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(Stroke. 2009;40:e315.)
© 2009 American Heart Association, Inc.

Advances in Stroke 2008

Advances in Vascular Cognitive Impairment

From Department of Neurology (J.V.B.), Royal Free Hospital, London, England; and the Center for Stroke Research (P.B.G.), Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Ill.

Correspondence to John V. Bowler, MD, FRCP, Consultant Neurologist, Department of Neurology, Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail j.bowler@ucl.ac.uk

Key Words: VCI • advances

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

	Introduction

 
Vascular cognitive impairment (VCI) has continued to evolve over the past year. Much of the data has been confirmatory with further work on risk factors, silent strokes, leukoaraiosis and lesion volume and location. The importance of the interaction between cerebrovascular disease and other causes of cognitive impairment, most importantly Alzheimer disease (AD) remains a prominent theme. The natural history of VCI remains uncertain and further data on the rate of progression and factors affecting this are presented. It increasingly seems that the rate of progression in well-defined cases is low with no progression over 1 year in 1 study. Interestingly, a novel study from Toronto suggested that steal may be an etiologic mechanism. New trial data have been scanty but of note 1 long trial of aspirin was negative.

	Pathogenesis and Etiology

 
Silent strokes are the most common form of stroke.¹ In 1998 in the United States it was estimated that there were about 9 million silent infarcts and 2 million silent hemorrhages. Cerebral infarcts are an important cause of dementia; however, there is controversy regarding the role of silent or asymptomatic infarcts, infarct size and location, and vascular risk factors.² Troncoso et al² report autopsy findings from the Baltimore Longitudinal Aging Study among 122 men and 57 women of whom 92% were white, had 17.5 years of education, and a mean age at death of 86.9 years. The odds of dementia were increased by both asymptomatic and symptomatic infarcts; however, dementia was not increased by risk factors for stroke in the absence . . . [Full Text of this Article]