November 2025
New diagnostic criteria for vascular cognitive impairment and dementia
By Sasha Ellery BM BCh
An international consortium of experts has developed updated diagnostic criteria to improve the consistency and accuracy of diagnosing vascular cognitive impairment and dementia (VCID). The process was led by Professor Perminder Sachdev and his team of researchers at the Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney.
The VasCog-2-WSO criteria, published in JAMA Neurology, sought to address longstanding challenges in the field, including inconsistent terminology, varied assessment methods and a lack of standardised imaging thresholds. It consolidated prior definitions – such as vascular dementia, vascular neurocognitive disorder and vascular cognitive disorder – under the single umbrella term VCID.
Dr Adam Bentvelzen, coauthor of the new guidelines and Clinical Neuropsychologist at CHeBA, said unified terminology would reduce confusion and misperceptions in the field.
‘Previous definitions...were limited by our Alzheimer’s disease-dominated viewpoint, including until fairly recently the strict requirement to have an episodic memory impairment, when this domain is not necessarily affected in VCID until later stages of the disease.’
Standardised criteria, he added, would enable simpler and more consistent diagnosis across clinical and research settings. ‘This should help increase recognition of VCID and reduce underdiagnosis, which has been an ongoing problem.’
The revised framework emerged from a Delphi consensus process involving about 50 international experts, who achieved agreement on definitions for preclinical, mild and major stages of VCID.
‘The new preclinical category is aimed at identifying persons that, while they do not yet present symptoms, are incidentally discovered to have high levels of cerebrovascular disease via neuroimaging,’ Dr Bentvelzen said. ‘[These individuals] should be targeted for monitoring, risk reduction and preventative interventions.’
The update also introduced guidance on using imaging and fluid biomarkers.
‘The new criteria change the role of MRI and biomarkers, firstly, in the approach to VCID itself – there is greater specificity of neuroimaging markers in line with greater understanding of strategic locations or dimen- sions of cerebrovascular disease,’ Dr Bentvelzen explained.
‘Secondly, there is greater recognition of neuroimaging and fluid biomarkers from other dementias, acknowledging the rapid recent advances, such as in markers of Alzheimer’s disease (e.g. phosphorylated tau in the cerebrospinal fluid and blood) and amyloid imaging via positron emission tomography techniques.’
Dr Bentvelzen advised that a clear diagnosis of VCID likely required neuroimaging using MRI, or at a minimum CT, to investigate a potential vascular cause. ‘This should be done as early as possible, as even if the results are negative, a good baseline is extremely important for establishing the possibility of change in the near future and hence allows more confidence in the suspected diagnosis.’
He advised GPs to conduct early cognitive screening and if the results were positive to refer patients to a memory clinic for a comprehensive assessment.
‘A knowledgeable informant or carer will also support a personal history, and cast light on whether a person has had mood or personality change that can overlap or mimic VCID and its associated cerebrovascular changes, and may be treatable on its own,’ he added.