Vascular cognitive impairment

Published on March 30, 2021   31 min

A selection of talks on Neurology

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My name is Eric Smith, I'm a professor of Neurology and Katthy Taylor Chair in Vascular Dementia at the University of Calgary. I'll be talking about vascular cognitive impairment, a common but less well-recognized consequence of cerebrovascular disease.
My talk will cover these areas: the definition of vascular cognitive impairment abbreviated, VCI, types of VCI, the pathology and pathophysiology, diagnosis, and treatment.
Vascular cognitive impairment is an umbrella term defined as any cognitive impairment to which cerebrovascular diseases are contributing. In other words, cerebrovascular disease does not have to be the sole contributor. It could be one of a number of contributors, including other common neurodegenerative diseases of aging, such as Alzheimer's disease. It includes any range of cognitive impairment, but modern definitions of VCI distinguish between two cognitive syndromes, mild cognitive impairment and dementia. In mild cognitive impairment, there's objective evidence of low cognitive function, a concern on the part of the patient, a care partner, or the clinician, that the cognitive impairment is symptomatic. But there are not disabilities in instrumental and basic activities of living that accompany dementia. In contrast, dementia is the term used for an acquired cognitive disorder in which there's objective evidence of impairment that is disabling the patient.
There are two common clinical scenarios in which vascular cognitive impairment is encountered: VCI post-stroke, in which VCI occurs immediately following a clinical stroke event. In this case, the link between the stroke event and VCI is usually quite readily apparent. In contrast, in the other scenarios where there is VCI without recent stroke, where there's no clinical history of stroke, but the presence of cerebrovascular disease is instead recognized after brain imaging is done. These two different syndromes of VCI are encountered in different health settings. Post-stroke VCI is seen on the stroke ward or in the stroke prevention clinic. VCI without recent stroke is most commonly encountered in a dementia clinic, family physician's office, or during a geriatric assessment, where a brain scan is done in a patient with cognitive decline, and it's recognized that there's a high burden of cerebrovascular disease. VCI without recent stroke, most of cerebrovascular disease is caused by small vessel disease, visible as lacunar infarcts, white matter hyperintensities or microbleeds. Only about 20 percent of these unrecognized strokes that cause VCI is related to embolic infarcts from large artery disease, cardioembolism, or cryptogenic sources. In contrast, the types of strokes that can cause post-stroke VCI are similar to causes of stroke in general, mostly caused by large artery disease or cardioembolism, with only about 20 percent caused by small vessel disease. So the two different syndromes occur in different settings and have different causes.