The article reviewed here is ‘Beyond Mild Cognitive Impairment: Vascular Cognitive Impairment, No Dementia VCIND’ by Stephan and colleagues and freely available here. The abstract reads
‘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……………….However very little is known regarding the mildest stage of VCI, generally termed ‘vascular cognitive impairment, no dementia (VCIND)‘
and puts the aim of this paper into perspective. The review contains no explicitly stated methodology but is divided into seven main sections. The role of vascular disease in ageing of the brain including atrophy is discussed briefly. The authors then look at classification schemes. The importance of Mild Cognitive Impairment (MCI) as a category is discussed as is the associations of vascular risk factors with MCI. The authors then distinguish between the broader term vascular cognitive impairment (VCI) and the more restricted use of the term MCI. The authors emphasise the current difficulties with VCIND as refinements in the diagnostic criteria are still needed and also look at the relationship of VCIND to dementia. The ambiguity in this relationship makes it more difficult to make the case for a boundary between VCIND and MCI at the current time. The boundary issue however is the subject of the next section and the authors provide neuropsychological, neuropathological and neuroimaging evidence of differences between MCI with and without vascular pathology although the picture is less than straightforward. The authors then focus on the evidence for minimising vascular risk factors for progression to dementia. They suggest that there is relatively little evidence that this prevents MCI or improving MCI if it is already present although adding that modifying vascular risk factors is effective in reducing risk of hypertension and strokes. They conclude by identifying a need for further understanding in this area. The concept of VCIND is relatively young and it will be interesting to see how this develops.
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