Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence: A Scientific Statement From the American Heart Association

Vascular contributions to cognitive impairment and dementia (VCID) are common and may be the most preventable cause of clinically significant cognitive decline. However, an estimate of the prevalence and incidence of VCID in the United States is lacking. In this scientific statement, we reviewed studies on the incidence and prevalence of VCID, defined as patients diagnosed with vascular dementia, evidence of vascular dementia in epidemiological studies, neuropathological evidence of cerebrovascular contributions to dementia, and neuroimaging evidence of covert (clinically silent) cerebrovascular disease. We found variability in estimates of vascular dementia, with a higher prevalence in prospective epidemiological and autopsy-based studies than studies of physician diagnoses. There were many more studies of vascular contributions to dementia than to mild cognitive impairment. Epidemiological studies suggest that in the 2020 US population >65 years of age, 2.7 million individuals were living with vascular dementia or mixed dementia with a vascular contribution, whereas health care billing data suggest that 809 000 people were diagnosed with vascular dementia. In 2020, as many as 603 000 new individuals developed new vascular dementia or mixed vascular dementia according to epidemiological studies, whereas there were 102 000 new cases according to health care billing data. In addition, we estimate that in 2020 there were 11.3 million people with covert brain infarcts, 11.1 million with high volumes of white matter hyperintensity, and 19.9 million with cerebral microbleeds potentially detectable by magnetic resonance imaging, contributing to VCID. These covert cerebrovascular lesions may be preventable with appropriate risk factor modification. Indeed, we estimate that eliminating cerebrovascular disease from the population would prevent 27% to 33% of dementia cases, resulting in 1.5 to 1.8 million fewer people with dementia in 2020. Population health approaches to reduce VCID would benefit millions of Americans.