Validation of the VasCog-2-WSO VCID Criteria in a Dementia-Free and Stroke-Free Community Cohort

BACKGROUND AND OBJECTIVES: Vascular cognitive impairment and dementia (VCID), a major contributor of dementia, remains underrecognized, owing to the absence of universally accepted diagnostic criteria. The VasCog Society and WSO recently released updated criteria (VasCog-2-WSO); however, their applicability is unknown yet. We aimed to evaluate these criteria in a dementia-free and stroke-free community cohort and determine their associations with vascular burden and long-term mortality. METHODS: We conducted a community-based cohort study using data from the I-Lan Longitudinal Aging Study. Adults aged 50 years or older without prior stroke or dementia underwent standardized brain MRI and comprehensive neuropsychological assessment. VCID was classified according to the VasCog-2-WSO criteria using a neuroimaging-first approach. Participants were categorized as non-VCID, preclinical VCID (with or without objective cognitive impairment), or vascular mild cognitive impairment (vaMCI). Baseline 10-year Framingham cardiovascular disease risk was assessed. The primary outcome was all-cause mortality over a mean follow-up of 9.4 years, analyzed using multivariable Cox proportional hazards and Poisson regression models. RESULTS: for trend <0.001). DISCUSSION: The VasCog-2-WSO criteria identify a spectrum of MRI-defined vascular cognitive vulnerability associated with increased cardiovascular risk and mortality, with excess mortality risk detectable at a neuroimaging-defined preclinical stage before overt cognitive impairment. These findings support their utility for early detection and risk stratification in community settings. A key limitation is the inability to assess mixed etiologies due to the absence of genetic data and Alzheimer disease biomarkers, which limits the ability to thoroughly evaluate the VasCog-2-WSO VCID diagnostic framework.