Major or Mild Vascular Neurocognitive Disorder 623
been reported in African Americans compared with Caucasians, and in East Asian countries
(e.g., Japan, China). Prevalence is  higher in males than in females.
Development and Course
Major or mild vascular NCD can occur at an y age, although the prevalence increases ex-
ponentially after age 65 years. In older indivi duals, additional pathologies may partly ac-
count for the neurocognitive de ficits. The course may vary fr om acute onset with partial
improvement to stepwise decline to progressive decline, with fluctuations and plateaus of
varying durations. Pure subcortical major or  mild vascular NCD can have a slowly pro-
gressive course that simulates major or mild NCD due to Alzheimer’s disease.
Risk and Prognostic Factors
Environmental. The neurocognitive outcomes of vascular brain injury are influenced by
neuroplasticity factors such as education, physical exercise, and mental activity.
Genetic and physiological. The major risk factors for major or mild vascular NCD are the
same as those for cerebrovascular disease, incl uding hypertension, diab etes, smoking, obesity,
high cholesterol levels, high homocysteine levels, other risk factors for atherosclerosis and ar-
teriolosclerosis, atrial fibrillati on, and other conditions increasing  the risk of cerebral emboli.
Cerebral amyloid angiopathy is an important risk factor in which amyloid deposits occur
within arterial vessels. Another key risk factor is the hereditary condition cerebral autosomal
dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL.
Diagnostic Markers
Structural neuroimaging, using MRI or CT, ha s an important role in the diagnostic pro-