Beyond mild cognitive impairment: vascular cognitive impairment, no dementia (VCIND)

Abstract

Identifying the causes of dementia is important in the search for effective preventative and treatment strategies. The concept of mild cognitive impairment (MCI), as prodromal dementia, has been useful but remains controversial since in population-based studies it appears to be a limited predictor of progression to dementia. Recognising the relative contribution of neurodegenerative and vascular causes, as well as their interrelationship, may enhance predictive accuracy. The concept of vascular cognitive impairment (VCI) has been introduced to describe the spectrum of cognitive change related to vascular causes from early cognitive decline to dementia. A recent review of this concept highlighted the need for diagnostic criteria that encompass the full range of the VCI construct. However, very little is known regarding the mildest stage of VCI, generally termed 'vascular cognitive impairment, no dementia' (VCIND). Whether mild cognitive change in the context of neurodegenerative pathologies is distinct from that in the context of cerebrovascular diseases is not known. This is key to the definition of VCIND and whether it is possible to identify this state. Distinguishing between vascular (that is, VCIND) and non-vascular (that is, MCI) cognitive disorders and determining how well each might predict dementia may not be possible due to the overlap in pathologies observed in the older population. Here, we review the concept of VCIND in an effort to identify recent developments and areas of controversy in nosology and the application of VCIND for screening individuals at increased risk of dementia secondary to vascular disease and its risk factors.

Vascular Dementia and Alzheimer's Disease: Is There a Difference?

“…To date, there is no consensus on where boundaries between disease and non-disease lie. Rather than a strict dichotomisation, the determination of impairment may instead be based on the likelihood or probability that ageing is not occurring in accordance with normative expectations (Stephan et al, 2009). …”

Current Pathogenetic Concepts of Vascular Cognitive Impairment

“…Currently, several sets of criteria for the clinical diagnosis of VCI/VaD are used (see [8]): the NINDS-AIREN criteria [9], the ADDTC criteria [10], the DSM-V criteria (APA), distinguishing possible, probable and proven VaD (with pathologically proven multiple cerebrovascular lesions/CVLs) [11]; the NINDS-CSN criteria [12], the EFNS guidelines [13], the consensus statement of the American Stroke Association [14], and the VASCOG criteria [6]. Vascular cognitive impairment no dementia (VCIND) describes a condition related to vascular disease, in which cognitive impairment is not severe enough to fi t the criteria of dementia [15].…”

Work Protocol for Cognitive Optimization Intervention Using Computer Applications in Patients with Cognitive Impairment after Stroke

“…The residual cognitive impairment after stroke is reported in the literature as Vascular Cognitive Impairment (VCI), a generic term that has been introduced to describe a broad spectrum of cognitive changes related to vascular disorders that are not included in the dementia diagnosis [2].…”