History of Vascular Cognitive Impairment and Dementia

Since the circle of Willis was described (1664), “cerebral congestion” has become the main assumed cause of dementia for several centuries. The seminal pathological descriptions in the 1900s by Alzheimer and Binswanger put cerebrovascular disease on the map as one of the main drivers of cognitive dysfunction, although under the rather confusing umbrella term of arteriosclerosis. It was not until the 1970s, with the advent of brain imaging, that the concept of vascular dementia (VaD) became widely accepted. The concept of vascular contributions to cognitive impairment and dementia (VCID), on the other hand, was a result of developments in the understanding of a broad clinical spectrum of vascular disease, ranging from minor to major cognitive decline. The imaging revolution has led to the phenotyping of small-vessel disease, including the in vivo diagnosis of cerebral amyloid angiopathy, a key driver of VCID. VaD became widely recognized as the second most common form of dementia. Surprisingly, the incidence of dementia has decreased over the last decades, leading to the recognition of vascular health as a strong determinant for brain health. We provide a brief overview of the field’s evolution, from Sir Thomas Willis to our recent understanding of VCID.