Vascular Contributions to Cognitive Impairment & Dementia (VCID)

People with vascular contributions to cognitive impairment and dementia (VCID) almost always have abnormalities in the brain on magnetic resonance imaging (MRI) scans. These include evidence of prior strokes, often small and asymptomatic, as well as scattered changes in the brain’s “white matter," or the connecting “wires” of the brain that are critical for relaying messages between brain regions. Microscopic brain examination shows thickening of blood vessel walls called arteriosclerosis and thinning or loss of components of the white matter.

Forms of VCID include:

• Vascular dementia, which refers to progressive loss of memory and other cognitive functions caused by vascular injury or disease within the brain. Symptoms of vascular dementia may sometimes be difficult to distinguish from Alzheimer’s disease. Problems with organization, attention, slowed thinking and problem solving are all more prominent in VCID, while memory loss is more prominent in Alzheimer’s.
• Vascular cognitive impairment, which involves changes with language, attention and the ability to think, reason and remember that are noticeable but are not significant enough to greatly impact daily life. These changes, caused by vascular injury or disease within the brain, progress slowly over time.
• Post-stroke dementia, which can develop months after a major stroke. Not everyone who has had a major stroke will develop vascular dementia, but the risk for dementia is significantly higher in someone who has had a stroke.
• Multi-infarct dementia, which is the result of many small strokes (infarcts) and ministrokes. Language or other functions may be impaired, depending on the region of the brain that is affected. The risk for dementia is significantly higher in someone who has had a stroke. Dementia is more likely when strokes affect both sides of the brain. Even strokes that don’t show any noticeable symptoms can increase the risk of dementia.
• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an extremely rare, inherited disorder caused by a thickening of the walls of small and medium-sized blood vessels, which reduces the flow of blood to the brain. CADASIL is associated with multi-infarct dementia, stroke and other disorders. The first symptoms can appear in people between ages 20 and 40. CADASIL may have symptoms that can be confused with multiple sclerosis. Many people with CADASIL are undiagnosed.
• Subcortical vascular dementia (previously known as Binswanger’s disease) involves extensive microscopic damage to the small blood vessels and nerve fibers that make up white matter, tissue that transmits signals between different areas of the brain, as well as between the brain and other parts of the body. Some consider it an aggressive form of multi-infarct dementia. Cognitive changes include problems with short-term memory, organization, attention, decision making and behavior. Symptoms tend to begin after age 60, and they progress in a stepwise manner. People with subcortical vascular disease often have high blood pressure, a history of stroke, or evidence of disease of the large blood vessels in the neck or heart valves.
• Cerebral amyloid angiopathy is a buildup of amyloid plaques in the walls of blood vessels in the brain. It is generally diagnosed when multiple tiny bleeds in the brain are discovered using MRI.

Vascular cognitive impairments (VCID) arise as a result of risk factors that similarly increase the risk for cerebrovascular disease, such as a stroke, atrial fibrillation, hypertension, diabetes and high cholesterol. Symptoms of VCID can begin suddenly and progress or subside during one’s lifetime. VCID can occur along with Alzheimer’s disease. 

VCID can also be caused by small blood clots that block blood vessels in the brain as well as vessel wall disease. A series of mini strokes, known as “transient ischaemic attacks,” causing widespread brain damage. These conditions lead to damage in the brain cells because of lack of oxygen. 

The primary risk factors for developing vascular contributions to cognitive impairment and dementia (VCID) are age, genetics, lifestyle and preexisting health issues, including a history of stroke and high blood pressure. 

Additionally, the following health conditions may contribute to VCID: 

• Hyperglycemia
• Insulin resistance
• Metabolic syndrome
• Diabetes mellitus
• Hyperlipidemia
• Smoking, or a regular cigarette habit
• Obesity
• Lack of physical activity
• Poor diet
• Medical history of coronary artery disease, stroke, chronic renal disease, atrial fibrillation, peripheral arterial disease and heart failure 

Several studies have shown the Montreal Cognitive Assessment (MoCA) to be an effective tool in diagnosing vascular contributions to cognitive impairment and dementia (VCID). The MoCA is a short test of cognitive function that assesses short term memory, executive function, attention, working memory, visuospatial function, concentration, language, and orientation. 

Another test that may be effective in screening VCID is the Mini-Mental State Examination (MMSE). This is a simple pen‐and‐paper test of cognitive function based on a total possible score of 30 points; it includes tests of orientation, concentration, attention, verbal memory, naming and visuospatial skills.

People with vascular dementia may experience:

• Difficulty performing tasks that used to be easy, such as paying bills
• Trouble following instructions or learning new information and routines
• Forgetting current or past events
• Misplacing items
• Getting lost on familiar routes
• Problems with language, such as finding the right word or using the wrong word
• Changes in sleep patterns
• Difficulty reading and writing
• Loss of interest in things or people
• Changes in personality, behavior and mood, such as depression, agitation and anger
• Hallucinations or delusions (believing something is real that is not)
• Poor judgment and loss of ability to perceive danger

Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement. Vascular dementia can occur alone or be a part of a different diagnosis such as Alzheimer’s disease or other forms of dementia. When an individual is diagnosed with vascular dementia, their symptoms can be similar to the symptoms of Alzheimer’s.

Several studies have shown the Montreal Cognitive Assessment (MoCA) to be an effective tool in diagnosing vascular contributions to cognitive impairment and dementia (VCID). The MoCA is a short test of cognitive function that assesses short term memory, executive function, attention, working memory, visuospatial function, concentration, language and orientation. 

Another test that may be effective in screening VCID is the Mini-Mental State Examination (MMSE). This is a simple pen‐and‐paper test of cognitive function based on a total possible score of 30 points; it includes tests of orientation, concentration, attention, verbal memory, naming and visuospatial skills.

Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement. Vascular dementia can occur alone or be a part of a different diagnosis such as Alzheimer’s disease or other forms of dementia. When an individual is diagnosed with vascular dementia, their symptoms can be similar to the symptoms of Alzheimer’s.

Vascular dementia refers to changes to memory, thinking and behavior resulting from conditions that affect the blood vessels in the brain. Cognition and brain function can be significantly affected by the size, location and number of vascular changes.

Because many different disease processes can result in different forms of vascular dementia, there may not be one treatment for all. However, vascular dementia is often managed with medications to prevent strokes and reduce the risk of additional brain damage. Some studies suggest that medications that are used to treat Alzheimer’s might benefit some people with an early form of vascular dementia. Treating modifiable risk factors like high blood pressure, diabetes, high cholesterol and problems with the rhythm of the heartbeat can help prevent additional stroke. Living a healthy lifestyle is important to help reduce the risk factors of vascular dementia.

Following diagnosis, most people with vascular contributions to cognitive impairment and dementia (VCID) live for around five years after onset of symptoms. Lifestyle changes can improve health and living with VCID. A healthy diet, weight management, cessation of smoking, alcohol management, and blood pressure or cholesterol medication can all improve outlook. 

Volunteers are needed for clinical trials that are testing ways to prevent and treat vascular dementia. By joining one of these studies, you may help scientists learn about different conditions that affect blood flow to the brain and contribute useful information to help other older adults in the future.