New Vascular Cognitive Impairment and Dementia Diagnostic Criteria Published

An international panel of experts has published updated diagnostic criteria for vascular cognitive impairment and dementia (VCID), marking the first major revision of the International Society for Vascular Cognitive and Behavioral Disorders (VasCog) standards in more than a decade (2014). The new VasCog-2–World Stroke Organization (WSO) criteria, published in JAMA Neurology, provide detailed operational guidance for diagnosing VCID that incorporates advances in neuroimaging strategies and biomarker measures. The updated framework is intended to improve diagnostic consistency across clinical and research settings worldwide.

The criteria were developed through a 3-round Delphi consensus process involving 70 international experts with expertise in VCID invited from medical and nonmedical fields including neurology, nursing, social work, psychiatry, geriatrics, rehabilitation physiology, occupational therapy, and neuropsychology. Participants reviewed existing guidelines and emerging evidence on cognitive testing, cerebrovascular imaging, and biomarkers. Agreement required at least 75% consensus across rounds, and the final recommendations were endorsed by the WSO.

Key elements of the VasCog-2–WSO criteria include:

• Adoption of “Vascular Cognitive Impairment and Dementia (VCID)” as the overarching term, with categories for preclinical, mild, and major disease.
• Revised cognitive domains emphasizing attention, processing speed, and executive function as early indicators of small-vessel disease.
• Updated neuroimaging thresholds based on STRIVE-2 (Standards for ReportIng Vascular changes on nEuroimaging-2) standards, including guidance for white matter hyperintensities and the number, size, and location of infarcts.
• Integration of biomarkers for Alzheimer and Lewy body disease to aid differential diagnosis.
• Introduction of a preclinical/at-risk VCID category for individuals with cerebrovascular changes but no overt cognitive impairment.

Source: The VasCog-2-WSO Criteria Consortium. Revised diagnostic criteria for vascular cognitive impairment and dementia—the VasCog-2-WSO Criteria. JAMA Neurol. Published online September 16, 2025. doi:10.1001/jamaneurol.2025.3242