Top Things to Know: Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence
Published: August 18, 2025
Prepared by Anne Leonard MPH, RN, National Senior Director Science and Medicine, American Hearth Association
- Dementia is a clinical syndrome that can be caused by various diseases presenting alone or in combination; Alzheimer’s disease is the most common, but there are other causes and even when AD brain pathology is present, it is usually accompanied by neuropathological evidence of other diseases.
- In 2020 in the U.S., about 5.8 million people were living with dementia and it is expected that by 2026, this number will increase to 13.9 million, accounting for 3.3% of the population.
- Vascular dementia is the second most common type of dementia, and is a complex syndrome caused by a range of cardiovascular and cerebrovascular conditions.
- Vascular contributions to cognitive impairment and dementia (VCID) are common and may be the most preventable cause of clinically significant cognitive decline. The prevalence and incidence of VCID in the U.S. is limited and explored in this paper.
- Key areas discussed within this statement include definitions and methods used to understand incidence and prevalence of VCID according to physician diagnosis, according to epidemiological studies, according to brain autopsy data, neuroimaging markers of VCID), subclinical markers of VCID, and according to race and ethnicity and sex.
- Per epidemiological studies, 2.7 million individuals are estimated to be living with vascular or mixed dementia with only 809,000 individuals formally diagnosed with vascular dementia according to health care billing records.
- According to epidemiological studies in 2020, as many as 603,000 new individuals developed new vascular dementia or mixed vascular dementia and according to healthcare billing data 102,000 new cases.
- This statement estimates that in 2020 there were 11.3 million people with covert (silent) brain infarcts by neuroimaging, 11.1 million with high volumes of white matter hyperintensity, and 19.9 million with cerebral microbleeds potentially detectable by magnetic resonance imaging, contributing to VCID.
- Silent cerebrovascular lesions may be preventable with appropriate risk factor modification. Estimations show that eliminating cerebrovascular disease from the population would prevent 27% to 33% of dementia cases, resulting in 1.5 to 1.8 million fewer people with dementia in 2020.
- Optimizing modification of risk factors including obesity, hypertension, diabetes, smoking physical activity, alcohol, diet modification, depression, hearing loss, sleep duration among others can reduce or prevent VCID. Population health approaches to reduce VCID could benefit millions of Americans.
Citation
Smith EE, Aparicio HJ, Gottesman RF, Goyal MS, Greenberg SM, Schneider JA, Sorond FA, Wright CB; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Peripheral Vascular Disease. Vascular contributions to cognitive impairment and dementia in the United States: prevalence and incidence: a scientific statement from the American Heart Association. Stroke. Published online August 18, 2025. doi: 10.1161/STR.0000000000000494