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Alzforum Corriveau
Vascular contributions to cognitive impairment and dementia (VCID) is proposed as a distinct scientific discipline, recognized for its significant overlap with Alzheimer's disease and its impacts on disease burden. The document outlines the historical background, key findings from studies, and the importance of acknowledging the spectrum of vascular conditions related to cognitive impairment. VCID advocates for a unified approach to research and clinical practice, emphasizing the common comorbidities associated with dementia.
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- 1. Vascular Contributions toCognitive Impairment and Dementia (VCID) is proposed as a distinct discipline on the stroke spectrum, closely related to and in part embedded in Alzheimer’s, that is scientifically and clinically poised for impact on disease burden. Proposal: Roderick A. Corriveau, Ph.D. Program Director, NINDS
- 2. Years of follow-up 3,53,02,52,01,51,0,50,0 Dementia-freesurvival 100% 95% 90% 85% noSBI with SBI HR (adj) =2.3 Dementia-freesurvival Vermeer, Breteler NEJM 2003;348:1215 (=21% of stroke-free individuals age 60-90) Years Follow-Up (Population-Based Imaging) Vermeer, Breteler NEJM 2003;348:1215 Decades of Studies Reveal Vascular Disease/Dementia links No Impairment Dementia Alzheimer alone 29% 42% Alzheimer + small strokes 8% 30% Schneider Ann Neurol 2009;66:200
- 3. Vascular Contributions toCognitive Impairment & Dementia (VCID) cardiac disease micro-infarct micro-bleed small vessel ischemic stroke silent stroke small vessel hemorrhagic strokeCADASIL cerebral amyloid angiopathy (CAA) large vessel ischemic stroke TIA large vessel hemorrhagic stroke • VCID recognizes & unifies as a discipline the spectrum of Vascular Contributions to Cognitive Impairment & Dementia • VCID was historically siloed among disciplines with various names & inclusivity; scientific progress impacted • Separating VCI & dementia not advantageous for mechanisms focused research; e.g., a person may progress from VCI to dementia ~multi-infarct dementia ~vascular brain injury
- 4. Co-Morbidities are theNorm in Dementia: VCID is the Most Common Co-Morbidity Attems and Jellinger, 2013, Neuropathology. In: Dening T, Thomas A (eds) Oxford textbook of old age psychiatry, 2 edn., Oxford University Press., pp 87-105.
- 5. cardiac disease micro-infarct micro-bleed small vesselischemic stroke silent stroke small vessel hemorrhagic strokeCADASIL cerebral amyloid angiopathy (CAA) large vessel ischemic stroke TIA large vessel hemorrhagic stroke • VCID recognizes & unifies as a discipline the spectrum of Vascular Contributions to Cognitive Impairment & Dementia • VCID includes & embraces its largely comorbid nature AD Pathology ~multi-infarct dementia ~vascular brain injury
- 6. Stroke AD Dementia Strokeand AD Dementia: Overlapping Fields
- 7. Stroke AD Dementia VCID VascularContributions to Cognitive Impairment and Dementia (VCID) as a Discipline
- 8. Stroke AD Dementia VCID VascularContributions to Cognitive Impairment and Dementia (VCID) as a Discipline Cognitively Normal Cognitive Impairment (e.g. MCI, VCI) Dementia
- 9. VCID Recognizes/Unifies theBiological Spectrum of Vascular Contributions to Cognitive Impairment & Dementia Sugar + Lipid Metabolism Immune Function AD Biology Stroke + Vascular Biology Neurovascular Unit
- 10. Congressional TaskForce on Alzheimer’s (1999, US) Plan Alzheimer et Maladies Apparentées (2001-12, FR) Evaluation du Plan Alzheimer 2013 «Elargir le champ du plan au-delà de la maladie d’Alzheimer» England’s National Dementia Strategy (2009) National Alzheimer’s Project Law (2011, US) includes AD, vascular dementia, FTD, and LBD 2013: G8 Dementia Summit (London) VCID Poised as Distinct Scientific Discipline: International Recognition of the Relationship Between Dementia and the Vasculature