Diagnosing vascular cognitive impairment: Current challenges and future perspectives.
Johannes Matthijs BiesbroekGeert Jan BiesselsPublished in: International journal of stroke : official journal of the International Stroke Society (2022)
Cerebrovascular disease is a major cause of cognitive decline and dementia. This is referred to as vascular cognitive impairment (VCI). Diagnosing VCI is important, among others to optimize treatment to prevent further vascular injury. This narrative review addresses challenges in current diagnostic approaches to VCI and potential future developments. First we summarize how diagnostic criteria for VCI evolved over time. We then highlight challenges in diagnosing VCI in clinical practice: assessment of severity of vascular brain injury on brain imaging is often imprecise and the relation between vascular lesion burden and cognitive functioning shows high intersubject variability. This can make it difficult to establish causality in individual patients. Moreover, because VCI is essentially an umbrella term, it lacks specificity on disease mechanisms, prognosis, and treatment. We see the need for a fundamentally different approach to diagnosing VCI, which should be more dimensional, including multimodal quantitative assessment of injury, with more accurate estimation of cognitive impact, and include biological definitions of disease that can support further development of targeted treatment. Recent developments in the field that can form the basis of such an approach are discussed.
Keyphrases
- cognitive impairment
- brain injury
- cognitive decline
- mild cognitive impairment
- clinical practice
- subarachnoid hemorrhage
- high resolution
- emergency department
- ejection fraction
- end stage renal disease
- randomized controlled trial
- newly diagnosed
- systematic review
- combination therapy
- risk assessment
- mass spectrometry
- cancer therapy
- photodynamic therapy
- drug delivery
- peritoneal dialysis
- chronic pain
- current status
- adverse drug
- preterm birth
- human health
- gestational age
- patient reported