Updating data on cognitive impairment in stroke patients

Vascular cognitive impairments are the expression of complex interactions between vascular etiology, risk factors (brain diseases, white matter lesions, etc.) and cellular changes at the brain level. Consequently, vascular cognitive impairment is highly dependent on the location, extent (volume of brain tissue affected) and number of lesions. Memory impairment is not necessarily characteristic of vascular cognitive decline, usually having an evolution with episodic exacerbations and multiple cerebrovascular attacks (cumulative effect), thus producing a gradual deterioration. In recent years, the concept of mild cognitive impairment has emerged as a potential form of predementia, but which can progress to different types of dementia, including Alzheimer's disease or vascular dementia. This review presents recent data related to the etiological and risk factors of cognitive decline after stroke, the associated neuropsychological and behavioral changes, the clinical forms/diagnosis and general principles of vascular dementia therapy. As preliminary conclusions, the Hachinski score is a very useful tool in differentiating vascular dementia from Alzheimer's dementia. A score greater than 7 points (especially when associated with imaging and anamnestic criteria) suggests a vascular etiology of dementia, whereas a score of 4 points or less excludes such an etiology. Although it is not the only factor involved, vascular etiology is still intensively studied because it is the only one that can be prevented and treated.