Vascular cognitive impairment in the memory clinic

Introduction When assessing cognition, four clinical questions emerge that help guide the practitioner [1]:Does this patient with a cognitive complaint have a cognitive problem?Is the cognitive problem caused by dementia or by something else?If dementia is present, what is the cause?What is to be done?In reviewing the clinical presentation of vascular cognitive impairment (VCI) we will focus on the last three.Vascular cognitive impairment is a heterogeneous group of cognitive disorders that share a vascular cause. Although the semantic construct of VCI is fraught with challenges, the problem it describes remains clinically important because of its prevalence, cost, and opportunities for prevention. This chapter focuses on the clinical subtypes of VCI while providing insight into the history of the construct, its neuropathological and neuroradiological correlates, as well as current developments for treatment and prevention.The history of the terminologyWhile it is currently largely agreed that VCI is a clinical diagnosis, and that neuropathology and neuroradiology remain supportive (but not diagnostic) tools [2], a brief review of the history of the terminology sheds light on how the understanding of the syndrome has evolved. In fact, the terminology offers a kind of carbon dating test for neurologists, providing immediate and useful information about their training cohort and camp.