Interpretation of the diagnostic guidelines for vascular mild cognitive impairment in China 2016

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Author: Yuan Junliang, Yang Shuna, Chen Yudan, Hu Wenli
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Chinese Journal of cardiovascular and cerebrovascular diseases, 2017,19 (1): (108-110)
Introduction: according to the 2015 world Alzheimer's disease (AD) report, approximately every 3 seconds, 1 new cases of dementia in patients with Alzheimer's, currently 46 million, is expected in 2050 the number of elderly dementia worldwide will increase to 131 million 500 thousand [1]. The World Stroke Day declaration of 2015 has also changed dramatically, from a focus on stroke disability to focus on post stroke cognition". As a result, dementia is one of the greatest global public health and health care challenges facing humanity today and in the future [2].
As the second most common cause of dementia, vascular cognitive impairment (Vascular cognitive impairment, VCI) was first proposed in 1995 by [3]. In 2006 the U.S. National Institute of neurological disorders and stroke (National Institute for Neurological Disorders and Stroke, NINDS) and the Canadian Stroke Network (Canadian Stroke Network, CSN) released the first unified diagnostic criteria for VCI, namely by the vascular factors leading to or associated with cognitive impairment in [4]. Among them, mild vascular cognitive impairment (Vascular mild cognitive impairment, VaMCI) is caused by vascular causes or reasons associated with vascular mild cognitive impairment syndrome, is a transitional stage between normal cognitive and dementia [5]. The concept is similar to vascular cognitive impairment (Vascular cognitive impairment no dementia, VCIND), mild vascular cognitive impairment (Mild VCD) and mild cognitive impairment (Mild NCD). VaMCI is the precursor of vascular dementia (Vascular dementia, VaD) or dementia, is a key target of dementia prevention and treatment, and is a hot topic of current research VCI [6]. However, the diagnostic criteria of VaMCI is still not unified, for lack of powerful evidence, coupled with China's special language and cultural environment, so Specialized Committee Alzheimer's disease and related diseases China Aged Care Association (ADC) has formulated 2016 guidelines for VaMCI Chinese [7].
This paper mainly focuses on the clinical diagnosis, cognitive function assessment, ADL assessment, neuroimaging examination, diagnostic criteria and other aspects of the detailed interpretation, in order to diagnosis and treatment is beneficial to VaMCI.
Clinical diagnosis (medical history, neurological and physical examination, laboratory examination)
Recommendations: (1) clinical history should be informed by the supplement. (2) all patients should have neurologic and physical examination. (3) at the time of diagnosis, should check the blood of vitamin B12, folic acid, thyroid stimulating hormone, homocysteine, blood glucose, blood calcium, blood cell count, liver and kidney function, and serological tests such as Borrelia and AIDS virus, to the exclusion of other related diseases.
Cognitive function assessment (executive, memory, language, visual space, and holistic cognition)
(1) cognitive assessment: Previous studies have found that the main clinical features of VCI including memory retention, and the attention and frontal executive dysfunction, and may be accompanied by action and information processing speed, can also suffer from depression, emotional instability, apathy and other emotional disorders [8]. The most significant cognitive impairment in VCI area is information processing speed and executive function of frontal [9-10] VaMCI, frontal executive function impairment is related to Alzheimer's disease with mild cognitive impairment (Mild cognitive impairment due to Alzheimer's disease, AD-MCI) was [11]. Episodic memory impairment is common in VaMCI, mainly for the encoding of new information and impaired memory retrieval impairment, visible immediate memory, language retrieval, processing speed, and the overall recognition (cognitive) impairment; and AD-MCI is the memory impaired, is quickly forgotten [12]. The onset of VaMCI cognitive impairment and cognitive impairment were closely related with the type, location and severity of vascular lesions. The most common lesion is SVD (Small vessel disease), which is generally manifested as progressive onset, slow progress, mainly affecting the speed of information processing, attention and frontal executive function [13].
(2) cognitive screening program: at present, only in 2006 NINDS-CSN co published VCI collaboration standard [4]. The standard recommends 3 programs: 60min program, 30min program and 5min program to meet the different needs of cognitive screening. 60min from memory, visual space, language, performance test and assembly of the overall cognitive tests and emotional / mental behavior, is suitable for the study of screening; 30min scheme in 60min solution based on the deletion of the visual space test, suitable for clinical screening; 5min program by the Montreal cognitive assessment scale (MoCA), directional memory and the language evaluation project portfolio which is suitable for rapid screening, and large-scale epidemiological survey and telephone screening. To this end, China ADC formed a consensus 30min neuropsychological assessment scheme, constitute the program by memory, language, visuospatial, executive 4 cognitive domains and overall cognitive assessment project, added the tool life events scale. Usually have 1 or more domains of cognitive impairment evidence, overall normal cognition and tool life ability to retain the basic, or VaMCI can be diagnosed with mild cognitive impairment (MCI).
Recommendations: (1) VaMCI diagnosis must be based on neural psychology test, cognitive assessment should include 1 overall cognitive tests and tested at least 4 cognitive domains, such as execution, memory, language, visuospatial function (class I evidence, Grade A)