New Diagnostic Criteria Set Standards for Vascular Cognitive Impairment
An international panel has established revised diagnostic criteria for vascular cognitive impairment and dementia under the umbrella term VCID.
The World Stroke Organization endorsed the framework following a consensus process. Researchers developed the updated guidelines through a three-round online Delphi survey conducted in 2023. Between 49 and 54 international experts participated in each round, requiring at least 75 percent agreement for each item. The initiative replaces various prior labels—including vascular dementia and vascular neurocognitive disorder—with a single standard terminology. The framework establishes specific thresholds for preclinical, mild, and major dementia stages.
Established MRI markers and research guidelines for small vessel disease
The criteria define established MRI markers of small vessel disease, such as white matter hyperintensities, lacunes, and microbleeds. The panel adopted the term lacunes to replace lacunar infarcts while recognizing dilated perivascular spaces as an additional marker.
Diffusion-based metrics like peak width of skeletonized mean diffusivity remain restricted to research settings.
Functional techniques currently under evaluation include cerebrovascular reactivity testing with a carbogen challenge, blood-brain barrier integrity measures, and arterial spin labeling.
Investigators also reviewed fluid and retinal biomarkers during the consensus process. Permitting such measures in clinical practice requires further maturation, according to the panel.
With this plethora of measures coming into the field, we wanted to see which ones were mature enough,
Parminder Sachdev said.
What does the VasCog-2-WSO framework cover?
What does the VasCog-2-WSO framework cover?
The criteria define preclinical, mild, and major dementia levels of vascular cognitive impairment under the overarching term vascular cognitive impairment and dementia.
How many experts participated in the Delphi survey?
Out of 70 international experts invited in 2023, between 49 and 54 took part across the three consensus rounds.
What imaging markers are now established for diagnosis?
Established markers include white matter hyperintensities, lacunes, microbleeds, and dilated perivascular spaces.
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