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(Stroke. 2008;39:739.)
© 2008 American Heart Association, Inc.

Editorials

Untangling Vascular Cognitive Impairment

José G. Merino, MD, MPhil

From the Suburban Hospital Stroke Program, Suburban Hospital, Bethesda, Md.

Correspondence to José G. Merino, MD, Suburban Hospital Stroke Program, 8600 Old Georgetown Rd, Bethesda, MD 20814. E-mail merinoj@ninds.nih.gov

Key Words: cognition • cognitive impairment • cognitive neurology • vascular dementia • VCI

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related articles, pages 783–830.

Vascular pathology is often the cause of cognitive impairment and dementia. The entities implicated include large cortical infarcts; single strategically-placed or multiple small infarcts, cerebral hemorrhage, cortical changes due to hypoperfusion (eg, hippocampal sclerosis, ischemic-anoxic damage, cortical laminar sclerosis), and a variety of vasculopathies (eg, lipohyalinosis, CADASIL, cerebral amyloid angiopathy). Vascular cognitive impairment (VCI) is an umbrella term that encompasses these instances of cognitive decline due to vascular factors, and includes patients with mixed vascular and neurodegenerative pathologies.^1,2 It is an evolving concept, and as our understanding grows, new questions arise, including two that are addressed by studies published in this issue of Stroke: do white matter lesions and silent infarcts lead to a specific pattern of cognitive impairment, and if so, how?; and do changes in the microvasculature precede and potentially lead to the development of Alzheimer pathology?

The effect of silent infarcts and CT- and MRI-detected white matter changes on cognition is still controversial. On the one hand, these lesions are commonly seen in healthy individuals with intact mental functions, and some researchers in the field question whether they play a role in cognitive decline in the elderly.³ On the other hand, the results of many clinical, epidemiological, and pathological studies suggest that people with white matter changes and silent infarcts are more likely to have varying degrees of cognitive impairment and dementia.^4,5 The mechanisms through which these pathologies lead to cognitive decline are not well understood. One putative mechanism . . . [Full Text of this Article]

Related Article:

Assessing the Impact of Vascular Disease in Demented and Nondemented Patients

David J. Libon and Kenneth M. Heilman
Stroke 2008 39: 783-784. [Extract] [Full Text] [PDF]

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				C. H Rojas-Fernandez and P. Moorhouse Current Concepts in Vascular Cognitive Impairment and Pharmacotherapeutic Implications Ann. Pharmacother., July 1, 2009; 43(7): 1310 - 1323. [Abstract] [Full Text] [PDF]