ESOC 2018 – Vascular Cognitive Impairment

Didier LEYS (France) and Suzana GDOVINOVA (Slovakia)

Vascular Cognitive Impairment (VCI) will become a major public health issue in the future because of (i) the longer life-expectancy in all parts of the world free of any war; (ii) the arrival of the ex-baby boomers at the age at risk ; (iii) the longer survival of patients with vascular risk factors (arterial hypertension, diabetes mellitus etc.) ; and (iv) the longer life-expectancy of patients with acute vascular events (stroke, myocardial infarction etc.). This is, therefore, an important chapter in the stroke field.

In the session devoted to VCI, Terry Quinn (UK) showed what are the factors associated with VCI after a stroke, and how VCI may be associated with delirium. Marco Duering (Germany) made a review of the time-course of cognitive symptoms and VCI evolves over time after a stroke. Steven M. Greenberg (USA) reported on specific cause of VCI, cerebral amyloid angiopathy (CAA), and showed in which clinical context it may be encountered and what are the various mechanisms of VCI in these patients. Yael D. Reijmer (The Netherlands) showed how connectivity loss may interfere with cognition in patients with stroke, and the crucial effect of cortical thinning. Finally, Edo Richard (The Netherlands) showed that several vascular risk factors may theoretically explain a big part of the burden of VCI, but also that is it difficult in practice to prove the benefit of lifestyle intervention on the risk of dementia, especially in countries where the level of care is already almost optimal.

Besides the consequences of an acute event, cognitive functions may be altered by both pre-existing lesions of the brain (silent infarcts, microbleeds, and white matter changes) and network dysfunctions leading to cortical thinning and atrophy, structural changes that are highly associated with cognitive changes. This degenerative process, secondary to a vascular event, should focus our attention in the future and may lead to disease-modifier strategies. There are many similarities with what is reported in multiple sclerosis (where a subacute event finally leads to a degenerative process in the cortex and subsequent cognitive impairment). It is likely that both disorders of the brain (Stroke and MS) may learn from each other on this aspect.