approaches for VCI.
• Analysis of challenges in assessing vascular brain injury and cognitive function.
• Discussion of emerging diagnostic methodologies.

Main Results:

• Current VCI diagnosis is hampered by imprecise neuroimaging assessments and high inter-individual variability in the relationship between vascular lesions and cognitive deficits.
• The broad nature of VCI as an umbrella term limits specificity regarding disease mechanisms, prognosis, and treatment strategies.
• Establishing causality between vascular injury and cognitive impairment in individual patients is difficult.

Conclusions:

• A paradigm shift towards a dimensional diagnostic approach for VCI is needed.
• Future VCI diagnostics should incorporate multimodal quantitative assessments and biological definitions.
• Developing targeted treatments requires a more precise understanding of VCI mechanisms, supported by advanced diagnostic tools.