Mild cognitive impairment of vascular origin: Proposal for an empirical approach in primary care

The incidence of mild cognitive impairment of vascular origin is increasing continuously among individuals with cardiovascular risk factors. The etiology of this kind of impairment is related to cerebrovascular pathologies, with the presence of silent cerebral infarctions the most relevant etiology. The incidence of cognitive impairment affects around 22% of patients at 3 months after an ischemic stroke, and this incidence is maintained or increased even 5 years after the stroke. Silent infarction should be considered the first clinical suspicion in patients with cardiovascular risk factors (such as hypertension, diabetes and dyslipidemia) who are attending a consultation for cognitive complaints, not only memory complaints. There are various tools for detecting such cognitive problems during the examination, such as brief cognitive tests and neuropsychological evaluations (for example, MMSE, SPMSQ or MoCA), and to assess its development. For a patient with cardiovascular risk factors and cognitive complaints it should be possible to carry out an empirical treatment and assess the development of the cognitive deficits before referring the patient to the specialist. This review outlines various attitudes and therapeutic possibilities that might be useful in the scope of Primary Care.