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Practice Guideline
. 2025 Jan;21(1):e14324.
doi: 10.1002/alz.14324. Epub 2025 Jan 16.

Canadian Stroke Best Practice Recommendations: Vascular cognitive impairment, 7th edition practice guidelines update, 2024

Richard H Swartz  1   2   3 , R Stewart Longman  4 , M Patrice Lindsay  5 , Rebecca Lund  5 , Aravind Ganesh  6 , Gail A Eskes  7 , Melissa Austin  8   9 , Lauren E Bechard  10 , Jaspreet Bhangu  11 , Venera C Bruto  12 , Sherri Carter  13   14 , Nelly Chow  15 , Yan Deschaintre  16   17 , Kathleen Fedorchuk  18 , Lesley Fellows  19   20 , Norine Foley  21 , Lee-Anne Greer  22 , Douglas S Lee  23   24 , Carol Leonard  25 , Ronak Patel  26 , Sepideh Poonyania  27   28 , Valerie Poulin  29 , Fatima Quraishi  30 , Pamela Roach  31 , Tricia Shoniker  32   33 , Carmen Tuchak  34   35 , Anita Mountain  36 , Chelsy Martin  5 , Eric E Smith  6   37 ; Canadian Stroke Best Practice Recommendations Advisory Committee, in collaboration with the Canadian Stroke Consortium, Canadian Neurological Sciences Federation, and CanStroke Recovery Trials Platform
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Practice Guideline

Canadian Stroke Best Practice Recommendations: Vascular cognitive impairment, 7th edition practice guidelines update, 2024

Richard H Swartz et al. Alzheimers Dement. 2025 Jan.

Abstract

The Canadian Stroke Best Practice Recommendations (CSPR) 7th edition includes this new module on the diagnosis and management of vascular cognitive impairment (VCI) with or without neurodegenerative disease. An expert writing group and people with VCI lived experience (PWLE) reviewed current evidence. Existing recommendations were reviewed and revised, and new recommendations added. Sections include definitions, signs and symptoms, screening, assessment, diagnosis, pharmacological and non-pharmacological management, secondary prevention, rehabilitation, and end-of-life care. PWLE were actively involved in all aspects of the development, ensuring their experiences are integrated. A unique VCI journey map, developed by PWLE, is included, and helped to motivate and anchor the recommendations. We encourage it to be displayed across healthcare settings to raise awareness and support persons with VCI. These VCI CSBPRs emphasize the need for integrated multidisciplinary care across the continuum. Evidence for the diagnosis and management of VCI continues to emerge and gaps in knowledge should drive future research. HIGHLIGHTS: This Canadian Stroke Best Practice Recommendations module focuses specifically on VCI using a structured framework and validated methodology. A comprehensive set of evidence-based recommendations is presented that addresses the continuum from symptom onset to diagnosis, management, and end of life. The recommendations consider individuals who experience VCI because of stroke or because of other vascular pathologies such as atrial fibrillation or heart failure. A journey map of an individual's experience with VCI has been developed by individuals with lived experience. It is a valuable guide to inform educational content, approaches to caring for individuals and families with VCI, and systems planning.

Keywords: cognitive dysfunction; dementia; management of VCI; practice guidelines; stroke; vascular cognitive impairment.

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Conflict of interest statement

The following authors have identified actual or potential conflicts of interest which have been mitigated through the design of a multidisciplinary writing group model and additional measures by the advisory committee as required. Richard H Swartz holds research grants from the Canadian Institutes for Health Research (CIHR), Ontario Brain Institute (OBI), National Institutes of Health (NIH); advisory board membership for Hoffman‐LaRoche; and stock options in FollowMD. R Stewart Longman received support for attending meetings and/or travel for CASEM Annual Sport Medicine Conference. M Patrice Lindsay is a member of the March of Dimes Canada After Stroke advisory committee (no financial remuneration). Aravind Ganesh holds a new investigator award from the Heart and Stroke Foundation of Canada; research grants from the Canadian Institutes of Health Research, Canadian Cardiovascular Society, Alberta Innovates, Campus Alberta Neuroscience, Government of Canada—INOVAIT Program, Government of Canada—New Frontiers in Research Fund, MicroVention, Alzheimer Society of Canada, Alzheimer Society of Alberta and Northwest Territories, Heart and Stroke Foundation of Canada, Panmure House, Brain Canada, MSI Foundation, France‐Canada Research Fund; receives consulting fees from MD Analytics, My Medical Panel, Figure 1, CTC Communications Corp, Atheneum, Deep Bench, Research on Mind, Creative Research Designs, Alpha Sights, 42mr; payment or honoraria from Figure 1, Alexion, Biogen, Servier Canada; expert testimony for Grosso Harper Law, Lerners Law; support for attending meetings and/or travel from the American Academy of Neurology, Association of Indian Neurologists in America, American Heart Association, University of Calgary; patents planned, issued or pending as follows: Patent filed for (1) a system for patient monitoring and delivery of remote ischemic conditioning or other cuff‐based therapies and (2) systems and methods for enhancing the efficiency of initiating, conducting and funding research projects; leadership or fiduciary role paid or unpaid as a member of the editorial board for Neurology: Clinical Practice, Neurology, Stroke; stock or stock options in SnapDx Inc, Collavidence Inc (LetsGetProof)—Patient monitoring and decision support technology, research crowdfunding and collaboration platform. Gail A. Eskes holds grants or contracts from Nova Scotia Health, CIHR Health Research Training Platform, Innovacorp, Dalhousie University—NSH, Dalhousie—Operating funds; CIHR ‐Training Grant; payment or honoraria from Mount Allison University; Parkinson Canada; Patents planned, issued, or pending: UK Patent pending for cognitive enhancement technology. Lauren E. Bechard receives consulting fees from Canadian Consortium on Neurodegeneration and Aging (payments made as independent contractor for trainee and capacity building initiatives, unrelated to current manuscript); support for attending meetings and/or travel for Canadian Consortium on Neurodegeneration and Aging (related to graduate research on a separate topic and contract work to support training and capacity building). Yan Deschaintre received payment or honoraria from CPASS (Centre de pédagogie appliquée aux sciences de la santé de l'Université de Montréal), SSVQ (Société des sciences vasculaires du Québec), FMC (Fondation des maladies du coeurs et de l'AVC), ANQ (Association des neurologues du Québec), and SRQ (Société de radiologie du Québec) for presentations about stroke (cognitive health after stroke, tele‐stroke, Tenecteplase for acute stroke, Imaging and clinical criteria for acute stroke treatments, and neurological exam). Lesley Fellows received grants from the Canadian Institutes of Health Research, FRQS (Fonds de recherche du Québec). Anita Mountain received grants from Brain Canada, Heart and Stroke Foundation of Canada, Canadian Partnership for Stroke Recovery/CIHR/Governors of the University of Calgary; Site Qualified Investigator for FLOW Trial/MODEX Trial/CAMAROS Trial. Eric E Smith has received royalties or licenses from UpToDate (Royalties paid to him for chapter on diagnosis of VCI); participation on a Data Safety Monitoring Board or Advisory Board for National Institutes of Health Discovery project; Leadership or fiduciary roles Deputy Editor, Stroke.The following authors have no conflicts of interest to declare: Rebecca Lund, Melissa Austin, Jaspreet Bhangu, Venera C. Bruto, Sherri Carter, Nelly Chow, Kathleen Fedorchuk, Norine Foley, Lee‐Anne Greer, Douglas S Lee, Carol Leonard, Ronak Patel, Sepideh Pooyania, Valerie Poulin, Fatima Quraishi, Pamela Roach, Tricia Shoniker, Carmen Tuchak, Chelsy Martin. Author disclosures are available in the Supporting Information.

Figures

FIGURE 1
FIGURE 1
Multiple clinical presentations can lead to VCI, with the main components of clinical pathways covered in these recommendations. VCI, vascular cognitive impairment.
FIGURE 2
FIGURE 2
The lived experience of VCI journey map. HCP, healthcare provider; VCI, vascular cognitive impairment.
See this image and copyright information in PMC

References

    1. Craig L, Hoo ZL, Yan TZ, Wardlaw J, Quinn TJ. Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta‐analysis. J Neurol Neurosurg Psychiatry. 2022;93:180‐187. doi:10.1136/jnnp-2020-325796 - DOI - PMC - PubMed
    1. Koton S, Pike JR, Johansen M, et al. Association of ischemic stroke incidence, severity, and recurrence with dementia in the atherosclerosis risk in communities cohort study. JAMA Neurol. 2022;79:271‐280. doi:10.1001/jamaneurol.2021.5080 - DOI - PMC - PubMed
    1. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre‐stroke and poststroke dementia: a systematic review and meta‐analysis. Lancet Neurol. 2009;8:1006‐1018. doi:10.1016/s1474-4422(09)70236-4 - DOI - PubMed
    1. Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population‐based oxford vascular study. Lancet Neurol. 2019;18:248‐258. doi:10.1016/s1474-4422(18)30442-3 - DOI - PMC - PubMed
    1. VanGilder JL, Hooyman A, Peterson DS, Schaefer SY. Poststroke cognitive impairments and responsiveness to motor rehabilitation: a review. Curr Phys Med Rehabil Rep. 2020;8:461‐468. doi:10.1007/s40141-020-00283-3 - DOI - PMC - PubMed

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