Vascular cognitive impairment and dementia — structured clinical viva

Define VCI as the cerebrovascular cognitive spectrum from mild impairment to dementia. Use NINDS-AIREN historically, then VASCOG and VICCCS for modern mild/major VCI and phenotypes, and DSM-5-TR major/mild vascular NCD for independence-based severity.^[1][2][3]

This stem mixes subcortical gradual features with stepwise multi-infarct events — formulate hybrid vascular phenotype and allow mixed AD-vascular rather than forcing purity. Imaging: discuss lacunes/WMH using STRIVE terms; do not invent a scan report.^[7]

Management lead: BP (SPRINT MIND — intensive control reduced MCI; probable dementia alone NS), glycaemia, smoking, secondary prevention, AF if present, rehab, carer support. AChEI/memantine: modest benefits (Kavirajan); example donepezil 5→10 mg if used after counselling. BPSD: non-drug first; antipsychotics time-limited with mortality signal (Schneider). Capacity: Appelbaum four abilities, decision-specific.^[4][5][6][8]