As the second most common cause of dementia after Alzheimer’s disease (AD) in North America and Europe, vascular cognitive impairment and dementia (VCID) accounts for 15-20% of dementia cases, though this prevalence can be higher in developing countries. Mixed dementia, where AD and vascular pathologies coexist, becomes more common with age.

The pathogenesis of VCID involves damage to brain networks, leading to impairments in executive function and attention. Diagnosing VCID relies on neuroimaging, which reveals white matter changes and infarcts, and assessments like the Montreal Cognitive Assessment (MoCA), known for capturing executive dysfunction. Cerebral amyloid angiopathy (CAA) is a distinct subtype associated with amyloid plaques, increasing the risk of intracerebral hemorrhage. While statins and blood pressure management play a role in prevention, treatment of cognitive symptoms remains limited. Pharmacologic options, including donepezil and galantamine, offer modest cognitive benefits, particularly in mixed dementia. Prevention through lifestyle modifications and cardiovascular risk control is critical, as VCID’s progression is largely preventable with proper care.

Reference: Chang Wong E, Chang Chui H. Vascular Cognitive Impairment and Dementia. Continuum (Minneap Minn). 2022 Jun 1;28(3):750-780. doi: 10.1212/CON.0000000000001124. PMID: 35678401; PMCID: PMC9833847.