{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:43:00Z","timestamp":1792561380556,"version":"4.5.0"},"reference-count":70,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000274","name":"british heart foundation","doi-asserted-by":"publisher","award":["RG\/F\/26\/110198"],"award-info":[{"award-number":["RG\/F\/26\/110198"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"British Heart Foundation Centre of Research Excellence, Cambridge","award":["RE\/24\/130011"],"award-info":[{"award-number":["RE\/24\/130011"]}]},{"DOI":"10.13039\/501100000272","name":"national institute for health and care research","doi-asserted-by":"publisher","award":["BRC-1215-20014"],"award-info":[{"award-number":["BRC-1215-20014"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Vascular cognitive impairment (VCI) and vascular dementia (VaD) represent a substantial and growing global health burden, yet remain under-recognized and comparatively under-researched. Two broad categories are post-stroke cognitive impairment, and VCI secondary to chronic cerebrovascular disease of which the most common cause is cerebral small vessel disease (SVD). In addition, cerebrovascular pathology frequently coexists with Alzheimer\u2019s disease (AD), increasing the probability that AD pathology will manifest as clinical dementia. Current management focuses primarily on prevention through modification of cardiovascular risk factors and lifestyle interventions. Intensive blood-pressure control has shown the strongest evidence, reducing future all-cause dementia while slowing progression of white-matter abnormalities. Multidomain lifestyle interventions incorporating exercise, diet, cognitive training, and vascular risk monitoring may also preserve cognition, although results across trials remain variable. In established VCI and VaD, treatment options are limited; cholinesterase inhibitors and memantine lack convincing evidence of benefit, and no pharmacological therapy has definitively demonstrated symptomatic improvement or delayed disease progression. Advances in understanding SVD and VCI pathophysiology are, however, identifying promising therapeutic targets. Emerging evidence highlights endothelial dysfunction, impaired cerebral autoregulation, increased blood\u2013brain barrier permeability, inflammation, and glymphatic dysfunction as possible mechanisms underlying SVD. Current trials are evaluating treatment approaches based on this framework including cerebral vasodilators such as cilostazol, isosorbide mononitrate and phosphodiesterase-5 inhibitors, anti-inflammatory therapies, glucagon-like peptide-1 receptor agonists, remote ischemic conditioning, and strategies targeting glymphatic function. Improved mechanistic understanding, appropriately targeted interventions, and adequately powered long-term clinical trials are required to translate these emerging approaches into effective treatments for VCI and VaD.<\/jats:p>","DOI":"10.1177\/17474930261492876","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:00:38Z","timestamp":1792393238000},"page":"1200-1210","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Vascular dementia and vascular cognitive impairment\u2014current treatments and future prospects"],"prefix":"10.1177","volume":"21","author":[{"given":"Hugh S","family":"Markus","sequence":"first","affiliation":[{"name":"Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930251404243"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930241279888"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.122.319951"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987318825484"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-325796"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00060-0"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2016.05.007"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1177\/17474930251397083","article-title":"Magnitude and temporal dynamics of dementia risk before and after stroke diagnosis","volume":"21","author":"Huang X","year":"2025","unstructured":"Huang X, Yang X, Zhu M, et al. Magnitude and temporal dynamics of dementia risk before and after stroke diagnosis. Int J Stroke 2025; 21: 1311\u20131320.","journal-title":"Int J Stroke"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930251411472"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930221144911"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00131-X"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.3122"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135523"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000612"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002502"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005551"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261425249"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261441916"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261421046"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261470506"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.07.222"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540340047031"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001831"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/nan.12923"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1197623"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3003748"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2015.119"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261475465"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70699"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abb8739"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.conb.2021.07.006"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01296-0"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511939"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21442"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.10551"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03616-8"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2023.1126183"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930241253988"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30173-3"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(26)00459-9"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.037775"},{"key":"e_1_3_2_43_2","article-title":"Statin use and dementia risk: a systematic review and updated meta-analysis","volume":"11","author":"Westphal Filho FL","year":"2025","unstructured":"Westphal Filho FL, Moss Lopes PR, Menegaz de Almeida A, et al. Statin use and dementia risk: a systematic review and updated meta-analysis. Alzheimers Dement 2025; 11: e70039.","journal-title":"Alzheimers Dement"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2607314"},{"key":"e_1_3_2_45_2","first-page":"3883","article-title":"European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment","volume":"28","author":"Quinn TJ","year":"2021","unstructured":"Quinn TJ, Richard E, Teuschl Y, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur Stroke J 2021; 28: 3883\u20133920.","journal-title":"Eur Stroke J"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60461-5"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(26)01278-X"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261451077"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2025-004198"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261444936"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30079-1"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2015.62"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00028.2024"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261456372"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.04.001"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.1526"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1093\/esj\/aakag023.2031"},{"key":"e_1_3_2_58_2","article-title":"PDE5 inhibitor drugs for use in dementia","volume":"9","author":"Hainsworth AH","year":"2023","unstructured":"Hainsworth AH, Arancio O, Elahi FM, Isaacs JD, Cheng F. PDE5 inhibitor drugs for use in dementia. Alzheimers Dement 2023; 9: e12412.","journal-title":"Alzheimers Dement"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.124.324327"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.051602"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261461366"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2015.21"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13830"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-026-01427-8"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2016.09.006"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1002\/alz.71336"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2024.148917"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261487798"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045857"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930261424089"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200493"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261492876","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17474930261492876","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261492876","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:16:45Z","timestamp":1792559805000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17474930261492876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":70,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/17474930261492876"],"URL":"https:\/\/doi.org\/10.1177\/17474930261492876","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}