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F4‐01‐03: Vcid: From the clinic to models, mechanisms, and protection
Author(s) -
Kalaria Raj N.
Publication year - 2015
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2015.07.331
Subject(s) - dementia , stroke (engine) , hyperintensity , medicine , atrophy , disease , vascular dementia , neuroimaging , cognitive decline , cognition , psychology , cardiology , magnetic resonance imaging , psychiatry , radiology , mechanical engineering , engineering
VCID and AD.Methods:A systematic literature review of the field, focusing on diagnostic, natural history and therapeutic studies, supplemented by recent outputs from expert consensus groups. Results: Current concepts of vascular dementia and VCID have proved difficult to operationalise and validate, partly because of a lack of a clear pathological “gold standard” and because, unlike Alzheimer’s disease, broad clinical diagnostic categories such as vascular dementia have unfortunately not proved useful as therapeutic targets. In particular, the current generation of anti-dementia drug treatments, effective in Alzheimer’s disease, offer no benefit in vascular dementia. Several different sets of diagnostic criteria for VCID have been proposed, though none adequately deal with the increasingly commonly recognised situation of concurrent degenerative pathology contributing to cognitive impairment. Conclusions:There have been some evidence-based advances in the conceptualisation of vascular cognitive disorders, for example removal of the requirement for memory impairment in recent definitions and increasing recognition of the need for validated subtyping. It remains unclear whether VCID is best categorised using a continuous or dimensional model, and flexibility to apply both concepts simultaneously may be required. There remain key gaps in our understanding of pathophysiology, outcome and therapeutics of VCID. Application of biomarkers for both degenerative and vascular pathology, to enable accurate subject stratification, will be key to future diagnostic, prognostic and therapeutic studies.