Open Access Open Access  Restricted Access Subscription Access

Mild cognitive impairment of vascular origin: Proposal for an empirical approach in primary care

Julio J Secades


The incidence of mild cognitive impairment of vascular origin is increasing continuously among individuals with cardiovascular risk factors. The etiology of this kind of impairment is related to cerebrovascular pathologies, with the presence of silent cerebral infarctions the most relevant etiology. The incidence of cognitive impairment affects around 22% of patients at 3 months after an ischemic stroke, and this incidence is maintained or increased even 5 years after the stroke. Silent infarction should be considered the first clinical suspicion in patients with cardiovascular risk factors (such as hypertension, diabetes and dyslipidemia) who are attending a consultation for cognitive complaints, not only memory complaints. There are various tools for detecting such cognitive problems during the examination, such as brief cognitive tests and neuropsychological evaluations (for example, MMSE, SPMSQ or MoCA), and to assess its development. For a patient with cardiovascular risk factors and cognitive complaints it should be possible to carry out an empirical treatment and assess the development of the cognitive deficits before referring the patient to the specialist. This review outlines various attitudes and therapeutic possibilities that might be useful in the scope of Primary Care.


Mild cognitive impairment. Cardiovascular risk factors. Evaluation. Therapy. Algorithm. Diagnosis.

Full Text:


Alvarez-Sabín, J., Ortega, G., Jacas, C., Santamarina, E., Maisterra, O., Ribo, M., …Román, G.C. (2013). Long-term treatment with citicoline may improve poststroke vascular cognitive impairment. Cerebrovasc Dis, 35(2), 146-154.

Amenta, F., Lanari, A., Mignini, F., Silvestrelli, G., Traini, E. & Tomassoni, D. (2009). Nicardipine use in cerebrovascular disease: a review of controlled clinical studies. J Neurol Sci, 283(1-2), 219-223.

Arvanitakis, Z., Leurgans, S.E., Barnes, L.L., Bennett, D.A., & Schneider, J.A. (2011). Microinfarct pathology, dementia, and cognitive systems. Stroke, 42(3), 722-727.

Boksha, I.S., Gavrilova, S.I., Kolykhalov, I.V., Fedorova, I.B., Kalyn, I.B., Selezneva, N.D., …Mukaetova-Ladinska, E.B. (2014). Progression of Cognitive Deficit in Older People with Mild Cognitive Impairment Treated with Cerebrolysin. Health, 6, 2581-2591. http://dx.doi.org/10.4236/health.2014.619297

Brown, J., Pengas, G., Dawson, K., Brown, L.A., & Clatworthy, P. (2009). Self administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross sectional study. BMJ, 338, b2030.

Buschke, H., Kuslansky, G., Katz, M., Stewart, W.F., Sliwinski, M.J., Eckholdt, H.M., & Lipton, R.B. (1999). Screening for dementia with the memory impairment screen. Neurology, 52(2), 231-238.

Cherrier, M.M., Anderson, K., Shofer, J., Millard, S. & Matsumoto, A.M. (2014). Testosterone treatment of men with mild cognitive impairment and low testosterone levels. Am J Alzheimers Dis Other Demen, 30(4), 421-430.

Chertkow, H., Massoud, F., Nasreddine, Z., Belleville, S., Joanette, Y., Bocti, C., …Bergman, H. (2008). Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ, 178(10), 1273-1285.

Cooper, C., Li, R., Lyketsos, C., & Livingston, G. (2013). Treatment for mild cognitive impairment: systematic review. Br J Psychiatry, 203(3), 255-264.

Cooper, C., Sommerlad, A., Lyketsos, C.G., & Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. Am J Psychiatry, 172(4), 323-334.

Cordell, C.B., Borson, S., Boustani, M., Chodosh, J., Reuben, D., Verghese, J., …Fried, L.B. (2013). Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement, 9(2), 141-150.

Cotroneo, A.M., Castagna, A., Putignano, S., Lacava, R., Fantò, F., Monteleone, F., …Gareri, P. (2013). Effectiveness and safety of citicoline in mild vascular cognitive impairment: the IDEALE study. Clin Interv Aging, 8, 131-137.

Dal Pan, G., Stern, Y., Sano, M., & Mayeux, R. (1989). Clock-drawing in neurological disorders. Behav Neurol, 2(1), 39-48.

De Jesus Moreno Moreno, M. (2003). Cognitive improvement in mild to moderate Alzheimer's dementia after treatment with the acetylcholine precursor choline alfoscerate: a multicenter, double-blind, randomized, placebo-controlled trial. Clin Ther, 25(1), 178-193.

DeKosky, S.T., Ikonomovic, M.D., Styren, S.D., Beckett, L., Wisniewski, S., Bennett, D.A, …Mufson, E.J. (2002). Upregulation of choline acetyltransferase activity in hippocampus and frontal cortex of elderly subjects with mild cognitive impairment. Ann Neurol, 51(2), 145-155.

Dixon, O., & Mead, G. (2013). Selective Serotonin Reuptake Inhibitors for Mild Cognitive Impairment: A Systematic Review. J Neurol Disord Stroke, 1(3), 1022.

Douaud, G., Refsum, H., de Jager, C.A., Jacoby, R., Nichols, T.E., Smith, S.M., & Smith, A.D. (2013). Preventing Alzheimer's disease-related gray matter atrophy by B-vitamin treatment. Proc Natl Acad Sci U S A, 110(23), 9523-9528.

Douiri, A., Rudd, A.G., & Wolfe, C.D. (2013). Prevalence of poststroke cognitive impairment: South London Stroke Register 1995-2010. Stroke, 44(1), 138-145.

Eshkoor, S.A., Hamid, T.A., Mun, C.Y., & Ng, C.K. (2015). Mild cognitive impairment and its management in older people. Clin Interv Aging, 10, 687-693.

Farina, N., Isaac, M.G., Clark, A.R., Rusted, J., & Tabet, N. (2012). Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst Rev, 11, CD002854. doi: 10.1002/14651858.CD002854.pub3.

Fiatarone Singh, M.A., Gates, N., Saigal, N., Wilson, G.C., Meiklejohn, J., Brodaty, H., …Valenzuela, M. (2014). The Study of Mental and Resistance Training (SMART) study—resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. J Am Med Dir Assoc, 15(12), 873-880.

Fioravanti, M., & Yanagi, M. (2005).

Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000269. DOI: 10.1002/14651858.CD000269.pub3.

Folstein, M.F., Robins, L.N., & Helzer, J.E. (1983). The Mini-Mental State Examination. Arch Gen Psychiatry, 40(7), 812.

Gauthier, S., Reisberg, B., Zaudig, M., Petersen, R.C., Ritchie, K., Broich, K., …Winblad B; International Psychogeriatric Association Expert Conference on mild cognitive impairment. (2006). Mild cognitive impairment. Lancet, 367(9518), 1262-1270.

Hachinski, V.C., & Bowler, J.V. (1993). Vascular dementia. Neurology, 43, 2159–2160.

Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., …Leblanc, G.G. (2006). National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 37(9), 2220-2241.

Haring, B., Wu, C., Coker, L.H., Seth, A., Snetselaar, L., Manson, J.E., … Smoller, S. (2015). Hypertension, Dietary Sodium, and Cognitive Decline: Results From the Women's Health Initiative Memory Study. Am J Hypertens, pii hpv081.

Intzandt, B., Black, S.E., Lanctôt, K.L., Herrmann, N., Oh, P., & Middleton, L.E. (2015). Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment? Can Geriatr J, 18(2), 65-72.

Jekel, K., Damian, M., Wattmo, C., Hausner, L., Bullock, R., Connelly, P.J., …Frölich, L. (2015). Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther, 7(1), 17. doi: 10.1186/s13195-015-0099-0.

Jellinger, K.A. (2014). Pathogenesis and treatment of vascular cognitive impairment. Neurodegener Dis Manag, 4(6), 471-490.

Joosten, H., van Eersel, M.E., Gansevoort, R.T., Bilo, H.J., Slaets, J.P., & Izaks, G.J. (2013). Cardiovascular risk profile and cognitive function in young, middle-aged, and elderly subjects. Stroke, 44(6), 1543-1549.

Jorm, A.F. & Jacomb, P.A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med, 19(4), 1015-1022.

Kaduszkiewicz, H., Eisele, M., Wiese, B., Prokein, J., Luppa, M., Luck, T., …Riedel-Heller, S.G. (2014). Prognosis of mild cognitive impairment in general practice: results of the German AgeCoDe study. Ann Fam Med, 12(2), 158-165.

Kalaria, R.N. (2012). Cerebrovascular disease and mechanisms of cognitive impairment: evidence from clinicopathological studies in humans. Stroke, 43(9), 2526-2534.

Kelley, B.J. (2015). Treatment of Mild Cognitive Impairment. Curr Treat Options Neurol, 17(9), 372. doi: 10.1007/s11940-015-0372-3.

Kim, S.A., & Jung, H. (2015). Prevention of cognitive impairment in the midlife women. J Menopausal Med, 21(1), 19-23.

López-Arrieta, J.M. & Birks, J. (2002). Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database Syst Rev, 3, CD000147.

Luna-Lario, P., Azcárate-Jiménez, L., Seijas-Gómez, R., & Tirapu-Ustarroz, J. (2015). [Proposal for a neuropsychological cognitive evaluation battery for detecting and distinguishing between mild cognitive impairment and dementias]. Rev Neurol, 60(12), 553-561.

Mahmoudi, M.J., Hedayat, M., Sharifi, F., Mirarefin, M., Nazari, N., Mehrdad, N., …Fakhrzadeh, H. (2014). Effect of low dose ω-3 poly unsaturated fatty acids on cognitive status among older people: a double-blind randomized placebo-controlled study. J Diabetes Metab Disord, 13(1), 34. doi: 10.1186/2251-6581-13-34.

Makin, S.D., Turpin, S., Dennis, M.S., & Wardlaw, J.M. (2013). Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry, 84(8), 893-900.

Mikhaĭlova, N.M., Selezneva, N.D., Kalyn, IaB., Roshchina, I.F., & Gavrilova, S.I. (2013). [Efficacy of actovegin in the treatment of elderly patients with vascular mild cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova, 113(7 Pt 2), 69-76.

Mitchell, J., Arnold, R., Dawson, K., Nestor, P.J., & Hodges, J.R. (2009) Outcome in subgroups of mild cognitive impairment (MCI) is highly predictable using a simple algorithm. J Neurol, 256(9), 1500-1509.

Mora-Simón, S., García-García, R., Perea-Bartolomé, M.V., Ladera-Fernández, V., Unzueta-Arce, J., Patino-Alonso, M.C., & Rodríguez-Sánchez, E. (2012). [Mild cognitive impairment: early detection and new perspectives]. Rev Neurol, 54(5), 303-310.

Morris, J.C. (2002). Challenging assumptions about Alzheimer's disease: mild cognitive impairment and the cholinergic hypothesis. Ann Neurol, 51(2), 143-144.

Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., …Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 53(4) ,695-69.

Ngandu, T., Lehtisalo, J., Levälahti, E., Laatikainen, T., Lindström, J., Peltonen, M., …Kivipelto, M. (2014). Recruitment and baseline characteristics of participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)-a randomized controlled lifestyle trial. Int J Environ Res Public Health, 11(9), 9345-9360.

Parnetti, L., Mignini. F., Tomassoni, D., Traini, E., & Amenta, F. (2007). Cholinergic precursors in the treatment of cognitive impairment of vascular origin: ineffective approaches or need for re-evaluation? J Neurol Sci, 257(1-2), 264-269.

Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G., & Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Arch Neurol, 56(3), 303-308.

Petersen, R.C., Stevens, J.C., Ganguli, M., Tangalos, E.G., Cummings, J.L., & DeKosky, ST. (2001). Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56(9), 1133-1142.

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc, 23(10), 433-441.

Ramlall, S., Chipps, J., Pillay, B.J., & Bhigjee, A.I. (2013). Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile. Afr J Psychiatry, 16, 456-465.

Russ, T.C. (2014). Cholinesterase inhibitors should not be prescribed for mild cognitive impairment. Evid Based Med, 19(3), 101. doi: 10.1136/eb-2013-101687.

Schaapsmeerders, P., Maaijwee, N.A., van Dijk, E.J., Rutten-Jacobs, L.C., Arntz, R.M., Schoonderwaldt, H.C., …de Leeuw, F.E. (2013). Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke ,44(6), 1621-1628.

Schneider, J.A., Arvanitakis, Z., Leurgans, S.E., & Bennett, D.A. (2009). The neuropathology of probable Alzheimer disease and mild cognitive impairment. Ann Neurol. 2009, 66(2), 200-208.

Schneider, L.S., Dagerman, K.S., Higgins, J.P., & McShane, R. (2011). Lack of evidence for the efficacy of memantine in mild Alzheimer disease. Arch Neurol, 68(8), 991-998.

Secades, J.J. (2011). Citicoline: pharmacological and clinical review, 2010 update. Rev Neurol, 52 Suppl 2, S1-S62.

Sherwin, B.B. (2000). Mild cognitive impairment: potential pharmacological treatment options. J Am Geriatr Soc, 48(4), 431-441.

Sun, J.H., Tan, L., & Yu, J.T. (2014). Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med, 2(8), 80. doi: 10.3978/j.issn.2305-5839.2014.08.05.

Sun, Y., Lee, H.J., Yang, S.C., Chen, T.F., Lin, K.N., Lin, C.C., …Chiu, M.J. (2014). A nationwide survey of mild cognitive impairment and dementia, including very mild dementia, in Taiwan. PLoS One, 9(6), e100303. doi: 10.1371/journal.pone.0100303.

Tan, M.S., Yu, J.T., Tan, C.C., Wang, H.F., Meng, X.F., Wang, C., …Tan, L. (2015). Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis. J Alzheimers Dis, 43(2), 589-603.

Thal, L.J., Ferris, S.H., Kirby, L., Block, G.A., Lines, C.R., Yuen, E., … Reines, S.A. (2005). A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology, 30(6), 1204-1215.

van Rooij, F.G., Schaapsmeerders, P., Maaijwee, N.A., van Duijnhoven, D.A., de Leeuw, F.E., Kessels, R.P., & van Dijk, E.J. (2014). Persistent cognitive impairment after transient ischemic attack. Stroke, 45(8), 2270-2274.

Waegemans, T., Wilsher, C.R., Danniau, A., Ferris, S.H., Kurz, A. & Winblad, B. (2002). Clinical efficacy of piracetam in cognitive impairment: a meta-analysis. Dement Geriatr Cogn Disord, 13(4), 217-224.

Yj, H., Eh, J., J, H., Jh, R., & J-H, L. (2015). The Efficacy of Cognitive Intervention Programs for Mild Cognitive Impairment: A Systematic Review. Curr Alzheimer Res, [Epub ahead of print].

Zhao, Y., Wu, G., Shi, H., Xia, Z., & Sun, T. (2014). Relationship between cognitive impairment and apparent diffusion coefficient values from magnetic resonance-diffusion weighted imaging in elderly hypertensive patients. Clin Interv Aging, 9, 1223-1231.

DOI: http://dx.doi.org/10.18103/mra.v2i6.370


  • There are currently no refbacks.