Background Vascular Cognitive Impairment Vascular Cognitive Impairment VCI

Background

Vascular Cognitive Impairment • Vascular Cognitive Impairment (VCI) includes the cognitive and behavioural disorders associated with cerebrovascular disease and risk factors, from mild cognitive deficits to frank dementia. VCI is a syndrome with cognitive impairment affecting at least one cognitive domain (e. g. , attention, memory, language, perception or executive function) and with evidence of clinical stroke or subclinical vascular brain injury. • VCI encompasses a large range of cognitive deficits, from relatively mild cognitive impairment of vascular origin (Va. MCI) to Vascular Dementia (Va. D) the most severe form of VCI. • VCI also plays a role in patients with Alzheimer’s disease pathology who have coexisting vascular lesions 1.

Vascular Cognitive Impairment –cont’d • Vascular Cognitive Impairment affects up to 60% of stroke survivors and is associated with poorer recovery and decreased function in activities of daily living and instrumental activities of daily living. • Cognitive abilities in the areas of executive function, attention and memory appear important in predicting functional status at discharge. In addition, cognitive impairment can be chronic and progressive after stroke; post stroke dementia is estimated to occur in 26% of stroke pts by 3 months and adversely affects recovery. • Cognitive impairment increases long-term dependence and is associated with increased mortality rates (61% versus 25%) (Black, 2007)2.

Covert Strokes • Cognitive impairment due to covert vascular pathology is also increasing. Covert strokes, e. g. , lacunes are common (23% of community elderly) and are associated with cognitive decline, dementia, and stroke. For every clinically evident stroke there could be up to 10 “covert” strokes. • Signs of covert stroke are often manifested as signs and symptoms of cognitive impairment 3.

Dementia In population studies, vascular dementia is the most common cause of dementia after Alzheimer Disease. The combination of Alzheimer disease and vascular disease results in the commonest substrate of dementia in the elderly. A single macroscopic hemispheric infacrt is sufficient to cause dementia in people with intermediate Alzheimer pathology 4.