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Imaging Biomarkers of VCI: A Focused Update
Una Clancy1, Angelina K Kancheva2, Maria Del C Valdés Hernández1
1Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.).
Insights
Vascular cognitive impairment (VCI) is prevalent and often undiagnosed. Neuroimaging, particularly MRI and CT, plays a crucial role in diagnosing, monitoring, and understanding VCI, aiding in differentiating vascular from other pathologies.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Vascular cognitive impairment (VCI) is a significant health concern, frequently observed post-stroke and in elderly care settings.
- Vascular disease is a leading cause of dementia, often co-existing with or preceding Alzheimer's disease, leading to mixed dementias.
Purpose of the Study:
- To provide an evidence-based summary of current neuroimaging biomarkers for diagnosing and monitoring VCI.
- To discuss the role of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing vascular contributions to cognitive impairment.
Main Methods:
- Review of established and emerging neuroimaging biomarkers for VCI.
- Focus on MRI and CT techniques for identifying vascular pathologies and their association with cognitive function.
Main Results:
- Neuroimaging is essential for quantifying vascular versus other pathologies in cognitive impairment.
- Both established and novel quantitative tissue markers of vascular injury show promise.
Conclusions:
- Neuroimaging biomarkers are critical for the diagnosis, prognosis, and monitoring of VCI.
- Gaps remain in the accessibility and clinical translation of these advanced imaging markers.
Abstract:
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
