Vascular behavioral and cognitive disorders.

Vascular disease can attack the brain suddenly, causing a stroke, or subtly, inducing cognitive and behavioral changes. Mounting evidence suggests that the risk factors for stroke are also risk factors for cognitive impairment, including Alzheimer’s disease, and that depression can be associated with vascular changes in the brain (www.congrex.com/VAS-COG2003). Epidemiological surveys tend to be either inclusive and scant or detailed, but focused on one disease. Thus, studies seldom report several illnesses thoroughly enough to look at possible interactions. Canadian statistics suggest that 4.1% of individuals over the age of 65 years have suffered a stroke,1 twice as many (8%) being demented, and that for every person demented, 2 (16.8%) have cognitive impairment short of dementia.2 Could vascular factors underlie all 3 conditions? A new approach addressing the whole spectrum of cognitive impairment and emphasizing treatment and prevention has been proposed. It suggests that all types of cognitive decline caused or contributed by vascular factors should be addressed in a broad and systematic manner as “vascular cognitive impairment.”3 Moreover, the evidence suggests a reciprocal relationship between depression and stroke: depressed patients being more prone to suffering stroke,4 and stroke patients being at higher risk for depression.5 Furthermore, late-life depression can be associated with leukoaraiosis and subcortical infarcts.6 Since the treatment of vascular risk factors can prevent heart attacks and strokes, it may also be possible to avoid mental decline, subtle forms of stroke, and some types of depression. One problem of medicine has been increasing specialization, research focusing on one disease at the exclusion of another. A new society has been formed to bring together research from a broad range of disciplines and to advance our knowledge about vascular factors in the causation of mental decline, stroke, and depression. The International Society for Vascular Behavioral and Cognitive Disorders (VAS-COG) held its first Congress in Goteborg, Sweden, August 28-31, 2003. It attracted 550 participants, who discussed 234 papers and posters. The Society is eager to have more stroke physicians and scientists at its Florence Congress (June 8-11, 2005). A 10-person international executive committee was selected and officers chosen: Vladimir Hachinski, President, Canada; Ingmar Skoog, Secretary General, Sweden, and Anders Wallin, Co-Secretary General, Sweden, both of whom organized the Goteborg Congress; and Philip Scheltens, Treasurer, Holland. The commonality of risk factors for heart disease, stroke, cognitive impairment, and depression make it particularly important for those interested in stroke to learn about the more subtle manifestations of cerebrovascular disease and contribute to their treatment and prevention along the whole spectrum. To this end, a free 1-year provisional membership is being offered to all those interested. Please e-mail your request to [email protected]. Stroke also invites manuscripts on the more subtle forms of cerebrovascular disease and papers bridging different disciplines. This is in keeping with its policy of publishing “reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases from many disciplines . . . .” The manuscripts will be reviewed in the same rigorous manner as all others on the same criteria: Is it valid? Is it new? Is it important? The fact that vascular disease underlies or contributes to stroke, cognitive decline, and depression offers the opportunity for a united approach in the treatment and prevention of the 3 most common scourges of the aging brain.