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Treatment of Vascular Cognitive Impairment

  • Dementia (E McDade, Section Editor)
  • Published:
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Opinion statement

Cerebrovascular disease (CVD) is an important cause of cognitive dysfunction and dementia. The term vascular cognitive impairment (VCI) is used to describe the entire spectrum of cognitive dysfunction—ranging from mild impairment to dementia—attributable to all forms of cerebrovascular disease. Accurate assessment and management of vascular risk factors are a top priority in the treatment of VCI, particularly early in the disease when prevention strategies may prove to be more effective. There are limited treatment options to improve cognition and function in VCI. Several acetylcholinesterase inhibitors and the NMDA receptor antagonist memantine have been studied in large, well-designed trials. These agents are safe and provide modest cognitive benefits in vascular dementia (VaD) but have demonstrated inconsistent efficacy on functional measures. Other therapies, such as aspirin, calcium channel blockers, and vitamin supplementation, have less evidence to support their use in improving cognition in VCI. Although primary prevention trials suggest that treatment of hypertension, adherence to a Mediterranean diet, physical activity, and smoking cessation may reduce the risk of cognitive decline, there is limited evidence regarding these interventions in helping improve cognition in VCI. The pathophysiology and treatment of cerebral autosomal dominant arteriopathy with subcortical infarcts (CADASIL), cerebral amyloid angiopathy (CAA), and subcortical white matter disease (SWMD) deserves special consideration.

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Aaron Ritter and Jagan A. Pillai declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by the authors.

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Authors and Affiliations

  1. Department of Neurology, Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV, 89106, USA

    Aaron Ritter MD

  2. Department of Neurology, Lou Ruvo Center for Brain Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Jagan A. Pillai MBBS, PhD

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  1. Aaron Ritter MD
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  2. Jagan A. Pillai MBBS, PhD
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Correspondence to Jagan A. Pillai MBBS, PhD.

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This article is part of the Topical Collection on Dementia

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Ritter, A., Pillai, J.A. Treatment of Vascular Cognitive Impairment. Curr Treat Options Neurol 17, 35 (2015). https://doi.org/10.1007/s11940-015-0367-0

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