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Diagnosing vascular cognitive impairment: Current challenges and future perspectives
J Matthijs Biesbroek1,2, Geert Jan Biessels1
1Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Diagnosing vascular cognitive impairment (VCI) is crucial for preventing further brain injury. Current methods face challenges due to imprecise imaging and variable patient responses, necessitating a more dimensional diagnostic approach.
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.
Abstract:
Cerebrovascular disease is a major cause of cognitive decline and dementia. This is referred to as vascular cognitive impairment (VCI). Diagnosing VCI is important, among others to optimize treatment to prevent further vascular injury. This narrative review addresses challenges in current diagnostic approaches to VCI and potential future developments. First we summarize how diagnostic criteria for VCI evolved over time. We then highlight challenges in diagnosing VCI in clinical practice: assessment of severity of vascular brain injury on brain imaging is often imprecise and the relation between vascular lesion burden and cognitive functioning shows high intersubject variability. This can make it difficult to establish causality in individual patients. Moreover, because VCI is essentially an umbrella term, it lacks specificity on disease mechanisms, prognosis, and treatment. We see the need for a fundamentally different approach to diagnosing VCI, which should be more dimensional, including multimodal quantitative assessment of injury, with more accurate estimation of cognitive impact, and include biological definitions of disease that can support further development of targeted treatment. Recent developments in the field that can form the basis of such an approach are discussed.
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