Investigations in primary care

Vascular cognitive impairment relates to subjects who have a broad spectrum of cognitive deficits,including all forms of mild to severe cognitive impairment associated with and presumed to becaused by cerebrovascular diseases. The latter may be represented by multiple cortical infarcts, multiplesubcortical infarcts, or both, silent infarcts, strategic infarcts, small-vessel disease with whitematter lesions, and lacunes, all more or less related to stroke. Some authors also include in the categoryof vascular cognitive impairment Alzheimer's disease patients with evidence of additional vascularlesions. The recognition of early cognitive decline in the primary care setting is an importantstep as it may allow an early referral of patients to the specialist level, thus permitting a correct diagnosisof the etiologic subtype and the best treatment approach for that particular patient. The aim ofthis chapter is to provide an overview of the role of the primary care physician in the screening ofpatients with suspected vascular cognitive decline. Patients in whom screening for cognitive declinecould be of clinical relevance are depicted, and a brief overview of investigations and diagnostictests in the primary care setting is outlined. This specific diagnostic approach includes suggestionson how to take the clinical history, how to perform the physical examination, and on how to choosethe appropriate tools for the cognitive and non-cognitive screening; finally, the role of neuroimagingin the primary care setting is illustrated.