Chapter 15 – Cognitive Vascular Impairment: An Overview of Clinical, Diagnosis, and Treatment

Emphasis has shifted from diagnosis of vascular dementia (VaD) based on restrictive criteria to include a broader spectrum of disease, named “vascular cognitive impairment (VCI).” This construct includes mixed dementia and cognitive impairment with no dementia. While VaD is the second leading cause of cognitive impairment in late life, either alone or in combination with Alzheimer’s disease, the milder form is much more common. The concept of mixed dementia has been included in the clinical diagnosis of VCI. With the advent of amyloid imaging, it will be possible to assess the relative contributions of both pathologies to brain function, thereby further elucidating the combined effects on cognitive aging and dementia risk. Novel neuroimaging methodology to identify biomarkers and risks for vascular injuries associated with VCI are necessary. Given its growing health, social, and economic burden, the prevention and treatment of milder forms of VCI are critical priorities for clinical care and research.