Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study

INTRODUCTION: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. METHODS: We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. RESULTS: Six survey rounds comprising 65–79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders–Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. DISCUSSION: The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders–Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration

Dementia resources in Argentina: policy, services, and statistics overview-up to date

Argentina, the second largest country in South America, has traditionally been involved in caring for elderly. In 1971 the National Government created the Institute for the Elderly to take care of the social and medical needs of retired people with the program PAMI. This review has updated the local resources of dementia and the challenges that these face with regard to the issues associated with cognitive impairment in elderly people. Health care is shared between the public and private sectors. The distribution of resources and specialists (neurologists, psychiatrist, and geriatricians) is unequal most located in large cities. Facilities for accurate diagnosis are scarce; most of the memory clinics are in big cities like Buenos Aires, Rosario, and Cordoba. Early diagnosis is another challenge with the incorporation of the biomarkers of Alzheimer’s diseases (MRI scan, FDG-PET, amyloid-PET, and Aβ42, tau, and f-tau in cerebrospinal fluid). However the availability is limited to one center in Buenos Aires (FLENI Neurological Institute). ALMA (Association against Alzheimer’s Disease), a member of Alzheimer Disease International, is the local voluntary health organization in Alzheimer’s care and family support. In 2011, the Argentine Neurological Society launched the first dementia guideline for diagnosis and treatment. Although we have a long road ahead, the first steps taken by the organization of a dementia national plan constitute a hopeful challenge.Fil: Bagnati, Pablo Miguel. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; ArgentinaFil: Román, Fabián. Gobierno de la Ciudad Autónoma de Buenos Aires. Ministerio de Salud; ArgentinaFil: Bonafina, Marcela. Clinical and Forensic Neuropsychology; Estados UnidosFil: Blake, Andrew. Gobierno de la Ciudad Autónoma de Buenos Aires. Ministerio de Salud; ArgentinaFil: Allegri, Ricardo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; Argentin