The Vascular Impairment of Cognition Classification Consensus Study

Introduction: Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. / Methods: The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. / Results: VICCCS had a mean of 122 (98–153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. / Discussion: VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research

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

The combined effects of hardness, pH, and dissolved organic carbon on the chronic toxicity of Zn to D-magna: development of a surface response model

The effect of changes in pH, hardness, and dissolved organic carbon (DOC) and the possible interactions among these parameters on the chronic toxicity of zinc to D. inagna were investigated. Based on a Central Composite Design, models were developed that can explain the observed variation in EC10 and EC50 as a function of these toxicity modifying factors. All three parameters significantly altered the observed effect concentrations based on net reproductive rate. The largest differences in 21-day EC(10)s and EC(50)s caused by these factors were 10.1 and 4.9, respectively. An increase in pH and/or DOC decreased zinc toxicity. The significant interaction between pH and DOC on observed chronic Zn toxicity is in accordance with earlier reported increased sorption efficiency of Zn to humic substances at higher pH levels. Lowest Zn toxicity was observed in tests performed with moderately hard test media (between 200 and 300 mg/L as CaCO3). Lower or higher hardness of the test medium resulted in lower effect concentrations. Based on physico-chemical characteristics of the test media, developed models can be used to explain the variation between reported NOECs for Zn and may improve current environmental risk assessment procedures of metals