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Dichgans, Martin; Böhm, Michael; Diener, Hans-Christoph; Hamann, Gerhard F.; Herbst, Heinz-Peter; Minnerup, Jens; Parhofer, Klaus G.; Petzold, Gabor; Schmidtke, Klaus and Zerr, Inga (2017): Vaskuläre Demenzen. In: Aktuelle Neurologie, Vol. 44, No. 5: pp. 299-311

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Background Vascular Cognitive Impairment (VCI) encompasses the full spectrum from vascular mild cognitive impairment to vascular dementia and includes cases with isolated vascular disease as well as mixed vascular and neurodegenerative pathologies. There is considerable uncertainty in terms of optimal diagnostic strategies and therapeutic decision making. Methods The German Neurological Society convened experts in the field of vascular neurology, cognitive neurology, gerontology, and acute stroke care. An interdisciplinary team of experts working in different clinical settings reviewed current literature with a specific focus on the following topics: (1) definitions and classifications considering the multiplicity of both vascular causes and manifestations in the brain;(2) pathophysiology;(3) diagnostic procedures including magnetic resonance imaging and laboratory investigations;(4) diagnostic algorithms;and (5) treatment. The guideline was prepared at an S1-level according to standards of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF). Results Among aspects currently gaining attention are the following: (1) the incidence rate of dementia after intracerebral hemorrhage (ICH) remains high even beyond the first year after ICH;(2) there is no requirement of a presence of memory deficits for a clinical diagnosis of VCI if deficits in other cognitive domains are present;(3) the treatment of VCI includes current strategies of stroke prevention, treatment of psychiatric symptoms, specific pharmacotherapy directed to the cognitive syndrome, and measures of neurorehabilitation. Conclusion The new guideline offers practical advice for physicians and allied health care representatives working in different segments of the health care sector.

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