Abstract
New guidelines for the diagnosis of vascular cognitive impairment (VCI) represent
an important step in the definition of this clinical entity. These guidelines still
remain vague in the definition of “vascular” brain lesions causing cognitive decline,
because longitudinal correlative imaging studies are still scarce. In this review
we explore which abnormalities are likely to contribute to VCI based on a proven vascular
etiology, fast progression and their incidence or progression being related to cognitive
decline. Among focal changes visible on standard MRI these features apply for coalescent
white matter changes. The evidence for lacunes and microbleeds is much less convincing.
Microstructural alterations in normal appearing brain tissue which can be detected
by new MRI techniques such as magnetization transfer imaging (MTI), diffusion tensor
imaging (DTI) and high resolution MR appear to better correlate with cognitive decline,
but the etiology of these changes and their histopathological correlates is still
incompletely understood as is their evolution over time. New multimodal image processing
such as voxel-based lesion-symptom mapping (VLSM) or combinations of DTI and voxel-based
analysis will allow to allocate the lesion patterns that show the greatest covariance
with clinical outcome. Such data and more longitudinal correlative data on lacunes
and microbleeds will increase our pathophysiologic understanding of VCI including
the interplay with primary degenerative processes and will lead to refinement of current
VCI criteria.
Keywords
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Article info
Publication history
Published online: June 25, 2012
Accepted:
June 5,
2012
Received:
February 10,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
