Latin American Delphi Consensus on Vascular Cognitive Impairment: Definitions, Clinical Features, Pathophysiology, Prevention and Treatment

Abstract

Cerebral vascular disease (CVD) represents the second cause in years of life lost, according to the Global Burden of Disease Study 2015 study. The global report on Alzheimer's disease 2015 estimates that in Latin America there are 9.2 million cases of dementia, with a prevalence of 8.2%. Undoubtedly, Alzheimer's disease is the most frequent cause, followed by vascular dementia (VD) with 15% of the cases, although global data are unknown in Latin America. Objective:To analyze and present the current evidence on the classification, pathophysiology, diagnosis and treatment of vascular cognitive impairment. Methodology:A group of experts met in Miami, Florida, in April 2016. The group included Neurologists, Geriatricians and Psychiatrists from the following countries: Mexico, Guatemala, El Salvador, Costa Rica, Peru, Spain, Bolivia, Chile, Paraguay, Colombia, Panama, Venezuela, Italy, the United States, Dominican Republic, Honduras and Nicaragua. The Delphi method was used to review available information (provided months before the meeting), in relation to assigned topics: definition of Cognitive Vascular Impairment (CVI), risk factors, pathophysiology, diagnosis (neuropsychological and imaging) and treatment. For the allocation of evidence and recommendation of available treatments, the GRADE system was used.The working groups analyzed and discussed available evidence on CVI concerning proposed definitions, risk factors and diagnostic elements. Subsequently, the conclusions of each of the working groups were drafted, which were reviewed by each of the authors and by the rest of the study groups until a global consensus was reached. Once this process was completed, the process of external validation and preparation of the final document was carried out.The results of this consensus allow the incorporation of the opinion and experience of physicians of different specialties in Latin America regarding the vascular cognitive impairment.

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“…The drug may be more effective for mild cognitive disorders [299][300][301][302] and cases related to vascular pathologies [303][304][305][306]. In addition, citicoline has been shown to have beneficial effects on some neurophysiological and neuroimmune changes.…”

Cerebral Vascular Reactivity in Frail Older Adults with Vascular Cognitive Impairment

“…Additionally, to determine the vascular etiology of MCI, the definition of the Latin American Delphi Consensus on Vascular Cognitive Impairment was used. There are two critical areas for the diagnosis of vascular dementia: one, the certainty of the presence of a cognitive disorder, and two, the determination that vascular disease is the dominant, if not the only pathology, accounting for the cognitive disorder [20].…”

Prevalence and incidence of possible vascular dementia among Mexican older adults: Analysis of the Mexican Health and Aging Study

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