Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia

Development and validation of a multimodal deep learning framework for vascular cognitive impairment diagnosis

Cerebrovascular disease (CVD) is the second leading cause of dementia worldwide. The accurate detection of vascular cognitive impairment (VCI) in CVD patients remains an unresolved challenge. We collected the clinical non-imaging data and neuroimaging data from 307 subjects with CVD. Using these data, we developed a multimodal deep learning framework that combined the vision transformer and extreme gradient boosting algorithms. The final hybrid model within the framework included only two neuroimaging features and six clinical features, demonstrating robust performance across both internal and external datasets. Furthermore, the diagnostic performance of our model on a specific dataset was demonstrated to be comparable to that of expert clinicians. Notably, our model can identify the brain regions and clinical features that significantly contribute to the VCI diagnosis, thereby enhancing transparency and interpretability. We developed an accurate and explainable clinical decision support tool to identify the presence of VCI in patients with CVD.

Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health

INTRODUCTION

The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI.

AREAS COVERED

The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They emphasize modifiable risk factors identified by the 2020 Lancet Dementia Commission. The most profound risks for VCI also include lower education, cardiometabolic factors, and compromised cognitive reserve. Finally, they discuss pharmacological and non-pharmacological interventions.

EXPERT OPINION

By virtue of the high frequencies of stroke and cardiovascular disease the global prevalence of VCI is expectedly higher than prevalent neurodegenerative disorders causing dementia. Since ~ 90% of the global burden of stroke can be attributed to modifiable risk factors, a formidable opportunity arises to reduce the burden of not only stroke but VCI outcomes including progression from mild to the major in form of vascular dementia. Strict control of vascular risk factors and secondary prevention of cerebrovascular disease via pharmacological interventions will impact on burden of VCI. Non-pharmacological measures by adopting healthy diets and encouraging physical and cognitive activities and urging multidomain approaches are important for prevention of VCI and preservation of vascular brain health.