Guideline registry — vascular dementia¶
Last verified: 2026-09-02 (second deepening pass; four further records added — EAN 2020 medical management in dementia, AAN 2018 mild cognitive impairment (retired), ACR Appropriateness Criteria 2024 update, Alzheimer's Association DETeCD-ADRD 2025 — all PMIDs re-resolved live, bringing the registry to 25 records). PubMed identifiers were live-resolved. Web-only national guidance is listed only where its current page was fetched successfully.
Master table¶
| Body / framework | Year | Region | Scope | Citation | Status |
|---|---|---|---|---|---|
| ADDTC | 1992 | US | ischaemic vascular dementia criteria | Chui et al., PMID 1549205 | historical; superseded by later VCI criteria |
| NINDS–AIREN | 1993 | international | research VaD criteria | Román et al., PMID 8094895 | historical high-specificity research criteria |
| NINDS–CSN | 2006 | international | VCI harmonization standards | Hachinski et al., PMID 16917086 | current measurement standards; not a diagnosis |
| AHA/ASA | 2011 | US/international | vascular contributions to cognitive impairment | Gorelick et al., PMID 21778438 | superseded in parts by newer stroke/VCI guidance |
| VASCOG | 2014 | international | diagnostic criteria | Sachdev et al., PMID 24632990 | superseded by → VasCog-2-WSO for current criteria |
| VICCCS | 2018 | international | diagnostic/classification consensus | Skrobot et al., PMID 29055812 | current harmonization reference |
| ESO | 2021 | Europe | covert cerebral SVD | Wardlaw et al., PMID 34414301 | current |
| AHA/ASA | 2022 | US | spontaneous ICH | Greenberg et al., PMID 35579034 | current |
| Canadian Stroke Best Practices | 2024 (published 2025) | Canada | VCI assessment, prevention, management | Swartz et al., PMID 39822128 | current |
| International CAA Association / WSO | 2025 | international | CAA diagnosis and management | Cordonnier et al., PMID 40721902 | current |
| ESO–EAN joint | 2021 | Europe | post-stroke cognitive impairment: prevention, diagnosis, treatment, prognosis | Quinn et al., PMID 34746430 | current |
| Asian Clinical Expert Group on Neurocognitive Disorders | 2019 | Asia | EGb 761 in dementia and MCI with or without cerebrovascular disease | Kandiah et al., PMID 30648358 | current regional consensus; conflicts with European guidance |
| Korean Dementia Association | 2025 | Korea | cholinesterase inhibitors and memantine across dementia types | Kim et al., PMID 39944527 | current |
| VasCog-2-WSO | 2025 | international | revised VCI/dementia criteria | Sachdev et al., PMID 40955506 | current |
| AHA (Hypertension) | 2016 | US/international | impact of hypertension on cognitive function | Iadecola et al., PMID 27977393 | current scientific statement; explicitly makes no evidence-based recommendation |
| NICE NG97 | 2018 | UK | dementia assessment, management and support | Pink et al. (summary), PMID 29925626 | current national guidance; no vascular-specific pathway |
| WHO | 2019 (summary published 2021) | global | risk reduction of cognitive decline and dementia | Chowdhary et al., PMID 35082745 | current |
| AHA/ASA | 2021 | US/international | secondary prevention after stroke and TIA | Kleindorfer et al., PMID 34024117 | current |
| AHA/ASA | 2021 | US | primary care of adults after stroke | Kernan et al., PMID 34261351 | current scientific statement |
| AHA/ASA | 2023 | US/international | cognitive impairment after ischaemic and haemorrhagic stroke | El Husseini et al., PMID 37125534 | current scientific statement |
| Lancet standing Commission | 2024 | international | dementia prevention, intervention and care | Livingston et al., PMID 39096926 | current |
| European Academy of Neurology | 2020 | Europe | medical management issues in dementia (vascular risk, pain, antipsychotics, epilepsy, follow-up) | Frederiksen et al., PMID 32713125 | current GRADE guideline |
| American Academy of Neurology | 2018 | US | mild cognitive impairment: prevalence, prognosis, treatment | Petersen et al., PMID 29282327 | retired; not replaced. Its exercise recommendation remains the strongest graded one in the field |
| American College of Radiology | 2024 update (published 2025) | US | imaging appropriateness across dementia scenarios, incl. anti-amyloid monitoring | Expert Panel on Neurological Imaging, PMID 40409878 | current |
| Alzheimer's Association (DETeCD-ADRD) | 2025 | US | diagnostic evaluation, testing, counselling and disclosure for AD and related dementias | Atri et al., PMID 39713939 | current; primary-care facing, minimal vascular-specific content |
Record notes¶
ADDTC 1992 and NINDS–AIREN 1993¶
ADDTC operationalized ischaemic vascular dementia with neuroimaging and mixed categories (Chui 1992, PMID 1549205). NINDS–AIREN required dementia, cerebrovascular disease, and a relationship between them for research case definition, stratified definite/probable/possible (Román 1993, PMID 8094895). Both are historical relative to VASCOG/VasCog-2-WSO but still explain older trial entry criteria.
NINDS–CSN 2006¶
Measurement standards (5/30/60-minute cognitive protocols and imaging recommendations), not a competing diagnostic label (Hachinski 2006, PMID 16917086).
AHA/ASA 2011¶
Broad scientific statement integrating vascular exposures, imaging, prevention, and cognitive outcomes. It predates STRIVE-2 and contemporary Alzheimer blood biomarkers but remains a foundational prevention synthesis (Gorelick 2011, PMID 21778438).
VASCOG 2014 → VasCog-2-WSO 2025¶
VASCOG established mild and major vascular cognitive disorders, removed mandatory memory impairment, and formalized etiologic certainty (Sachdev 2014, PMID 24632990). VasCog-2-WSO is the current revision and requires prospective implementation work (Sachdev 2025, PMID 40955506).
VICCCS 2018¶
International Delphi consensus sought standardized diagnosis and endorsed NINDS-CSN cognitive/imaging protocols. Its main contribution is comparability rather than proof of one causal threshold (Skrobot 2018, PMID 29055812).
ESO covert SVD 2021¶
Addresses incidentally detected/covert SVD and distinguishes vascular risk management from prescribing antithrombotics solely for MRI lesions (Wardlaw 2021, PMID 34414301).
AHA/ASA ICH 2022¶
Provides acute ICH management and secondary-prevention context relevant to CAA, microbleeds, BP, and anticoagulation decisions (Greenberg 2022, PMID 35579034).
Canadian VCI 2024 update¶
Current end-to-end guidance for awareness, screening, assessment, risk reduction, management, and support across the stroke pathway (Swartz 2025, PMID 39822128).
International CAA Association / WSO 2025¶
CAA-specific scientific statement integrating Boston v2.0 diagnosis, haemorrhage prevention, antithrombotic questions, cognitive presentations, and ARIA-facing practice (Cordonnier 2025, PMID 40721902).
ESO–EAN post-stroke cognitive impairment 2021¶
Developed under ESO standard operating procedure with GRADE, with expert consensus statements where GRADE could not be applied. Its findings are mostly negative and are stated as such: limited randomized evidence for single or multicomponent interventions to prevent post-stroke cognitive decline; lifestyle and vascular-risk treatment have many health benefits but cognitive benefit is not proven; no evidence supporting routine cognitive screening after stroke, though targeted assessment is endorsed and no screening test was clearly superior; insufficient evidence to recommend cholinesterase inhibitors, memantine, nootropics, or cognitive rehabilitation; limited evidence on prediction tools; and acute-imaging associations with post-stroke cognitive impairment mostly unclear, except that substantial white-matter hyperintensity of presumed vascular origin on acute MRI may help predict cognitive outcome (Quinn 2021, PMID 34746430). This document is the strongest published statement of how little the field has established.
Asian Clinical Expert Group on EGb 761, 2019¶
Regional evidence-based consensus that positions Ginkgo biloba extract EGb 761 for neurocognitive disorders with or without cerebrovascular disease. It records that WFSBP guidelines list EGb 761 at Grade 3 recommendation, Level B evidence — the same strength assigned to acetylcholinesterase inhibitors and NMDA antagonists — and that EGb 761 was the only agent with Level B evidence for cognition, behaviour, and ADL in both Alzheimer disease and vascular dementia; the group reports a positive risk-benefit profile and notes that randomized trials and two meta-analyses did not support a bleeding-risk association (Kandiah 2019, PMID 30648358). This conflicts directly with ESO–EAN and with the low-certainty, high-heterogeneity Cochrane assessment (Wieland 2026, PMID 41641880).
Korean Dementia Association clinical practice guideline, 2025¶
GRADE-graded, PICO-structured recommendations from a multidisciplinary panel. For Alzheimer disease, cholinesterase inhibitors are strongly recommended on moderate evidence, and memantine is strongly recommended for moderate-to-severe disease. For vascular dementia and Parkinson disease dementia, cholinesterase inhibitors are conditionally recommended; for Lewy body dementia the recommendation is strong. Both drug classes were judged to have favourable safety profiles with manageable side effects (Kim 2025, PMID 39944527). The vascular-dementia row is the operative one for this condition and sits between ESO–EAN's "insufficient evidence to recommend" and routine use.
AHA hypertension and cognition, 2016¶
A multidisciplinary AHA panel reviewed hypertension's effect on cognition and reached an unusual conclusion for a scientific statement: there were insufficient data to make evidence-based recommendations, though judicious treatment of hypertension "taking into account goals of care and individual characteristics" seemed justified to safeguard vascular and hence brain health. The statement separates strong evidence that midlife hypertension damages late-life cognition from a much less clear effect of late-life hypertension, and notes that observational data show cumulative cerebrovascular damage while trial evidence that antihypertensive treatment improves cognition is not conclusive (Iadecola 2016, PMID 27977393). It predates SPRINT MIND and the 2020–2022 pooled analyses and should be read as the pre-trial baseline position.
NICE NG97, 2018¶
The UK national guideline on dementia assessment, management and support (Pink 2018, PMID 29925626). It is generic across dementia subtypes; the absence of a vascular-specific diagnostic or management pathway is the reason the Canadian VCI update and the AHA/ASA post-stroke statement carry the operational content for this condition in English-language practice.
WHO risk-reduction guidelines, 2019¶
Developed under WHO guideline methodology with a geographically diverse panel as part of the Global Action Plan on the Public Health Response to Dementia 2017–2025. Recommendations are organized under lifestyle and behaviour interventions, interventions for physical health conditions, and specific interventions, with implementation and policy guidance aimed at health and social-care systems rather than at individual clinicians (Chowdhary 2021, PMID 35082745). It is the only document in this registry written primarily for low- and middle-income settings, where most people with dementia live.
AHA/ASA secondary stroke prevention, 2021¶
The evidence base for preventing recurrent stroke (Kleindorfer 2021, PMID 34024117). It is included here because every claim that vascular-risk control prevents delayed dementia depends on this document's recurrent-stroke evidence plus an unproven causal step from stroke prevention to dementia prevention.
AHA/ASA primary care after stroke, 2021¶
Places screening for cognitive impairment, depression and fall risk in primary care as both a short-term and long-term component of post-stroke care, alongside risk-factor management and referral for functional impairment, with practice-level quality-improvement strategies (Kernan 2021, PMID 34261351). It assigns the follow-up responsibility that the patient-experience evidence shows is most often unassigned.
AHA/ASA cognitive impairment after stroke, 2023¶
Scoping appraisal of prevalence, natural history, diagnosis and management of post-stroke cognitive impairment, providing a clinical-care framework. Key stated findings: PSCI is common, especially in the first year; it is reversible in some cases early after stroke; up to one-third of individuals with stroke develop dementia within 5 years; and the pathophysiology is likely an acute stroke precipitating pathological events on a background of pre-existing microvascular and neurodegenerative change. It calls for prospective trajectory studies and high-quality randomized trials of PSCI management (El Husseini 2023, PMID 37125534).
Lancet standing Commission, 2024¶
The most-cited synthesis of modifiable dementia risk and of care recommendations, and the document most national dementia policies reference (Livingston 2024, PMID 39096926). It is population-level and not vascular-dementia-specific; its risk-factor content is used in this knowledge base only where a vascular-specific source corroborates it.
European Academy of Neurology, 2020¶
A GRADE guideline covering systematic medical follow-up, vascular risk factors, pain, antipsychotics and epilepsy in established dementia. Its vascular content is the part that matters here and it is framed as management rather than prevention: systematic vascular-risk management in mild-to-moderate dementia (Good Practice statement), and anticoagulation for dementia plus atrial fibrillation without prior stroke (weak recommendation). Atypical antipsychotics for agitation or aggression only after non-pharmacological measures fail or in severe harm, with discontinuation once symptoms settle; newer anticonvulsants first-line for epilepsy; regular preplanned follow-up minimally through general practice with specialist access (Frederiksen 2020, PMID 32713125). Notably it recommends anticoagulation without conditioning on microbleed burden, which the CAA and ICH documents address from the opposite direction.
American Academy of Neurology mild cognitive impairment, 2018 (retired)¶
The only guideline in this registry that grades exercise above drugs: clinicians should recommend regular exercise (Level B); may choose not to offer cholinesterase inhibitors (Level B); and if offering them, must first discuss the lack of evidence (Level A). It also supplies the age-stratified MCI prevalence (6.7% at 60–64 to 25.2% at 80–84) and the 14.9% two-year cumulative dementia incidence in MCI over 65 used elsewhere in this knowledge base (Petersen 2018, PMID 29282327). It has been formally retired without replacement, which leaves the field's strongest pro-exercise recommendation in an archived document.
American College of Radiology Appropriateness Criteria, 2024 update¶
The only document in this registry that specifies which scan to order by clinical scenario — suspected MCI, suspected specific dementia syndromes including vascular dementia and normal-pressure hydrocephalus, rapidly progressive dementia, and pre- and post-treatment imaging for anti-amyloid monoclonal antibodies — using GRADE-adapted assessment supplemented by the RAND/UCLA appropriateness method where evidence is equivocal (PMID 40409878). Its anti-amyloid monitoring scenario governs the same imaging findings that define cerebral amyloid angiopathy.
Alzheimer's Association DETeCD-ADRD, 2025¶
A modified-Delphi guideline built from 7,374 screened publications (133 included) to give non-specialist clinicians a structured evaluation pathway for "Alzheimer's disease and related dementias", with a companion inventory of validated instruments for cognition, mood, behaviour and daily function (Atri 2025, PMID 39713939). Its relevance to this condition is partly negative: it is where most vascular cognitive impairment in the US will in practice be evaluated, and its vascular-specific content is minimal.
Disagreements and gaps¶
| Topic | Disagreement/gap | Evidence anchor |
|---|---|---|
| label | VaD vs major vascular NCD/VCI | PMIDs: 24632990, 40955506 |
| imaging threshold | no universal lesion burden proves causality | PMID 37236211 |
| cholinesterase inhibitors | selective consideration vs not routine | PMID 33704781 |
| memantine | insufficient vascular-specific functional evidence | PMID 30891742 |
| covert SVD antiplatelets | imaging alone is not an indication | PMID 34414301 |
| BP target | small cognitive benefit vs orthostatic/frailty concerns | PMIDs: 32427305, 34752479 |
| mixed disease | measurement available unevenly | PMID 17568013 |
| global implementation | MRI/neuropsychology access differs | PMID 39822128 |
| cholinesterase inhibitors in VaD | ESO–EAN: insufficient evidence to recommend; Korean CPG: conditionally recommended; ESO covert-SVD: no evidence for conventional dementia treatments in covert SVD | PMIDs: 34746430, 39944527, 34414301 |
| EGb 761 | Asian expert consensus grades it at ChEI-equivalent strength (Grade 3, Level B); European guidance does not recommend it; Cochrane finds low-certainty benefit with I² 91–96% | PMIDs: 30648358, 34746430, 41641880 |
| BP control for cognition | ESO covert-SVD recommends BP control and notes lower targets may slow ccSVD progression; ESO–EAN concludes cognitive benefit after stroke is not proven — same year, same methodology, different endpoint | PMIDs: 34414301, 34746430 |
| post-stroke cognitive screening | ESO–EAN found no evidence for routine screening and no superior instrument; Canadian guidance supports systematic attention to cognition across the stroke pathway | PMIDs: 34746430, 39822128 |
| cognitive rehabilitation | ESO–EAN: insufficient evidence to recommend; no guideline body has issued a positive recommendation | PMID 34746430 |
| strength of the evidence base itself | ESO–EAN reports "limited randomised controlled trial evidence"; ESO covert-SVD reports "little direct evidence, mostly of low quality" — VCI guidance is largely consensus carrying GRADE labels | PMIDs: 34746430, 34414301 |
| whether to organize services in the absence of evidence | AHA/ASA 2023 builds a clinical-care framework and calls for interdisciplinary management of PSCI; ESO–EAN declines to recommend the same activities on overlapping evidence | PMIDs: 37125534, 34746430 |
| hypertension and cognition | AHA 2016 concluded there were insufficient data for any evidence-based recommendation; ESO covert-SVD 2021 recommends BP control partly for imaging progression | PMIDs: 27977393, 34414301 |
| subtype specificity of national guidance | NICE NG97 is generic across dementia subtypes; Canadian Stroke Best Practices carries a dedicated VCI pathway | PMIDs: 29925626, 39822128 |
| exercise versus drugs | AAN MCI guideline (retired) recommends exercise (Level B) while permitting clinicians not to offer cholinesterase inhibitors; ESO covert-SVD also recommends exercise; no guideline recommends a drug at equivalent strength — yet exercise appears in no VCI drug-treatment algorithm | PMIDs: 29282327, 34414301, 33704781 |
| anticoagulation in dementia with AF | EAN 2020 issues a weak recommendation to anticoagulate without conditioning on imaging; AHA/ASA ICH and CAA guidance make imaging markers central to the same decision | PMIDs: 32713125, 35579034, 40721902 |
| blood pressure after the 2025 cluster-randomized trial | no guideline in this registry yet incorporates the first positive adequately powered randomized dementia-prevention result (RR 0.85 on a 22 mm Hg contrast); current recommendations still rest on the small-contrast pooled estimates | PMIDs: 40258956, 32427305, 34028812 |
| who owns imaging selection | ACR Appropriateness Criteria specify scan choice by scenario; no neurology or stroke guideline in this registry does, and none cross-references the ACR document | PMID 40409878 |
| primary-care-facing pathways | the US structured evaluation pathway is framed as "AD and related dementias" with minimal vascular content, while the population it serves is where most VCI is evaluated | PMIDs: 39713939, 39822128 |
Watch list¶
- External validation and implementation studies for VasCog-2-WSO.
- Future AHA scientific statement replacing the live-resolved 2011 framework.
- ESO guidance extending from covert SVD to cognitive outcomes.
- CAA statement implementation and antithrombotic evidence.
- National guidance updates that specify Alzheimer-biomarker use in VCI.
- Whether any body reconciles the EGb 761 recommendation split, or whether it persists as a regional divergence.
- Guideline treatment of anticoagulation after intracranial haemorrhage once trials due to report in 2028 complete (PMID 37839434).
- Whether post-stroke cognitive screening recommendations change if a trial links screening to improved outcomes rather than detection.
- Uptake of the three-tiered NOTCH3 EGFr risk classification into genetic-counselling guidance (PMID 36535904).
- Whether NICE issues vascular-specific content at the next NG97 revision (PMID 29925626).
- Whether an AHA/ASA guideline (rather than a scientific statement) is issued for post-stroke cognitive impairment once management trials report (PMID 37125534).
- Whether WHO's risk-reduction recommendations are updated after the 2024 Lancet Commission report and the multidomain-prevention replications (PMIDs: 35082745, 39096926).
- Whether any body replaces the retired AAN mild-cognitive-impairment guideline, and whether a replacement retains the exercise recommendation (PMID 29282327).
- Whether the 2025 cluster-randomized blood-pressure trial changes any guideline's dementia-prevention language, and whether a subtype-adjudicated replication is commissioned (PMID 40258956).
- Whether EAN's anticoagulation recommendation in dementia with atrial fibrillation is revised to condition on microbleed burden (PMIDs: 32713125, 35579034).
- Whether the ACR Appropriateness Criteria are cross-referenced by neurology or stroke guidance rather than standing alone (PMID 40409878).
- Whether IMPACT (NCT07252544) reports and, if positive, whether guideline bodies treat isosorbide mononitrate and butylphthalide as separable recommendations.