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International Journal of Alzheimer’s Disease
Volume 2012, Article ID 608013, 7 pages
Clinical Study

Risk and Determinants of Dementia in Patients with Mild Cognitive Impairment and Brain Subcortical Vascular Changes: A Study of Clinical, Neuroimaging, and Biological Markers—The VMCI-Tuscany Study: Rationale, Design, and Methodology

1Department of Neurological and Psychiatric Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
2Department of Medical and Surgical Critical Care, University of Florence, 50134 Florence, Italy
3Department of Neurosciences, University of Pisa, 56126 Pisa, Italy
4Department of Neurological and Behavioral Sciences, University of Siena, 53100 Siena, Italy
5Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, 50134 Florence, Italy

Received 1 December 2011; Revised 16 January 2012; Accepted 16 January 2012

Academic Editor: Kurt A. Jellinger

Copyright © 2012 Anna Poggesi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Dementia is one of the most disabling conditions. Alzheimer’s disease and vascular dementia (VaD) are the most frequent causes. Subcortical VaD is consequent to deep-brain small vessel disease (SVD) and is the most frequent form of VaD. Its pathological hallmarks are ischemic white matter changes and lacunar infarcts. Degenerative and vascular changes often coexist, but mechanisms of interaction are incompletely understood. The term mild cognitive impairment defines a transitional state between normal ageing and dementia. Pre-dementia stages of VaD are also acknowledged (vascular mild cognitive impairment, VMCI). Progression relates mostly to the subcortical VaD type, but determinants of such transition are unknown. Variability of phenotypic expression is not fully explained by severity grade of lesions, as depicted by conventional MRI that is not sensitive to microstructural and metabolic alterations. Advanced neuroimaging techniques seem able to achieve this. Beside hypoperfusion, blood-brain-barrier dysfunction has been also demonstrated in subcortical VaD. The aim of the Vascular Mild Cognitive Impairment Tuscany Study is to expand knowledge about determinants of transition from mild cognitive impairment to dementia in patients with cerebral SVD. This paper summarizes the main aims and methodological aspects of this multicenter, ongoing, observational study enrolling patients affected by VMCI with SVD.