Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence: A Scientific Statement From the American Heart Association.
Level 5 - mechanism / opinion, no new human data
Expert scientific statement and narrative review synthesizing observational, billing, and imaging data
PubMed 40820756 · doi:10.1161/STR.0000000000000494
What was done
The American Heart Association reviewed published literature on the incidence and prevalence of vascular contributions to cognitive impairment and dementia (VCID) in the United States. The review integrated data across clinical diagnoses (healthcare billing data), prospective epidemiological studies, autopsy-based neuropathological studies, and neuroimaging studies of covert cerebrovascular lesions.
What was found
In the 2020 US population aged over 65 years, prospective epidemiological studies estimated 2.7 million individuals had vascular dementia or mixed dementia with a vascular contribution (incidence: 603,000 new cases/year), compared to only 809,000 identified by healthcare billing data (incidence: 102,000 new cases/year). Neuroimaging data estimated 11.3 million people had covert brain infarcts, 11.1 million had high white matter hyperintensity volumes, and 19.9 million had cerebral microbleeds. Modeling suggested eliminating cerebrovascular disease would prevent 27% to 33% of dementia cases, corresponding to 1.5 to 1.8 million fewer individuals with dementia in 2020.
Why it matters
Vascular dementia is heavily underdiagnosed in routine clinical practice compared to dedicated prospective cohorts. Because covert cerebrovascular disease affects tens of millions of older adults and contributes to up to one-third of all dementia cases, aggressive vascular risk factor modification represents a major modifiable target for dementia prevention.
Limits
The abstract notes substantial variability across diagnostic methods, with clinical billing data capturing less than one-third of the epidemiological burden. There were substantially fewer studies evaluating vascular contributions to mild cognitive impairment than to overt dementia. Estimates rely on modeled extrapolations and varied diagnostic criteria rather than a unified prospective national registry.
Cited by
- supports Postmortem examinations show that around 70% of Alzheimer's disease cases have vascular pathology contributing to the disease.