REVISED diagnostic criteria for vascular cognitive impairment and dementia have been agreed by international experts, standardising definitions for preclinical, mild, and major stages under the umbrella term VCID. The VasCog-2-WSO criteria integrate recent advances including neuroimaging and biomarker research for wider global adoption.
The revision addresses advances in the understanding of vascular cognitive impairment since the 2014 VasCog framework, with the aim of improving diagnostic consistency across clinical and research settings. Prior guidelines varied widely, leading to uncertainties in patient assessment and inconsistency in the recognition of overlapping or alternative causes of cognitive decline.
Using a Delphi survey process, 70 international experts were invited to participate in 2023, with 49 to 54 contributing across three rounds. A consensus threshold of 75 percent agreement was applied. Experts agreed on detailed diagnostic criteria for preclinical, mild, and major dementia stages, as well as on research standards incorporating neuroimaging and fluid biomarkers. Biomarkers were included largely as indicators of potential alternative or concomitant pathologies rather than as core diagnostic requirements. The criteria were formally endorsed by the World Stroke Organization, and renamed VasCog-2-WSO, to denote global consensus.
The new framework is expected to guide clinicians and researchers by operationalising diagnostic categories, aligning terminology, and clarifying the role of biomarkers in differential assessment. Future research is likely to refine these tools further, but the immediate impact will lie in standardising evaluation, supporting early intervention, and improving cross-study comparability. For clinical practice, the addition of a preclinical or at-risk category highlights opportunities for prevention and risk reduction, sharpening focus on vascular contributions to cognitive decline.
Reference
The VasCog-2-WSO Criteria Consortium. Revised diagnostic criteria for vascular cognitive impairment and dementia – the VasCog-2-WSO criteria. JAMA Neurol. 2025;DOI:10.1001/jamaneurol.2025.3242.
