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Vascular cognitive impairment

Key sources
The following summarized guidelines for the evaluation and management of vascular cognitive impairment are prepared by our editorial team based on guidelines from the European Society for Vascular Surgery (ESVS 2023), the Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD 2020), the European Federation of Neurological Societies (EFNS 2012), and the American Heart Association (AHA/ASA 2011).


1.Screening and diagnosis

Diagnostic criteria: use standardized criteria (the VASCOG criteria, DSM-5, VICCCS, or the AHA consensus statement) for the diagnosis of vascular MCI and vascular dementia.
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2.Diagnostic investigations

Brain imaging: as per CCCDTD 2020 guidelines, obtain MRI over CT for investigating VCI.

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  • Genetic testing

3.Diagnostic procedures

Skin or muscle biopsy: consider obtaining an ultrastructural examination of the skin or muscle biopsy specimen for granular osmiophilic deposits as an alternative or complementary procedure if genetic testing is either unavailable or demonstrates NOTCH3 mutations of unclear significance.

4.Medical management

Management of cardiovascular risk factors
As per CCCDTD 2020 guidelines:
Consider initiating antihypertensive therapy for average DBP readings ≥ 90 mmHg and for average SBP readings ≥ 140 mmHg in patients with cognitive disorders if a vascular contribution is known or suspected.
Initiate guideline-recommended treatments to prevent first-ever or recurrent stroke as appropriate in all patients with cognitive symptoms or impairment.

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  • Cholinesterase inhibitors

  • NMDA antagonists

  • Antiplatelet therapy

  • Immunosuppressive therapy

5.Nonpharmacologic interventions

Vitamin supplements: insufficient evidence to support the use of vitamin supplements for improving cognitive function.

6.Preventative measures

Primary prevention, lifestyle modifications: consider advising moderation of alcohol intake, weight control, physical activity, a Mediterranean-type dietary pattern,
and smoking cessation in patients at risk for VCI.

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  • Primary prevention (cardiovascular conditions)

  • Primary prevention (carotid interventions)