Vascular cognitive impairment

This chapter reviews the neurobiology of vascular cognitive impairment (VCI), a heterogenous entity. Cerebrovascular disease, cognitive impairment, and dementia are highly prevalent conditions affecting older people. Cerebrovascular disease and cognitive impairment often coexist, leading to much speculation about potential common mechanisms that may be involved in causing these disorders. Given their prevalence and effect on individuals and society, research into such potential common mechanisms is critical if appropriate therapeutic and preventive strategies are to be planned. VCI is a heterogeneous entity that can be attributed to a wide range of vascular disorders. These disorders may be hereditary, such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy and hereditary cerebral amyloid angiopathy. Nonamyloid and amyloid deposits within cerebral vessel walls characterize the hereditary disorders. This could be further supplemented by the use of sophisticated imaging techniques, including state of the art volumetric imaging and diffusion tensor imaging (DTI), to determine the contribution of lesion type and lesion location to the pattern and severity of cognitive impairment, and postmortem studies to help separate true VCI from cognitive impairment due to a mixture of causes.