The VAS-COG clinic: an out-patient service for patients with cognitive and behavioral consequences of cerebrovascular diseases

Services dedicated to patients with cognitive and behavioral consequences of cerebrovascular diseases (CVD) are not established. We started an out-patient clinic (the “VAS-COG clinic”) to assess patients with psycho-cognitive disturbances related to CVD. The work-up includes a clinical-neuroimaging diagnostic process and the individuation of the best therapeutic strategies as done in patients with neurodegenerative cognitive impairment. We report the results of the first 5 years of activity. Reasons for patient referral were not only cognitive, language, gait, and psychiatric disturbances related to stroke or chronic CVD, but also neuroimaging evidence of vascular encephalopathy and screening for familial microangiopathies. The patients were evaluated with uniformed protocols. From January 2006 to November 2010, we evaluated 403 patients. Of these, 374 (93%; mean age 69.7 years ± 15.0) were considered appropriate for the VAS-COG clinic. The following diagnoses were made: vascular dementia (8.6%), Alzheimer disease (2.1%), mixed dementia (vascular plus degenerative) (4.8%), vascular mild cognitive impairment (MCI) (9.1%), amnesic-MCI (8.0%), mixed-MCI (4.8%), post-stroke depression (2.7%), post-stroke language disturbances (4.5%), subjective memory complaint (1.3%), familiar microangiopathy (31.3%), vascular encephalopathy evidenced by neuroimaging not associated with specific clinical disturbances (15.3%), and other conditions (7.5%). Psycho-cognitive disturbances associated with CVD are heterogeneous. In addition to acute stroke care strategies, long-term assessment of patients with CVD is required. The VAS-COG clinic may represent a model in this regard and might be important for improving the care of patients and offering counseling to their families. The efficacy of this service needs, however, to be proved by successive work.