Neurochemical Research

, Volume 35, Issue 12, pp 1933–1938 | Cite as

Vascular Cognitive Disorder. A Biological and Clinical Overview

  • Leontino Battistin
  • Annachiara Cagnin


Although vascular dementia (VaD) represents the second most common cause of dementia after Alzheimer’s disease (AD) in the elderly, and is referred as the “silent epidemic of the twenty-first century”, there is still a controversy on terminology, classification and diagnostic criteria of VaD. The diagnosis of VaD resides in clinical criteria determining a cognitive impairment, the presence of cerebrovascular disease and, only in the case of post-stroke dementia or multi-infarct dementia, a temporal relationship between these. The search for a reliable biochemical tests helping in the diagnosis of VaD is so far not available. Several vascular risk factors have a role in the development of VaD and their identification and treatment are among the major aspects of management of VaD. A new line of research in this field is the study of genetic factors underlying vascular cognitive impairment which are: (1) genes predisposing to cerebrovascular disease, and (2) genes that influence brain tissue responses to cerebrovascular lesions. Evidence in favour of a coexistence of vascular and degenerative components in the pathogenesis of dementia in an elderly population comes from neuropathological and epidemiological studies. There is now a great debate whether VaD and AD are more than common coexisting unrelated pathologies and, instead, represent different results of synergistic pathological mechanisms. Preventive approaches aiming at reducing incident VaD by targeting patients at risk of cerebrovascular disease (primary prevention), or acting on patients after a stroke (secondary prevention) to prevent stroke recurrence and the progression of brain changes associated with cognitive impairment are mandatory therapeutic strategies.


Vascular cognitive disorder Biomarkers Alzheimer’s disease Risk factors 



This work was supported in part by a grant from the Italian Ministry of Health within the Finalized Research Projects 2006–2007 (type II, No. 107). This paper is intended to honor Dr. Abel Lajtha, who founded this journal many years ago and directed it in a superb way from the beginning. Abel Lajtha did a lot of outstanding research in many fields, and particularly on protein metabolism and on transport of metabolites through nerve cells membranes, and his contributions have been of absolute relevance for the progress of our knowledge in both basic and clinical neurosciences. He has been President of the American and of the International Society for Neurochemistry as well as of many other International Societies in neurosciences. He also received many awards and I like to remember especially the one given by the University of Padova, that is the laurea “honoris causa” in Medicine. I also like to recall his continuous and quite established relationship with the scientific community of neuroscientists in Italy; many of us worked and trained in the neuroscience in his lab and under his precious guidance. In this acknowledgement, certainly incomplete, I would like to add a few personal words, that is a really deep and warm thanks to him for what he has taught me and given to me; he has taught me both science and humanity, that is well being, and he has given to me his affection and his friendship, extended also to my family. I’m really very grateful forever, and I like to say a warm thank to Abel Lajtha.


  1. 1.
    Fratiglioni L, Launer LJ, Andersen K et al (2000) Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic diseases in the elderly research group. Neurology 54:S4–S9PubMedGoogle Scholar
  2. 2.
    Gorelick PB, Roman G, Mangone CA (1994) Vascular dementia. In: Gorelick PB, Alter MA (eds) Handbook of Neuroepidemiology. Mecel Dekker, New York, pp 197–214Google Scholar
  3. 3.
    Binswanger O (1894) Die Abgrenzung der allgemeinen progressiven paralyse. Berl. Klein. Wochenschr. 31:1102–1205, 1137–1139, 1180–1186Google Scholar
  4. 4.
    Hachinski VC, Lassen MA, Marshall J (1974) Multi-infarct dementia. A cause of mental deterioration in elderly. Lancet 2:207–210CrossRefPubMedGoogle Scholar
  5. 5.
    Roman GC, Sachdev P, Royall DR et al (2004) Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. Neurol Sci 226:81–87CrossRefGoogle Scholar
  6. 6.
    Sachdev P (1999) Vascular cognitive disorder. Int J Geriatr Psychiatry 14:402–403CrossRefPubMedGoogle Scholar
  7. 7.
    O’Brien JT, Erkinjuntti T, Reisberg B et al (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98CrossRefPubMedGoogle Scholar
  8. 8.
    Cagnin A, Battistin L (2007) Vascular dementia. In: Readerer Battistin (ed) Handbook of neurochemistry and molecular neurobiology. Springer-Verlag, Berlin-Eidelberg, pp 253–265CrossRefGoogle Scholar
  9. 9.
    Chui HC, Victoroff JI, Margolin D et al (1992) Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer disease diagnostic and treatment centers (ADDTC). Neurology 42:473–480PubMedGoogle Scholar
  10. 10.
    Roman GC, Tatemichi TK, Erkinjutti T et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology 43:250–260PubMedGoogle Scholar
  11. 11.
    Organization WorldHealth (1993) International classification of diseases. Tenth Revision. World Health Organization, GenevaGoogle Scholar
  12. 12.
    Price CC, Jefferson AL, Merino JG et al (2005) Subcortical vascular dementia: integrating neuropsychological and neuroradiologic data. Neurology 65:376–382CrossRefPubMedGoogle Scholar
  13. 13.
    Royall DR, Roman GC (2000) Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 55:604–606PubMedGoogle Scholar
  14. 14.
    Ballard CG, Burton EJ, Barber R et al (2004) NINDS AIREN neuroimaging criteria do not distinguish stroke patients with and without dementia. Neurology 63:983–988PubMedGoogle Scholar
  15. 15.
    Jellinger KA (2007) The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 113:349–388CrossRefPubMedGoogle Scholar
  16. 16.
    Lesser G, Kandiah K, Libow LS et al (2001) Elevated serum total and LDL cholesterol in very old patients with Alzheimer’s disease. Dement Geriat Cogn Disord 12:138–145CrossRefGoogle Scholar
  17. 17.
    Evans RM, Emsley CL, Gao S et al (2000) Serum cholesterol, APOE genotype, and the risk of Alzheimer’s disease: a population-based study of African Americans. Neurology 54:240–242PubMedGoogle Scholar
  18. 18.
    Kivipelto M, Ngandu T, Laatikainen T et al (2006) Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol 5:735–741CrossRefPubMedGoogle Scholar
  19. 19.
    Helzner EP, Luchsinger JA, Scarmeas N et al (2009) Contribution of vascular risk factors to the progression in Alzheimer disease. Arch Neurol 66:343–348CrossRefPubMedGoogle Scholar
  20. 20.
    Romas SN, Tang MX, Berglund L et al (1999) APOE genotype, plasma lipids, lipoproteins, and AD in community elderly. Neurology 53:517–521PubMedGoogle Scholar
  21. 21.
    Tan ZS, Seshadri S, Beiser A et al (2003) Plasma total cholesterol level as a risk factor for Alzheimer disease: the Framingham study. Arch Int Med 163:1053–1057CrossRefGoogle Scholar
  22. 22.
    Kivipelto M, Solomon A (2006) Cholesterol as a risk factor for Alzheimer’s disease-epidemiological evidence. Acta Neurol Scand 114:50–57CrossRefGoogle Scholar
  23. 23.
    Panza F, D’Introno A, Colacicco AM et al (2006) Lipid metabolism in cognitive decline and dementia. Brain Res Rev 51:275–292CrossRefPubMedGoogle Scholar
  24. 24.
    Panza F, Solfrizzi V, D’Introno A et al (2009) Higher total cholesterol, cognitive decline, and dementia. Neurobiol Aging 30:546–548CrossRefPubMedGoogle Scholar
  25. 25.
    Papassotiropoulos A, Wollmer MA, Tsolaki M et al (2005) A cluster of cholesterol-related genes confers susceptibility for Alzheimer’s disease. J Clin Psychiatry 66:940–947CrossRefPubMedGoogle Scholar
  26. 26.
    Cagnin A, ZAmbon A, Zarantonello G et al (2007) Serum lipoprotein profile and APOE genotype in Alzheimer’s disease. J Neural Transm Suppl 72:175–179CrossRefPubMedGoogle Scholar
  27. 27.
    Iadecola C (2004) Neurovascular regulation in the normal brain and in Alzheimer’s disease. Nat Rev Neurosci 5:347–360Google Scholar
  28. 28.
    Zlokovic BV (2008) The blood-brain barrier in health and chronic neurodegenerative disorders. Neuron 57:178–201CrossRefPubMedGoogle Scholar
  29. 29.
    Leblanc GG, Meschia JF, Stuss DT et al (2006) Genetics of vascular cognitive impairment. The opportunity and the challenges. Stroke 37:248–255CrossRefPubMedGoogle Scholar
  30. 30.
    Slooter AJC, Tang M-X, van Duijn CM et al (1997) Apolipoprotein E 4 and the risk of dementia with stroke: a population-based investigation. JAMA 277:818–821CrossRefPubMedGoogle Scholar
  31. 31.
    Traykov L, Rigaud AS, Caputo L et al (1999) Apolipoprotein E phenotypes in demented and cognitively impaired patients with and without cerebrovascular disease. Eur J Neurology 6:415–421CrossRefGoogle Scholar
  32. 32.
    Briani C, Cagnin A, Gallo L et al (2005) Anti-heparan sulphate antibodies and homocysteine: markers of vascular pathology? J Neurol Sci 229–230:215–218CrossRefPubMedGoogle Scholar
  33. 33.
    Adair JC, Charlie J, Dencoff JE et al (2004) Measurement of gelatinase B (MMP-9) in cerebrospinal fluid of patients with vascular dementia and Alzheimer disease. Brain 35:159–162Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of NeurosciencesUniversity of Padova Medical SchoolPadovaItaly
  2. 2.I.R.C.C.S. San Camillo HospitalVeniceItaly

Personalised recommendations