This handout is for vascular cognitive impairment / vascular dementia. Your care team identified this based on: cognitive decline within 3 mo of stroke (aha/asa vci 2019 pmid 21778438).
Other reasons your team may use this plan: step-wise cognitive decline with cerebrovascular events (ninds-airen pmid 8094895); severe periventricular + deep white-matter hyperintensities (fazekas 2-3) on mri; multiple lacunar infarcts + chronic small-vessel disease.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| atorvastatin | 40-80 mg PO daily | PO | daily | AHA/ASA 2021 PMID 34024117 — LDL <55 mg/dL target post-stroke; high-intensity statin |
| rosuvastatin | 20-40 mg PO daily | PO | daily | Alternative high-intensity statin |
| aspirin | 81 mg PO daily | PO | daily | AHA/ASA 2021 — first-line antiplatelet for non-cardioembolic; DAPT (aspirin + clopidogrel) × 21 d for minor stroke / high-risk TIA per CHANCE / POINT |
| clopidogrel | 75 mg PO daily (after 300-600 mg load) | PO | daily | AHA/ASA 2021 — DAPT × 21 d for minor stroke (NIHSS ≤3) or high-risk TIA (ABCD2 ≥4); long-term mono for aspirin intolerance |
| apixaban | 5 mg PO BID (2.5 mg BID if 2 of: age ≥80, weight ≤60 kg, Cr ≥1.5) | PO | BID | AHA/ASA 2021 — DOAC preferred over warfarin for non-valvular AF; lowest bleed risk vs other DOAC |
| rivaroxaban | 20 mg PO daily with food (15 mg if CrCl 15-50) | PO | daily with food | Alternative DOAC for AF |
| warfarin | 5 mg PO daily (target INR 2-3) | PO | daily; INR-titrated | Mechanical valve or DOAC contraindication; INR 2-3 |
| lisinopril | 10 mg PO daily; titrate to 20-40 mg | PO | daily | AHA/ASA 2021 — BP <130/80 target; SPRINT-MIND PMID 30688979 signal for intensive <120 in select older adults |
| amlodipine | 5 mg PO daily; titrate to 10 mg | PO | daily | AHA/ASA 2021 BP combination |
| hydrochlorothiazide | 12.5-25 mg PO daily | PO | daily | AHA/ASA 2021 BP combination |
| metformin | 500 mg PO BID with meals | PO | BID | ADA 2026 first-line DM; glycemic control reduces SVD progression |
| empagliflozin | 10 mg PO daily; titrate to 25 mg | PO | daily | EMPA-KIDNEY + EMPEROR — cardiorenal benefit; emerging cognitive signal in CKD overlap (forward-looking adjunct) |
| dapagliflozin | 10 mg PO daily | PO | daily | DAPA-CKD — cardiorenal benefit |
| smoking cessation counseling + varenicline / NRT | — | — | — | AHA/ASA 2021 — smoking cessation reduces stroke recurrence |
Plan: Secondary stroke prevention bundle — statin + BP + antiplatelet/anticoag + glycemic + smoking cessation (AHA/ASA 2021 PMID 34024117; SPRINT-MIND PMID 30688979)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Caregiver education + dementia care navigator; driving cessation per MoCA / on-road eval; advance directives / POLST; palliative referral at FAST 7 (NICE 2024 dementia)
Guideline: AHA/ASA VCI 2019 (Iadecola PMID 21778438) + AHA/ASA 2021 stroke prevention (PMID 34024117) + NINDS-AIREN (Roman PMID 8094895) + VASCOG 2014 (Sachdev PMID 24632990) + SPRINT-MIND (Williamson JAMA 2019 PMID 30688979) + Hachinski Ischemic Score (PMID 1164215) + AAN 2018 + APA 2024 BPSD + AGS Beers 2023