Vascular Cognitive Impairment (VCI)

Neurotherapeutics. 2022 Jan;19(1):68-88. doi: 10.1007/s13311-021-01170-y. Epub 2021 Dec 22.


Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.

Keywords: Biomarkers; Cognition; Neuroimaging; Small vessel disease; Vascular cognitive impairment; Vascular risk factors.

Publication types

  • Review

MeSH terms

  • Alzheimer Disease* / complications
  • Cerebrovascular Disorders* / complications
  • Cerebrovascular Disorders* / therapy
  • Cognition Disorders* / etiology
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / etiology
  • Cognitive Dysfunction* / therapy
  • Dementia, Vascular* / diagnosis
  • Dementia, Vascular* / epidemiology
  • Dementia, Vascular* / etiology
  • Humans