Letter by Rodríguez-García and Rodríguez-García Regarding Article, “Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association”

HomeStrokeVol. 42, No. 11Letter by Rodríguez-García and Rodríguez-García Regarding Article, “Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Rodríguez-García and Rodríguez-García Regarding Article, “Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association” Pedro Luis Rodríguez-García, MD and Damaris Rodríguez-García, MD Pedro Luis Rodríguez-GarcíaPedro Luis Rodríguez-García Search for more papers by this author and Damaris Rodríguez-GarcíaDamaris Rodríguez-García Search for more papers by this author Originally published22 Sep 2011https://doi.org/10.1161/STROKEAHA.111.634279Stroke. 2011;42:e584is corrected byCorrectionOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 To the Editor:Recently Gorelick et al published an interesting overview of the evidence on vascular contributions to cognitive impairment and dementia.1 This statement provides some outstanding aspects for practical classification of vascular cognitive impairment (VCI). First, the recent published advances in dementia and mild cognitive impairment definitions were summarized.2,3 Second, the guideline proposes a different perspective for some terms used for classifying certainty of VCI diagnosis (eg, probable for the most “pure” forms of vascular dementia and possible when the certainty of the diagnosis is diminished or exist a “mixed” process).1 However, in contrast with some classical criteria,4,5 the definitive level is currently not specified.Third, the following criteria description (Table 2) should be interpreted with caution: (1) For possible VCI, there is no clear relationship (temporal, severity, or cognitive pattern) between the vascular disease (eg, silent infarcts, subcortical small-vessel disease) and the cognitive impairment.1 However, no definitions are expressed for temporal, severity, and cognitive pattern relationship. Is temporal relation related to the 3-month poststroke cutoff? Is severity defined according classical criteria published? Is cognitive pattern a relationship criterion considered without cerebral localization diagnosis? Which singular or specific cognitive pattern can be applied for the heterogeneous forms of vascular dementia? (2) For possible VCI, there is cognitive impairment and imaging evidence of cerebrovascular disease, but information is insufficient for the diagnosis of vascular dementia (eg, clinical symptoms suggest the presence of vascular disease, but no CT/MRI studies are available).1 Then, is imaging evidence of cerebrovascular disease (CT/MRI) available? (3) Possible VCI is stated when severity of aphasia precludes proper cognitive assessment. However, patients with documented evidence of normal cognitive function (eg, annual cognitive evaluations) before the clinical event that caused aphasia could be classified as having probable vascular dementia.1 What are the foundations for the previously diagnosis of cognitive impairment if aphasia precludes proper assessment? Which precise criteria about aphasia are obviated if the word could is used? (4) There is no history of gradually progressive cognitive deficits before or after the stroke that suggests the presence of a nonvascular neurodegenerative disorder for probable VCI.1 However, some types of undoubtedly vascular dementia could start and develop in an insidious fashion without any clinically apparent stroke. Is it appropriate to consider a possible VCI when cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is diagnosed by progressive cognitive changes, typical findings on MRI, and mutations in the Notch 3 gene?In conclusion, until now, several groups of criteria have been proposed to decrease subjectivity and disagreement in the diagnosis of VCI. Unfortunately, none of these diagnostic criteria have satisfactorily consistency with regard to the onset, evolution, cognitive profiles, imaging evidence, and pathological markers. There is a need for agreement on criteria for the diagnosis of VCI as well as subtypes that would take into consideration the diverse mechanisms of the cerebrovascular disease.6 These criteria would be flexible enough to be used by healthcare providers as well as specialized investigators.Pedro Luis Rodríguez-García, MD Neurology Service E. Guevara Hospital Las Tunas, CubaDamaris Rodríguez-García, MD Radiology Service L. Iñiguez Hospital Holguín, CubaDisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org). References 1. Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al.. Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42:2672–2713.LinkGoogle Scholar2. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al.. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging and the Alzheimer's Association workgroup. Alzheimers Dement. 2011; 7:263–269.CrossrefMedlineGoogle Scholar3. Albert MS, Dekosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al.. The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging and Alzheimer's Association workgroup. Alzheimers Dement. 2011; 7:270–279.CrossrefMedlineGoogle Scholar4. Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer Disease Diagnostic and Treatment Centers (ADDTC). Neurology. 1992; 42:473–480.CrossrefMedlineGoogle Scholar5. Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, García JH, et al.. Vascular dementia: diagnostic criteria for research studies: report of the NINDS—AIREN International Workshop. Neurology. 1993; 43:250–260.CrossrefMedlineGoogle Scholar6. Wiederkehr S, Simard M, Fortin C, van Reekum R. Comparability of the clinical diagnostic criteria for vascular dementia: a critical review. Part I. J Neuropsychiatry Clin Neurosci. 2008; 20:150–161.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wang M, Hu H, Wang Z, Ou Y, Qu Y, Ma Y, Dong Q, Tan L and Yu J (2021) Association of cerebral microbleeds with risks of cognitive impairment and dementia: A systematic review and meta-analysis of prospective studies, Brain Disorders, 10.1016/j.dscb.2021.100010, 2, (100010), Online publication date: 1-Jun-2021. Dabbaghipour N, Javaherian M and Moghadam B (2020) Effects of cardiac rehabilitation on cognitive impairments in patients with cardiovascular diseases: a systematic review, International Journal of Neuroscience, 10.1080/00207454.2020.1773823, 131:11, (1124-1132), Online publication date: 2-Nov-2021. 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