What are the key diagnostic criteria for vascular dementia in primary care settings?

In primary care settings, the key diagnostic criteria for vascular dementia involve a comprehensive clinical assessment that includes a detailed history of cognitive, behavioural, and psychological symptoms, ideally obtained from both the patient and an informant who knows the person well. This assessment should focus on the impact of symptoms on daily life and exclude reversible causes of cognitive decline through physical examination and appropriate blood and urine tests. Cognitive testing using validated brief structured instruments such as the 6-item Cognitive Impairment Test (6CIT) or Mini-Cog is recommended, but a normal cognitive test score should not rule out dementia. If vascular dementia is suspected, structural brain imaging is essential, with MRI preferred to identify vascular lesions; if MRI is unavailable or contraindicated, CT scanning should be used. However, diagnosis should not be based solely on the burden of vascular lesions seen on imaging. The use of validated diagnostic criteria such as the NINDS-AIREN criteria is advised to guide clinical judgment in diagnosing vascular dementia. Referral to specialist dementia diagnostic services is recommended if dementia is still suspected after initial assessment and reversible causes have been excluded. Early involvement of dementia specialists ensures accurate diagnosis and access to appropriate post-diagnostic support and treatment. While the UK guidelines do not emphasize biomarkers or advanced imaging beyond MRI/CT for vascular dementia diagnosis in primary care, emerging research in related dementia subtypes suggests that multimodal approaches integrating lifestyle and medical interventions may influence future diagnostic and management strategies (Thunborg et al., 2024) ¹.