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Delphi 1: Updating the VASCOG Consensus Diagnostic Criteria and Harmonising Neuropsychological Assessment for Vascular Cognitive Impairment and Dementia

This project aimed to reconsider the Vascular Behavioural and Cognitive Disorders criteria (i.e. VASCOG) based on developments in the field of dementia diagnostics since the criteria were first published in 2014. In July 2025 the updated criteria were accepted for publication in JAMA Neurology. 

The Delphi process included three rounds, including two feedback rounds, therefore, a total of three surveys, from August 2023 to May 2024, completed by 54 international expert participants including members of the World Stroke Organization (WSO). The Delphi process aimed to reach consensus agreement on which potential diagnostic criteria for VCID remain acceptable and which may require modification. The survey also aimed to simplify and operationalize the criteria for clinical and research settings including clinical trials. The goal is that these updated “VASCOG-2-WSO” criteria become an international standard and thereby facilitate diagnostic consistency of VCID among clinicians and researchers.   

Novel and potentially contentious questions were put to the expert participants, including the potential inclusion of specific quantitative guidelines for neuroimaging markers of cerebrovascular disease, and the potential inclusion of novel biomarkers based on recent research developments. 

If you are interested in reading more about the diagnosis of VCID, please see these publications: 

• Sachdev P, Kalaria R, O'Brien J, Skoog I, Alladi S, Black SE, Blacker D, Blazer DG, Chen C, Chui H, Ganguli M, Jellinger K, Jeste DV, Pasquier F, Paulsen J, Prins N, Rockwood K, Roman G, Scheltens P; Internationlal Society for Vascular Behavioral and Cognitive Disorders. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014 Jul-Sep;28(3):206-18. 10.
• Sachdev PS, Lipnicki DM, Crawford JD, Brodaty H. The Vascular Behavioral and Cognitive Disorders criteria for vascular cognitive disorders: a validation study. Eur J Neurol. 2019 Sep;26(9):1161-1167. 

Delphi 2: Consensus on Harmonised Neuropsychological Test Measures for Vascular Cognitive Impairment and Dementia 

This project aimed to develop a harmonised neuropsychological battery for vascular cognitive impairment and dementia (VCID), building on the well-received NINDS-CSN battery that has now been adopted in several regions (Hachinski et al., 2006; 10.1161/01.STR.0000237236.88823.47, opens in a new window). We aimed to enhance and expand the NINDS-CSN battery which focused on traditional face-face testing by a clinician, to include telephone, videoconference, and computerised methods, and have greater guidance for cultural and linguistic differences across international regions. The Delphi process was conducted the same as Delphi 1 and simultaneously to align the consensus outcomes. 

The goal of Delphi 2 was that these harmonised neuropsychological measures become an international standard for VCID and thereby facilitate consistency of neuropsychological assessment of VCID between clinicians and research.     

If you are interested in the latest research on enhancing the neuropsychological assessment of VCID, please see these publications: 

• Bentvelzen A; Chander R; Foo H; Lee T; Lipnicki D; Sachdev P, 2023, 'Neuropsychological Assessment of Cognitive Aging', in The SAGE Handbook of Clinical Neuropsychology Clinical Neuropsychological Assessment and Diagnosis, SAGE, London, UK, pp. 77 - 93, 
• Paradise MB, Sachdev PS. Vascular Cognitive Disorder. Semin Neurol. 2019 Apr;39(2):241-250.