Message from the previous president Vladimir Hachinski
THE INTERNATIONAL SOCIETY OF BEHAVIOURAL AND COGNITIVE VASCULAR
What is being done
One in three individuals will end up with a stroke, dementia or
both1 unless we improve prevention. Moreover, for each person over the
age of 65 years who has had a stroke or dementia, two have some
cognitive problem short of dementia.2 At the moment, the major emphasis
is on the late stages, and the extremes i.e. stroke and dementia. That
leaves a neglected majority whose problems are seldom addressed, because
they may not be severe enough to prompt medical attention or if the
complaints are aired, they may be dismissed as attributable to old age.
Although it is becoming increasingly evident that depression can be
associated with certain types of cerebral infarcts and white matter
changes, we are yet to work out an anatomy of melancholy and provide a
neuroscientific bases for addressing what remains a major problem.
WHAT VAS-COG CAN DO
Most knowledge accrues in pieces but is understood in patterns. Most
organizations specialize in areas that themselves get subdivided “ad
infinitum”. Vas-Cog may be the only organization that tries to integrate
knowledge and understand the broad spectrum of cognitive disorders. It
emphasizes the vascular factors, which are potentially treatable and
provide means towards preventing, mitigating or delaying all types of
cognitive disorders, including Alzheimer disease. Cerebrovascular and
Alzheimer disease share the same vascular risk factors.
Focusing on stroke and dementia has been achieved to the relative
neglect of the prodromal and intermediate stages. Stroke investigators
have little interest in cognition, and dementia investigators even less
Even if stroke and dementia investigators did have a reciprocal interest
in the two areas, there has been no agreement on common data elements.
Dementia criteria can vary in their identification of the same set of
patients by a factor of 10!3
Vas-Cog established working groups to try to develop common minimal
standards. This endeavor took a leap forward when Dr. Gabrielle Leblanc,
Dr. Costantino Iadecola and Dr. Vladimir Hachinski organized a symposium
with the leadership, participation or contributions from members of the
different working groups of Vas-Cog, so that now exist minimum
recommended standards for the whole spectrum of cognitive impairment.4
The advantage of using common data elements is that several provisional
criteria can be tested simultaneously and modified many times according
to outcomes, as knowledge grows.
The San Antonio Congress in July 11-14, 2007 proved extensive, intensive
and very interactive. Through the initiative of Dr. Gustavo Roman, a
Declaration of San Antonio was issued calling for the public, the drug
industry, government, investigators and patients to become aware of the
growing burden of brain disease attributed to vascular injury and to do
something about it. (below)
The emphasis needs to shift from effects to causes of cognitive and
behavioural disorders. Therein lie the best hopes of treatment and
It may be time for a trial in prevention and/or delay of
cerebrovascular and Alzheimer disease by randomizing family
practices and/or communities to usual care or optimal care of vascular
risk and protective factors. Vas-Cog has established a working group
with the specific task of producing a proposal and discussion paper for
publication that outlines the need and means of implementing such a
What you can do
1. Join Vas-Cog.
2. After you have joined, have someone else join.
3. Join a working group.
In addition to a working group on prevention, there are working
groups on neuropsychology and mechanisms of vascular cognitive
impairment. If you have an idea for another working group, please
write me with suggestions about the topic and individuals who may lead
Advances occur not by breakthroughs alone, but also by many people
making small advances cumulatively contributing as much as the few who
make major advances. No-one’s work is important simply because it is
sophisticated, nor valueless because it is humble. We can all improve
what we do. We can all make a difference. Let’s make a difference!
Vladimir Hachinski, MD, FRCPC, DSc
1. Shahadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, Wolf
PA. The lifetime risk of stroke: estimates from the Framingham Study.
2. Jin YP, Di Legge S, Ostbye T, Feightner JW, Hachinski V. The
reciprocal risks of stroke and cognitive impairment in an elderly
population. Alzheimer’s & Dementia. 2006;2:171-178.
3. Erkinjunntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Demaraju
CV. Efficacy of galantamine in probable vascular dementia and
Alzheimer’s disease combined with cerebrovascular disease: a randomized
trial. The Lancet. 2002;359:1283-90
4. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black
SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman
DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG. National
Institute of Neurological Disorders and Stroke-Canadian Stroke Network
vascular cognitive impairment harmonization standards. Stroke.