Disease of aging
Vascular Cognitive Impairment
Last updated 2026-07-02· Last reviewed 2026-07-02· 1 min read
Reviewed by the Ultimate Longevity Bible editorial team. Educational reference — not medical advice. See disclaimer.
Substrates
- Large-vessel stroke: focal deficits + cognitive impact.
- Small-vessel disease: white-matter hyperintensities, lacunar infarcts, cerebral microbleeds.
- Chronic hypoperfusion: watershed injury from carotid disease.
- Cerebral amyloid angiopathy: overlaps with Alzheimer's.
Presentation
- Executive dysfunction, processing-speed decline, gait disturbance, mood changes — often more prominent than the amnestic phenotype of pure Alzheimer's.
- Stepwise decline in large-vessel disease; gradual in small-vessel disease.
Prevention
- Blood pressure control: SPRINT MIND demonstrated cognitive-outcome benefit of intensive BP lowering.
- Statin therapy and apoB reduction.
- AF management (anticoagulation to prevent embolic stroke).
- Diabetes control.
- Physical activity and Mediterranean diet.
- Smoking cessation.
Treatment
No disease-modifying drug for established VCI beyond secondary prevention of further vascular events. Cholinesterase inhibitors and memantine have modest effects in mixed dementia.