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Printable Handouts
Navigable Slide Index
- Introduction
- Outline
- Definition
- Stroke and VCI
- Neuropathology
- Epidemiology
- Pathophysiology
- Vascular causes of VCI
- Cerebral small vessel pathologies
- Molecular mechanisms of VCI
- Diagnosis: three step approach
- Diagnostic criteria
- Cognitive assessment of VCI
- Hachinski Ischemic Score
- Brain imaging
- Case example: Post-stroke VCI
- Case example: VCI without recent stroke
- Patient management principles
- Can VCI be prevented?
- RCTs of multi-domain interventions
- FINGER Trial: Intervention
- FINGER Trial: Results
- SPRINT MIND sub-study
- SPRINT MIND results
- Conclusions
- Disclosures
Topics Covered
- Definition of vascular cognitive impairment (VCI) and vascular dementia
- Epidemiology and pathophysiology of VCI
- Causes of VCI
- Molecular mechanisms of VCI
- Diagnostic approach
- Principles of management
- Prevention of VCI
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Smith, E.E. (2021, March 30). Vascular cognitive impairment [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 10, 2024, from https://doi.org/10.69645/JKHK9362.Export Citation (RIS)
Publication History
Financial Disclosures
- Commercial/Financial matters disclosed are consulting for Alnylam and Eli Lilly.
A selection of talks on Neurology
Transcript
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0:00
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.
0:17
My talk will cover these areas: the
definition of vascular cognitive impairment abbreviated, VCI,
types of VCI,
the pathology and pathophysiology, diagnosis, and treatment.
0:29
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.
1:22
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.