Revised Diagnostic Criteria for Vascular Cognitive Impairment and Dementia-The VasCog-2-WSO Criteria

VasCog-2-WSO Criteria Consortium; Perminder S Sachdev^{1

2}, Adam C Bentvelzen¹, Nicole A Kochan¹, Jiyang Jiang¹, Satoshi Hosoki^{1

3}, Rebecca Koncz^{1

4}, Russell J Chander¹, Danit Saks¹, Hugo P Aben⁵, Daisy Acosta⁶, Pia Andersen^{7

8}, Frédéric Assal⁹, Hee-Joon Bae¹⁰, Geert Jan Biessels¹¹, Deborah Blacker^{12

13}, Régis Bordet¹⁴, Emily M Briceno^{15

16}, Henry Brodaty¹, Amy Brodtmann¹⁷, Paulo Caramelli¹⁸, Erico Castro-Costa¹⁹, Hugues Chabriat²⁰, Christopher Chen²¹, Una Clancy²², Lucette Cysique^{23

24

25}, Charles DeCarli^{26

27}, Ding Ding²⁸, Marco Duering^{29

30

31}, Eliasz Engelhardt^{32

33}, Serge Gauthier^{34

35}, Fatemeh Geranmayeh³⁶, Olivier Godefroy^{37

38}, Philip Gorelick³⁹, Steven M Greenberg¹², Vesna Jelic^{40

41}, Hanna Jokinen^{42

43}, Raj N Kalaria⁴⁴, Murali Krishna⁴⁵, Kurt Lancaster⁴⁶, Frank-Erik de Leeuw⁴⁷, Jae-Sung Lim⁴⁸, Anna Marseglia⁴⁰, Javier Marta-Moreno⁴⁹, John T O'Brien⁵⁰, Leonardo Pantoni^{51

52}, Matthew P Pase^{53

54}, Sarah T Pendlebury^{55

56

57

58}, Gary Rosenberg⁵⁹, Behnam Sabayan^{60

61}, Emilia Salvadori⁵¹, Katherine Samaras^{62

63

64}, Ivy Anne Sebastian⁶⁵, Sudha Seshadri⁶⁶, Eric E Smith⁶⁷, Velandai Srikanth^{68

69

70}, Kathryn Stokes⁷¹, Felipe Kenji Sudo⁷², Lukas Sveikata⁹, Michael Valenzuela¹, Anders Wallin^{73

74}, Joanna M Wardlaw^{22

22}, Qun Xu⁷⁵

Affiliations

¹ Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
² Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia.
³ Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁴ National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands.
⁶ Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic.
⁷ Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
⁹ Cognitive Neurology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹⁰ Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
¹¹ Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
¹² Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston.
¹³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
¹⁴ Univ Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, Lille, France.
¹⁵ Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor.
¹⁶ Department of Neurology, University of Michigan Medical School, Ann Arbor.
¹⁷ Cognitive Health Initiative, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁸ Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
¹⁹ Center for Studies in Public Health and Aging, Belo Horizonte, Brazil.
²⁰ Centre Neurovasculaire Translationnel-CERVCO and Département de Neurologie, Hopital Lariboisiere, APHP, Université Paris-Cité and Brain Institute, Paris, France.
²¹ Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²² Centre for Clinical Brain Sciences, UK Dementia Institute Centre, University of Edinburgh, Edinburgh, United Kingdom.
²³ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
²⁴ UNSW Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia.
²⁵ St Vincent's Hospital Centre for Applied Medical Research, Sydney, New South Wales, Australia.
²⁶ Alzheimer's Disease Research Center, Department of Neurology, University of California, Davis, Sacramento, California.
²⁷ Imaging of Dementia and Aging Laboratory, Department of Neurology, University of California, Davis, Sacramento.
²⁸ Institute of Neurology, Fudan University Huashan Hospital, Shanghai, China.
²⁹ Medical Image Analysis Center, Basel, Switzerland.
³⁰ Translational Imaging in Neurology, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
³¹ Institute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Germany.
³² Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
³³ Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
³⁴ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
³⁵ Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
³⁶ Department of Brain Sciences, Imperial College London, London, United Kingdom.
³⁷ Department of Neurology, Amiens University Hospital, Amiens, France.
³⁸ Laboratory of Functional Neurosciences, Jules Verne University of Picardie, Amiens, France.
³⁹ Section of Vascular Neurology, Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁴⁰ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
⁴¹ Clinic for Cognitive Disorders, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
⁴² Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴³ Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁴⁴ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
⁴⁵ Centre for Health Systems Research, Institute of Public Health, Bangalore, India.
⁴⁶ Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁴⁷ Department of Neurology, Research Institute for Medical Innovation, Radboudum and Donders Institute Brain, Cognition & Behaviour, Nijmegen, the Netherlands.
⁴⁸ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴⁹ Neurovascular Unit, Department of Neurology, Hospital Universitario Miguel Servet, Instituto Investigación Sanitaria- IIS Aragón, Zaragoza, Spain.
⁵⁰ Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
⁵¹ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
⁵² Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy.
⁵³ School of Psychological Science, Monash University, Melbourne, Victoria, Australia.
⁵⁴ Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.
⁵⁵ Wolfson Building, Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
⁵⁶ Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁷ Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁸ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁹ Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque.
⁶⁰ Hennepin Healthcare Research Institute, Department of Neurology, Hennepin County Medical Center, Minneapolis, Minnesota.
⁶¹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
⁶² Clinical Obesity, Nutrition and Adipose Biology Laboratory, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.
⁶³ Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁶⁴ St Vincent's Clinical School, University of New South Wales Sydney, Kensington, New South Wales, Australia.
⁶⁵ Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
⁶⁶ Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio.
⁶⁷ Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
⁶⁸ National Centre for Healthy Ageing, Melbourne, Victoria, Australia.
⁶⁹ Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
⁷⁰ Peninsula Health, Melbourne, Victoria, Australia.
⁷¹ Neuropsychology and Cognitive Health, Baycrest Health Sciences Centre, Canada.
⁷² D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁷³ Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷⁴ Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁷⁵ Health Management Center, Department of Neurology, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.

PMID: 40955506
PMCID: PMC12441927 (available on 2026-09-16)
DOI: 10.1001/jamaneurol.2025.3242

Revised Diagnostic Criteria for Vascular Cognitive Impairment and Dementia-The VasCog-2-WSO Criteria

VasCog-2-WSO Criteria Consortium et al. JAMA Neurol. 2025.

. 2025 Sep 16:e253242.

doi: 10.1001/jamaneurol.2025.3242. Online ahead of print.

Authors

Affiliations

¹ Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
² Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia.
³ Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁴ National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands.
⁶ Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic.
⁷ Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
⁹ Cognitive Neurology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹⁰ Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
¹¹ Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
¹² Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston.
¹³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
¹⁴ Univ Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, Lille, France.
¹⁵ Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor.
¹⁶ Department of Neurology, University of Michigan Medical School, Ann Arbor.
¹⁷ Cognitive Health Initiative, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁸ Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
¹⁹ Center for Studies in Public Health and Aging, Belo Horizonte, Brazil.
²⁰ Centre Neurovasculaire Translationnel-CERVCO and Département de Neurologie, Hopital Lariboisiere, APHP, Université Paris-Cité and Brain Institute, Paris, France.
²¹ Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²² Centre for Clinical Brain Sciences, UK Dementia Institute Centre, University of Edinburgh, Edinburgh, United Kingdom.
²³ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
²⁴ UNSW Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia.
²⁵ St Vincent's Hospital Centre for Applied Medical Research, Sydney, New South Wales, Australia.
²⁶ Alzheimer's Disease Research Center, Department of Neurology, University of California, Davis, Sacramento, California.
²⁷ Imaging of Dementia and Aging Laboratory, Department of Neurology, University of California, Davis, Sacramento.
²⁸ Institute of Neurology, Fudan University Huashan Hospital, Shanghai, China.
²⁹ Medical Image Analysis Center, Basel, Switzerland.
³⁰ Translational Imaging in Neurology, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
³¹ Institute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Germany.
³² Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
³³ Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
³⁴ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
³⁵ Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
³⁶ Department of Brain Sciences, Imperial College London, London, United Kingdom.
³⁷ Department of Neurology, Amiens University Hospital, Amiens, France.
³⁸ Laboratory of Functional Neurosciences, Jules Verne University of Picardie, Amiens, France.
³⁹ Section of Vascular Neurology, Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁴⁰ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
⁴¹ Clinic for Cognitive Disorders, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
⁴² Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴³ Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁴⁴ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
⁴⁵ Centre for Health Systems Research, Institute of Public Health, Bangalore, India.
⁴⁶ Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁴⁷ Department of Neurology, Research Institute for Medical Innovation, Radboudum and Donders Institute Brain, Cognition & Behaviour, Nijmegen, the Netherlands.
⁴⁸ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴⁹ Neurovascular Unit, Department of Neurology, Hospital Universitario Miguel Servet, Instituto Investigación Sanitaria- IIS Aragón, Zaragoza, Spain.
⁵⁰ Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
⁵¹ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
⁵² Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy.
⁵³ School of Psychological Science, Monash University, Melbourne, Victoria, Australia.
⁵⁴ Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.
⁵⁵ Wolfson Building, Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
⁵⁶ Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁷ Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁸ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵⁹ Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque.
⁶⁰ Hennepin Healthcare Research Institute, Department of Neurology, Hennepin County Medical Center, Minneapolis, Minnesota.
⁶¹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
⁶² Clinical Obesity, Nutrition and Adipose Biology Laboratory, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.
⁶³ Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia.
⁶⁴ St Vincent's Clinical School, University of New South Wales Sydney, Kensington, New South Wales, Australia.
⁶⁵ Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
⁶⁶ Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio.
⁶⁷ Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
⁶⁸ National Centre for Healthy Ageing, Melbourne, Victoria, Australia.
⁶⁹ Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
⁷⁰ Peninsula Health, Melbourne, Victoria, Australia.
⁷¹ Neuropsychology and Cognitive Health, Baycrest Health Sciences Centre, Canada.
⁷² D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁷³ Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷⁴ Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁷⁵ Health Management Center, Department of Neurology, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.

PMID: 40955506
PMCID: PMC12441927 (available on 2026-09-16)
DOI: 10.1001/jamaneurol.2025.3242

Abstract

Importance: Several sets of diagnostic criteria have been proposed for vascular cognitive impairment and dementia (VCID). The International Society for Vascular Behavioural and Cognitive Disorders (VasCog) working group published comprehensive operationalized criteria in 2014. Considering subsequent advances in the field, a revision was needed.

Objective: To update the VasCog criteria to achieve consensus on diagnosis of VCID.

Design, setting, and participants: VasCog criteria and other published diagnostic guidelines, aided by literature review of recent developments in VCID, were used as reference points for an online Delphi survey (minimum 3 rounds, ≥75% threshold for agreement), including operationalization of criteria and guidance on potential biomarkers. Seventy international experts from diverse international regions were invited to participate in 2023.

Results: Three survey rounds included 49 to 54 participants that agreed on VasCog-2 diagnostic criteria for preclinical, mild, and major dementia levels of vascular cognitive impairment (under the overarching term VCID). Research guidelines, including the use of novel neuroimaging and fluid biomarkers, were also agreed on. The World Stroke Organization (WSO) endorsed the criteria, hence named VasCog-2-WSO.

Conclusions and relevance: The VasCog-2-WSO criteria update the VasCog criteria for the diagnosis of VCID, providing operationalization and additional guidance on potential neuroimaging and fluid biomarkers. VasCog-2-WSO should provide an international standard for VCID diagnosis, facilitating diagnostic consistency among clinicians and researchers.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Sachdev reported receiving advisory board fees from Eisai in 2020, Roche Australia in 2022, and Eli Lilly Australia in 2025 outside the submitted work. Dr Bentvelzen reported receiving personal fees from Eisai Australia outside the submitted work. Dr Briceno reported receiving personal fees from the American Psychological Association for service as associate editor of the Neuropsychology journal outside the submitted work. Dr Brodaty reported receiving personal fees from Eisai, Eli Lilly, Medicines Australia, Roche, Skin2Neuron, and Cranbrook Care outside the submitted work. Dr Caramelli reported receiving advisory board and/or speaker fees from Aché, Biogen, Danone, Eurofarma, Fleury, Eli Lilly, Lundbeck, Novo Nordisk, Knight Therapeutics, and personal fees from Passage Bio for work as a subinvestigator in a clinical trial outside the submitted work. Dr Gauthier reported serving as an unpaid member of the advisory board for Alzheon; receiving personal fees from AmyriAD, Eisai Canada, Enigma USA, Lilly Canada, Otsuka Canada, Novo Nordisk Canada, TauRx, and AbbVie; and receiving a stipend from The Journal of Prevention of Alzheimer’s Disease editorial board and Sharon Francis Foundation in Toronto, Canada. Dr Godefroy reported receiving personal fees from Eisai and funding for travel and meetings from Biogen, Roche, and Bristol Myers Squibb outside the submitted work. Dr Gorelick reported receiving advisory fees from American Telehealth Physicians/NeuroX, QuantalX, and JLK outside the submitted work. Dr O’Brien reported serving as a consultant for Biogen, Roche, GE Healthcare, and Okwin; receiving honorarium for lectures from GE Healthcare; serving on the advisory board for Data Safety Monitoring Board, TauRx and Novo Nordisk; serving as chair of UK Alzheimer’s Society Research Strategy Council; and receiving academic support for research from Avid/ Lilly, Merck, UCB, and Alliance Medical. Dr Pantoni reported receiving personal fees from Amicus, PIAM, and Medtronic outside the submitted work. Dr Pase reported personal fees from Alzheimer’s Drug Discovery Foundation. Dr Smith reported the receipt of fees paid to University of Calgary from Alnylam Pharmaceuticals to recruit participants in a clinical trial outside the submitted work. Dr Sveikata reported receiving small consultancy fees from Biomapas. Dr Valenzuela reported receiving personal fees from Skin2Neuron Pty Ltd outside the submitted work. No other disclosures were reported.

Comment in

doi: 10.1001/jamaneurol.2025.3234

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Revised Diagnostic Criteria for Vascular Cognitive Impairment and Dementia-The VasCog-2-WSO Criteria

Affiliations

Revised Diagnostic Criteria for Vascular Cognitive Impairment and Dementia-The VasCog-2-WSO Criteria

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

LinkOut - more resources

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