Summary
The protocol covers the spectrum of vascular cognitive impairment, from pre-dementia disorders to vascular dementia. It describes post-stroke, multi-infarct, subcortical, ischemic, hemorrhagic, and other subtypes, as well as mixed vascular and neurodegenerative disease. Clinical presentation is linked to the location and extent of cerebrovascular injury and may include slowed information processing, impaired attention and executive function, memory difficulty, gait and balance problems, and mood or behavioral symptoms. Severity is determined not only by a test score but also by decline from the person’s previous level of functioning and loss of independence.
Diagnosis involves interviewing the patient and a knowledgeable informant, reviewing vascular and neurological history, assessing daily activities, completing a detailed neurological examination, and performing neuropsychological testing. The protocol includes brief cognitive measures, including tools sensitive to executive dysfunction. Laboratory testing helps identify metabolic, endocrine, nutritional, and other conditions that may cause or worsen cognitive impairment. Brain CT or MRI is presented as an essential component of assessment for documenting vascular lesions, excluding potentially treatable causes, and differentiating vascular dementia from Alzheimer disease and other forms of dementia.
Management combines treatment of the underlying cerebrovascular condition and modifiable vascular risks, secondary stroke prevention, and symptom-oriented treatment of cognitive and neuropsychiatric manifestations. Cholinesterase inhibitors and memantine are considered for dementia, with selection depending on the clinical subtype, comorbidities, and the balance of potential benefit and harm. Non-pharmacological care includes physical activity, cognitive stimulation, occupational therapy, and a calm, structured environment. Long-term rehabilitation addresses self-care, communication, gait, balance, fall prevention, home adaptation, and caregiver education. The prevention section supports a multimodal approach involving vascular-risk management and continued physical, cognitive, and social activity.