Is the time ripe for new diagnostic criteria of cognitive impairment due to cerebrovascular disease? Consensus report of the International Congress on Vascular Dementia working group.
BACKGROUND
Long before Alzheimer's disease was established as the leading cause of dementia in old age, cerebrovascular lesions were known to cause cognitive deterioration and associated disability. Since the middle of the last century, different diagnostic concepts for vascular dementia and related syndromes were put forward, yet no widely accepted diagnostic consensus exists to date.


CONCLUSIONS
Several international efforts, reviewed herein, are ongoing to define cognitive impairment due to cerebrovascular disease in its different stages and subtypes. The role of biomarkers is also being discussed, including cerebrospinal fluid proteins, structural and functional brain imaging, and genetic markers. The influence of risk factors, such as diet, exercise and different comorbidities, is emphasised by population-based research, and lifestyle changes are considered for the treatment and prevention of dementia.


CONCLUSIONS
To improve the diagnosis and management of vascular cognitive impairment, further progress has to be made in understanding the relevant pathomechanisms, including shared mechanisms with Alzheimer's disease; bringing together fragmented research initiatives in coordinated international programs; testing if known risk factors are modifiable in prospective interventional studies; and defining the pre-dementia and pre-clinical stages in line with the concept of mild cognitive impairment due to Alzheimer's disease.
Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK. r.perneczky@imperial.ac.uk.|Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany. r.perneczky@imperial.ac.uk.|Cognitive Impairment and Dementia Service, West London Mental Health NHS Trust, Lakeside Mental Health Unit, West Middlesex University Hospital, Twickenham Road, TW7 6FY, London, UK. r.perneczky@imperial.ac.uk.|Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nussbaumstr. 7, 80336, München, Germany. r.perneczky@imperial.ac.uk.
Robert
R
Perneczky
Department of Psychiatry, Tel Aviv Sourasky Medical Center, Haim Weizman St 6, Tel Aviv-Yafo, 64239, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel.
Oren
O
Tene
Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, NE4 5PL, Newcastle upon Tyne, UK.
Johannes
J
Attems
Department of Psychiatry, University of Geneva School of Medicine, 2 rue Verte, 1205, Geneva, Switzerland.
Panteleimon
P
Giannakopoulos
Departments of Epidemiology, Radiology and Neurology, Erasmus MC, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
M Arfan
MA
Ikram
Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
Antonio
A
Federico
Unit of Neurology of Memory and Language, Centre de Psychiatrie et Neurosciences, INSERM UMR S894, Centre Hospitalier Sainte Anne and Université Paris Descartes, Sorbonne Paris Cité, 75013, Paris, France.
Marie
M
Sarazin
Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK. l.middleton@imperial.ac.uk.
Lefkos T
LT
Middleton
D001921:Brain / Q000473:pathology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D032921:Consensus; D015140:Dementia, Vascular / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012307:Risk Factors
Biomarker; CADASIL; Cerebrospinal fluid; Cerebrovascular disease; Cognition; Dementia; Genetics; Magnetic resonance imaging; Neuroimaging; Risk factor