Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.).
School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.).
Stroke. 2024 Apr;55(4):791-800. doi: 10.1161/STROKEAHA.123.044171. Epub 2024 Mar 6.
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
血管性认知障碍在脑卒中后较为常见，在记忆诊所、老年医学服务和社区中未被诊断出来。血管性疾病被认为是仅次于阿尔茨海默病的第二大痴呆症病因，但现在已知血管功能障碍先于阿尔茨海默病的认知下降，并且大多数老年痴呆症是混合性的。神经影像学在识别认知障碍患者中血管性与其他可能病理学的比例方面具有重要作用。在这里，我们旨在提供当前潜在影像学生物标志物的实用但基于证据的总结，重点是磁共振成像和计算机断层扫描，这些与诊断、估计预后、监测血管性认知障碍以及结合我们自己的经验有关。我们专注于那些已经确立的、与认知测量有已知关联的标志物，但也考虑了最近描述的标志物，包括血管损伤的定量组织标志物。我们强调了在可及性和向更常规临床实践转化方面的差距。
