title: Understanding and treating vascular cognitive impairment.
abstract: OBJECTIVE
  It is estimated that one in three people will experience a stroke, dementia, or both during their lifetime. The goal of this article is to assist clinicians in the identification and treatment of patients with vascular cognitive impairment (VCI). To that end, we will discuss the scope and definition of VCI; how this definition can be applied in clinical practice; VCI epidemiology and pathogenesis, its clinical features, and assessment; and prevention and treatment of this disorder.
  
  
  RESULTS
  During the past decade, we have gained a more complete understanding of clinical manifestations of VCI (eg, the importance of executive function and memory), what it looks like pathologically (eg, the role of cerebral amyloid angiopathy, microinfarcts, and "silent" strokes), and how VCI relates to other disease processes (eg, co-occurrence with Alzheimer disease). A recent American Heart Association and American Stroke Association guidance statement clarified the construct of VCI, including the severity of cognitive and behavioral dysfunction contained under the definition of VCI and the presence of both "pure" and "mixed" VCI forms. VCI treatments approved by the US Food and Drug Administration are still lacking, and challenges remain regarding how to convert promising observational study findings that link stroke and coronary heart disease risk factors to cognitive impairment and dementia into evidence-based preventive methods.
  
  
  CONCLUSIONS
  VCI is a common contributor to cognitive impairment in later life. Because the risk of Alzheimer disease may be heightened by the same risk factors that make us susceptible to stroke and coronary heart disease, these borderlands merit careful consideration as we strive to preserve cognitive function throughout the aging process.
authors.affiliation: Saint Mary’s Health Care, 220 Cherry Street SE, H3037, Grand Rapids, MI 49503, USA. pgorelic@trinity-health.org
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: David
authors.initials: D
authors.lastname: Nyenhuis
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D014652:Vascular Diseases / Q000150:complications* / Q000453:epidemiology
references.citation: Neurology. 2005 Mar 8;64(5):834-41
references.pmid: 15753419
references.citation: Stroke. 2002 Jul;33(7):1834-9
references.pmid: 12105362
references.citation: Arch Neurol. 2005 Mar;62(3):447-53
references.pmid: 15767510
references.citation: Clin Neuropsychol. 2004 Feb;18(1):41-9
references.pmid: 15595357
references.citation: Neurology. 1993 Feb;43(2):250-60
references.pmid: 8094895
references.citation: Neurology. 2005 Jan 11;64(1):132-3
references.pmid: 15642917
references.citation: Stroke. 2011 Feb;42(2):291-3
references.pmid: 21233478
references.citation: Mayo Clin Proc. 2006 Oct;81(10):1350-8
references.pmid: 17036561
references.citation: Stroke. 2004 Jun;35(6):1264-8
references.pmid: 15118167
references.citation: Arch Neurol. 2003 Dec;60(12):1707-12
references.pmid: 14676044
references.citation: Ann Neurol. 2008 Dec;64(6):698-706
references.pmid: 19107993
references.citation: Neurobiol Aging. 2006 Dec;27(12):1827-33
references.pmid: 16310892
references.citation: Stroke. 2008 Mar;39(3):785-93
references.pmid: 18258824
references.citation: N Engl J Med. 2009 Oct 15;361(16):1529-38
references.pmid: 19828530
references.citation: Neurology. 2000;54(11 Suppl 5):S10-5
references.pmid: 10854355
references.citation: JAMA. 2010 Oct 27;304(16):1787-94
references.pmid: 20978258
references.citation: Stroke. 2011 Sep;42(9):2672-713
references.pmid: 21778438
references.citation: Lancet Neurol. 2008 Apr;7(4):310-8
references.pmid: 18296124
references.citation: J Int Neuropsychol Soc. 2007 Sep;13(5):747-57
references.pmid: 17521485
references.citation: Neurology. 2007 Jul 31;69(5):448-58
references.pmid: 17664404
references.citation: Stroke. 2005 Apr;36(4):875-9
references.pmid: 15731466
references.citation: Gerontology. 2010;56(3):298-302
references.pmid: 20051663
references.citation: Arch Neurol. 2011 Jun;68(6):797-8
references.pmid: 21670403
references.citation: Drugs Aging. 2003;20(12):897-903
references.pmid: 14565783
references.citation: JAMA. 2005 Feb 2;293(5):596-608
references.pmid: 15687315
references.citation: Stroke. 2003 Oct;34(10):2323-30
references.pmid: 12970516
references.citation: Stroke. 2005 Mar;36(3):619-24
references.pmid: 15692125
references.citation: Dement Geriatr Cogn Disord. 2005;20(6):338-44
references.pmid: 16192723
references.citation: Stroke. 2006 Sep;37(9):2220-41
references.pmid: 16917086
references.citation: Lancet. 2002 Apr 13;359(9314):1283-90
references.pmid: 11965273
references.citation: Stroke. 2012 Jan;43(1):8-10
references.pmid: 22033989
references.citation: Arch Neurol. 2009 Jun;66(6):691-3
references.pmid: 19506128
references.citation: Neurology. 2006 Feb 14;66(3):433-5
references.pmid: 16476949
references.citation: Neurology. 2007 Dec 11;69(24):2197-204
references.pmid: 17568013
references.citation: Dement Geriatr Cogn Disord. 1997 Sep-Oct;8(5):320-8
references.pmid: 9298634
references.citation: Neurobiol Aging. 2012 May;33(5):1006.e25-36
references.pmid: 22048124
references.citation: Neurology. 1999 Dec 10;53(9):1992-7
references.pmid: 10599770
references.citation: Lancet Neurol. 2010 Jul;9(7):689-701
references.pmid: 20610345
references.citation: Neuroepidemiology. 2008;30(3):152-60
references.pmid: 18382114
references.citation: Ann Neurol. 2011 Nov;70(5):774-80
references.pmid: 22162060
references.citation: Stroke. 2008 Sep;39(9):2407-20
references.pmid: 18723419
references.citation: Ann Intern Med. 2010 Aug 3;153(3):176-81
references.pmid: 20547888
references.citation: Stroke. 2005 Jun;36(6):1330-40
references.pmid: 15879342
references.citation: Eur Neurol. 1996;36(5):315-21
references.pmid: 8864715
references.citation: BMJ. 2008 Sep 01;337:a1198
references.pmid: 18762476
references.citation: Arch Neurol. 1993 Jul;50(7):714-20
references.pmid: 8323474
references.citation: Neurology. 1994 Aug;44(8):1391-6
references.pmid: 8058135
references.citation: Neurology. 2002 Oct 22;59(8):1146-53
references.pmid: 12391341