Evidence-based medical research on diagnostic criteria and screening technique of vascular mild cognitive impairment

Abstract

Background Vascular mild cognitive impairment (VaMCI) is the prodromal syndrome of vascular dementia (VaD) and key target for drug treatment. There is controversy over the diagnostic criteria and screening tools of VaMCI, which affects its clinical diagnosis. This paper aims to explore the clinical features, diagnostic criteria and screening technique of VaMCI.  Methods Taking "vascular mild cognitive impairment OR vascular cognitive impairment no dementia" as retrieval terms, search in PubMed database from January 1997 to March 2015 and screen relevant literatures concerning VaMCI. According to Guidance for the Preparation of Neurological Management Guidelines revised by European Federation of Neurological Societies (EFNS) in 2004, evidence grading was performed on literatures. Results A total of 32 literatures in English were selected according to inclusion and exclusion criteria, including 3 guidelines and consensus and 29 clinical studies. Seven literatures (2 on Level Ⅰ, 5 on Level Ⅱ) studied on neuropsychological features in VaMCI patients and found reduced processing speed and executive function impairment were main features. Two literatures reported the diagnostic criteria of VaMCI, including VaMCI criteria published by American Heart Association (AHA)/American Stroke Association (ASA) in 2011 and "Diagnostic Criteria for Vascular Cognitive Disorders" published by International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2014. Fifteen literatures (4 on LevelⅠ, 11 on Level Ⅱ) described the diagnostic criteria of VaMCI used in clinical research, from which 6 operational diagnostic items were extracted. Fourteen literatures (4 on Level Ⅰ, 10 on Level Ⅱ) described neuropsychological assessment tools for VaMCI screening, and found the 5-minute protocol recommended by National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) was being good consistency with other neuropsychological assessment tools.  Conclusions The neuropsychological features of VaMCI have guiding significance for diagnosis. VASCOG diagnostic criteria for VaMCI is practical in clinical practice, and 5-minute protocol is suitable for clinical rapid screening of VaMCI.

DOI: 10.3969/j.issn.1672-6731.2015.07.007