Perminder Sachdev, MD, PhD, co-director of the Centre for Healthy Brain Ageing at UNSW Sydney.

The revised VasCog-2-WSO diagnostic criteria for 

, endorsed by the World Stroke Organization (WSO) and published in 2025, update the 2014 VasCog framework to reflect a decade of advances in small vessel disease imaging and Alzheimer disease biomarkers, according to Perminder Sachdev, MD, PhD, who discussed the revision at the 18th 

The original criteria, published in 2014 by the International Society for Vascular Behavioural and Cognitive Disorders, offered an operationalized framework for vascular cognitive disorders.² In an interview with HCPLive, Sachdev said the field now has a clearer understanding of the natural history of small vessel disease, along with greater standardization of its neuroimaging markers. He also pointed to imaging, cerebrospinal fluid, and blood biomarkers for Alzheimer disease now in clinical use, as well as markers available for dementia with Lewy bodies.

“Because these are co-pathologies and often competing pathologies in a differential diagnosis, having those biomarkers further aids the assessment of vascular dementia,” said Sachdev, co-director of the Centre for Healthy Brain Ageing at UNSW Sydney.

VasCog-2-WSO Vascular Dementia Criteria, With Perminder Sachdev, MD

The revision also aimed to broaden representation. According to Sachdev, members of the VasCog Society largely developed the 2014 criteria, leaving some regions of the world underrepresented on the expert panel.

VasCog-2-WSO Consensus Process and Standardized Terminology


The VasCog-2-WSO criteria revise the 2014 VasCog diagnostic criteria. They define preclinical, mild, and major dementia levels of vascular cognitive impairment under the umbrella term VCID, and the WSO has endorsed them.

How were the VasCog-2-WSO criteria developed?


An international panel reached consensus through 3 rounds of an online Delphi survey, with at least 75% agreement required for each item. Between 49 and 54 experts took part in each round.

Which MRI markers are relevant to vascular dementia diagnosis?


Established markers include white matter hyperintensities, lacunes, microbleeds, and dilated perivascular spaces. Diffusion-based metrics such as PSMD and functional measures of cerebrovascular reactivity and blood flow are still being studied in research settings.

Investigators developed the revised criteria through an online Delphi survey requiring ≥ 75% agreement per item across a minimum of 3 rounds.¹ Of 70 international experts invited in 2023, between 49 and 54 participated in each of the 3 survey rounds.¹

The panel agreed on diagnostic criteria for preclinical, mild, and major dementia levels of vascular cognitive impairment, grouped under the overarching term vascular cognitive impairment and dementia (VCID).¹ The framework brings earlier labels, including vascular dementia, vascular neurocognitive disorder, and vascular cognitive disorder, under this single umbrella term.³

Sachdev said a central aim was to replace the many terms introduced in recent years with 1 standard terminology going forward. The WSO endorsed the final criteria, which gave the framework its VasCog-2-WSO name.¹

The panel also agreed on research guidelines for novel neuroimaging and fluid biomarkers.¹ According to Sachdev, the group reviewed recent work on fluid and retinal biomarkers to judge whether either was mature enough for clinical practice or research diagnoses.

MRI Markers of Small Vessel Disease in Vascular Dementia Diagnosis

Established MRI markers of small vessel disease include white matter hyperintensities, lacunes, and microbleeds, according to Sachdev. He noted the field now uses the term lacunes in place of lacunar infarcts, and evidence supporting dilated perivascular spaces as an additional marker has grown.

Diffusion-based measures form a second category. Sachdev cited peak width of skeletonized mean diffusivity (PSMD), a diffusion tensor imaging (DTI) metric currently used in research settings.

Functional techniques are also in development, including cerebrovascular reactivity testing with a carbogen challenge, blood-brain barrier integrity measures, and cerebral blood flow assessment with arterial spin labeling or gadolinium-based perfusion. Investigators are deriving network metrics from DTI. Recent studies have also examined brain age, particularly white matter age, as a marker of cerebrovascular disease.

“With this plethora of measures coming into the field, we wanted to see which ones were mature enough,” Sachdev said.

Editor’s note: Sachdev has no reported disclosures.

Sachdev PS, Bentvelzen AC, Kochan NA, et al. Revised diagnostic criteria for vascular cognitive impairment and dementia: the VasCog-2-WSO criteria. 

Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. 

Ellery S. New diagnostic criteria for vascular cognitive impairment and dementia. 

. Published November 2025. Accessed November 6, 2026. 

https://medicinetoday.com.au/mt/2025/november/in-brief/new-diagnostic-criteria-vascular-cognitive-impairment-and-dementia

Videos

Sachdev explains how VasCog-2-WSO criteria integrate new MRI markers, biomarkers, and unified terminology for vascular dementia.

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Meena Bansal, MD, is director of the MASLD/MASH (NAFLD/NASH) Center of Excellence at Mount Sinai and System Chief, Division of Liver Diseases for the Mount Sinai Health System.

Resmetirom (Rezdiffra) reduced atherogenic lipids, including lipoprotein(a) [Lp(a)], in patients with 

metabolic dysfunction-associated steatohepatitis (MASH)

 regardless of baseline statin use, according to a secondary analysis of the phase 3 MAESTRO-NASH trial presented at 

.¹ A separate real-world analysis of nearly 4900 patients showed improvements in liver enzymes and noninvasive measures of fibrosis and steatosis within 12 months of starting resmetirom.²

Meena Bansal, MD, of the Icahn School of Medicine at Mount Sinai, presented both analyses and discussed them in an interview with 

. She emphasized cardiovascular risk should factor into every MASH treatment strategy.

Resmetirom in MASH: Lp(a), Statins, and Real-World Data

“The number one cause of death is cardiovascular,” Bansal said.

How Does Resmetirom Affect Cardiovascular Risk Markers in MASH?

Approximately half (49%; n = 473) of MAESTRO-NASH participants were taking statins at baseline, and these patients more often had diabetes (79.5% vs 55.0%) and F3 fibrosis (64.3% vs 56.6%) than those not taking statins.¹ The dual primary histologic endpoints remained directionally consistent with the overall trial and nominally significant for resmetirom 80 mg and 100 mg versus placebo in both subgroups.

At Week 24, resmetirom produced placebo-corrected reductions in LDL cholesterol, apolipoprotein B, triglycerides, and Lp(a) across statin and nonstatin subgroups. Among statin users with baseline LDL cholesterol of 70 mg/dL or higher, 44.4% reached less than 70 mg/dL with resmetirom 100 mg. Among those with elevated Lp(a), 36.3% and 37.5% shifted below the 30 mg/dL and 50 mg/dL thresholds, respectively, and patients in the highest baseline Lp(a) quartile had significant reductions independent of statin use.¹

Bansal noted many patients with MASH are undertreated with statins, as clinicians often hesitate to start them in patients with abnormal liver enzymes, and hepatologists frequently provide the reassurance needed to begin therapy. She highlighted Lp(a) as an emerging cardiovascular risk factor unaffected by statins, while noting cardiovascular outcomes with resmetirom have not been studied.

“Could there also be cardiovascular benefit? Not yet proven, but tantalizing,” she said.

What Does Real-World Resmetirom Use Look Like?

The real-world cohort used deidentified Trio Health electronic medical record data from 4886 adults initiating resmetirom between March 2024 and January 2026.² Patients had a mean age of 59.1 years, 60.3% were female, and common comorbidities included type 2 diabetes (45%), obesity (53.9%), and hypertension (61.8%). Glucagon-like peptide-1 receptor agonist use was 28.4% at baseline.²

Among patients with paired data at 6 and 12 months, 40.6% and 45.8% achieved an alanine aminotransferase reduction of at least 20%, and 43.4% and 54% had a controlled attenuation parameter reduction of at least 40 dB/m.² Liver stiffness fell by at least 25% in 36.5% and 45.5% of patients, and among 128 patients with fibrosis scores at baseline and 12 months, 36.7% improved by at least 1 stage.²

Bansal said the real-world population closely mirrored the clinical trial population, and she described resmetirom as easy to prescribe, with side effects typically resolving by Week 12 and no significant new safety signals emerging. The authors noted longer follow-up and analyses accounting for missing paired data are needed.² Bansal added full approval for resmetirom and semaglutide 2.4 mg will depend on outcomes data.

Bansal M, Taub R, Labriola D, et al. Reducing CV risk in patients with metabolic dysfunction-associated steatohepatitis independent of baseline based on Lp(a) and LDL lowering by resmetirom. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.

Bansal M, McEwen I, Parrinello C, et al. Real-world characteristics, treatment patterns, and clinical outcomes among patients with MASH initiating resmetirom. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.

Harrison SA, Bedossa P, Guy CD, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. doi:10.1056/NEJMoa2309000

Meena Bansal, MD, discusses data showing resmetirom lowered Lp(a) and LDL regardless of statin use, plus real-world liver outcomes in nearly 4900 patients.

Hepatology

MASH / MASLD

The HCPLive MASH & MASLD page is a comprehensive resource for clinical news and insights on metabolic dysfunction-associated steatotic liver disease and steatohepatitis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for fatty liver disease, steatohepatitis, and more.

Strategic Alliance Partnership

Resmetirom Lipid Benefits and Real-World Liver Outcomes: Meena Bansal, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for 

. He is also the executive producer of two podcasts: 

. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

GOLD 2027 now recommends a LAMA as initial therapy for group A.

The report defines 6 types of pre-COPD and expands CT guidance to cover mucus plugging and comorbidities.

New biologics stay out of the algorithm until the FDA or EMA approves them, though their data are reviewed in the text.

2027 Global Initiative for Chronic Obstructive Lung Disease (GOLD)

 report recommends a long-acting muscarinic antagonist (LAMA) as initial therapy for patients in GOLD group A and expands guidance on CT imaging, nonpharmacologic care, and cardiovascular comorbidities, according to a presentation at the GOLD 2026 

 International Conference in Philadelphia.¹

Claus F. Vogelmeier, MD, chair of the GOLD Science Committee, outlined the key revisions, and Alvar Agustí, MD, chair of the GOLD Board of Directors, introduced a separate Science Committee call to action. The full report is expected online on World COPD Day, November 18.

What Changed in COPD Definitions and Diagnosis?

A new section, developed with the Global Initiative for Asthma, addresses challenges shared by COPD and asthma, including limited access to diagnostic testing, inhaler availability and affordability, and climate impact. The report also clarifies terminology: early COPD should not be used in clinical settings, mild COPD should describe only spirometric severity, and COPD in young individuals refers to patients younger than 50 years.

Pre-COPD now spans 6 presentations in individuals with normal spirometry: preserved ratio impaired spirometry, airflow limitation resolving after bronchodilation, CT evidence of emphysema or airway wall thickening, chronic bronchitis symptoms in smokers, reduced diffusing capacity, and accelerated lung function decline.

An expanded spirometry section, written with the Global Lung Function Initiative, concludes neither the 0.70 fixed ratio nor the lower limit of normal is intrinsically superior, and the choice makes little practical difference. For borderline results, Vogelmeier said further investigation and repeat testing may be warranted.

How Does the Report Expand the Role of CT?

The CT section, previously limited to differential diagnosis, lung volume reduction, and lung cancer screening, now covers mucus plugging, which Vogelmeier described as a priority for future evaluation. He cited COPDGene data linking airway-occluding plugs to higher mortality³ and a CT substudy of approximately 700 patients from the OBERON and TITANIA trials showing dose-dependent plug reduction with tozorakimab, though the clinical implications remain unknown.

CT can also identify comorbidities, including coronary artery calcification, sarcopenia, and osteoporosis, and help evaluate persistent symptoms despite optimized treatment.

What are the GOLD Report’s Treatment Updates?

The only substantive pharmacologic change replaces the general bronchodilator recommendation for group A with a LAMA, based on a systematic review. Vogelmeier highlighted a Chinese trial of approximately 800 patients with GOLD 1 or 2 disease, most of them treatment naive, in which tiotropium improved FEV1 and reduced exacerbations compared with placebo.² New biologics remain outside the algorithm until approved by the FDA or EMA, although published data for tozorakimab and astegolimab are reviewed in the text.

Nonpharmacologic recommendations now mirror the pharmacologic ABE framework, with evaluation for pulmonary rehabilitation recommended at diagnosis for groups B and E. The chapter distinguishes physical activity coaching, exercise training, and pulmonary rehabilitation, and calls for physical activity programs after exacerbations managed at home.

A revised cardiovascular section, developed with cardiologist Chris Gale, notes standard risk calculators underestimate cardiovascular risk in COPD, with coronary calcium scoring improving prediction of major adverse cardiovascular events. SGLT2 inhibitors and cardioselective β-blockers are recommended across heart failure types, and no rate or rhythm control strategy for atrial fibrillation is contraindicated.

Agustí described the call to action as aspirational rather than a guideline. It urges prevention beyond smoking, earlier diagnosis, and personalized management, along with research into whether COPD identified at younger ages could be cured or brought into remission.

Editor’s Note: This summary of a session has been edited for grammar and clarity using artificial intelligence tools.

Vogelmeier CF, Agustí A. 2027 GOLD report review and COPD call to action. Presented at: GOLD 2026 COPD International Conference; November 5-6, 2026; Philadelphia, PA.

Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. 

. 2017;377(10):923-935. doi:10.1056/NEJMoa1700228.

Diaz AA, Orejas JL, Grumley S, et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease. 

. 2023;329(21):1832-1839. doi:10.1001/jama.2023.2065.

Articles

The 2027 GOLD report recommends a LAMA for group A, defines 6 pre-COPD types, and expands CT, rehabilitation, and cardiovascular guidance for COPD.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

What’s New in the 2027 GOLD Report for COPD

Eingun James Song, MD, is the director of clinical research for Frontier Dermatology. 

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

In ‘Individualizing Oral Therapy Selection for Patients With PsO,’ our panel explores how clinicians identify patients who may benefit from oral systemic therapy and how they distinguish among available options. The experts note that oral treatment may be particularly attractive to patients who are systemic-therapy naïve, prefer pills to injections, travel frequently, or value the flexibility associated with shorter drug exposure.

Individualizing Oral Therapy Selection for Patients With PsO

The discussion then examines how different oral therapies may fit different clinical scenarios. Faculty review the role of apremilast in patients with milder overall disease or involvement of high-impact sites such as the scalp, nails, palms, and soles. They discuss deucravacitinib as a more efficacious oral option for moderate-to-severe disease and note additional considerations related to psoriatic arthritis. The panel also considers icotrokinra for moderate-to-severe psoriasis, including younger eligible patients and those with high-impact-site involvement.

Head-to-head evidence is highlighted as an increasingly valuable tool for differentiating oral therapies. The faculty discuss the progression in efficacy seen across generations of oral treatment and how patient selection may also depend on speed of response, psoriatic arthritis, and willingness to use injectable therapy.

The experts conclude by reviewing high-level efficacy trends and emphasizing that patients with localized high-impact disease may experience substantial burden despite low body surface area.

Our next episode, ‘High-Impact Site Clearance and Durability With Oral IL-23 Inhibition in PsO,’ focuses on extended icotrokinra data in high-impact-site disease and explores the biology that may contribute to sustained response.

Selecting an oral psoriasis therapy requires balancing disease characteristics with efficacy, convenience, comorbidities, and individual patient priorities.

Video Series

In this episode, ‘Understanding the Pathophysiology of PsO,’ the expert dermatology panel explores how advances in psoriasis pathophysiology have led to increasingly targeted therapies. The discussion traces the evolution of understanding from earlier concepts of psoriasis as a predominantly TH1-mediated disease to recognition of the central role of the IL-23/TH17 pathway.

Understanding the Pathophysiology of PsO

The faculty describe how basic science discoveries surrounding IL-23 and TH17 cells directly contributed to the development of highly effective IL-17 and IL-23 biologic therapies. They then explain how similar mechanistic insights have driven innovation in oral treatment. Apremilast targets PDE4, an intracellular molecule involved in the generation of multiple pro-inflammatory cytokines, while deucravacitinib inhibits TYK2, which participates in intracellular signaling downstream of cytokines including IL-12 and IL-23.

The panel also discusses the emergence of icotrokinra, an oral peptide that targets the IL-23 receptor itself. Rather than neutralizing circulating IL-23 in the manner of a biologic, icotrokinra binds the receptor and prevents IL-23 signaling. Faculty consider this approach an important example of how traditionally biologic targets may increasingly become accessible through oral therapies.

The next episode in this series, ‘Individualizing Oral Therapy Selection for Patients With PsO,’ features the panelists discussing which patients may prefer oral therapy and how disease characteristics, convenience, efficacy, comorbidities, and treatment goals guide selection among available options.

Advances in psoriasis biology are translating key inflammatory pathways into increasingly precise oral treatment targets.

Jorg Taubel, MD, is a clinical pharmacologist and CEO of Richmond Pharmacology.

Jorg Taubel, MD, discusses data showing a single dose of CIDEB siRNA cut liver fat by up to 80% and normalized it in 62% of patients with MASLD.

Single Dose of CIDEB siRNA Normalizes Liver Fat in MASLD Through 36 Weeks

Behnood Bikdeli, MD, MS, is a physician at Mass General Brigham and assistant professor of medicine at Harvard University.

Behnood Bikdeli, MD, MS, discusses his long-term follow-up to the HI-PRO study, which noted apixaban’s lasting effects on venous thromboembolism.

Stroke

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Long-Term Apixaban Treatment Improves VTE Recurrence Risk, Benefit Fades After Discontinuation

Topline results presented at The Liver Meeting showed 79% of patients with HDV reached undetectable HDV RNA at 48 weeks with monthly elebsiran plus tobevibart.

Elebsiran Plus Tobevibart Suppresses HDV RNA in Phase 3 ECLIPSE 1 Trial

Ryan Tedford, MD, is the Dr. Peter C. Gazes Endowed Chair in Heart Failure and professor of medicine/cardiology at the Medical University of South Carolina and the deputy editor of 

Ryan Tedford, MD, discusses his analysis of the phase 2 CADENCE trial, highlighting sotatercept’s beneficial effects on both the right and left sides of the heart.

Heart Failure

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Sotatercept May Promote Broad Cardiac Remodeling in Addition to Pulmonary Vascular Benefit

Douglas Dieterich, MD, is a Professor of Medicine, Icahn School of Medicine at Mount Sinai.

Douglas Dieterich, MD, discusses AZURE-1 data showing brelovitug responses in chronic hepatitis D continued to improve with treatment beyond Week 24.

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AZURE-1: Brelovitug Responses Deepen Beyond Week 24 in Chronic Hepatitis D

Kausik Ray, MD, MBChB, MPhil, discusses Lp(a)HORIZON, remnant cholesterol targets, enlicitide, and the lipid outcome trials to watch in 2027.

Dyslipidemia

Lp(a)HORIZON, Oral PCSK9s, and 2027 Lipid Trials, with Kausik Ray, MD, MBChB, MPhil

In the phase 2b IMPACT trial, up to 42.9% of patients with MASH achieved concurrent liver fat, ALT, and stiffness responses on pemvidutide vs 3.3% on placebo.

Pemvidutide Improves Multiple MASH Fibrosis Markers at 48 Weeks

Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

In 757 adults with severe hypertriglyceridemia, plozasiran cut acute pancreatitis events by 78% overall and 91% in those with recent prior pancreatitis.

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This page also hosts content previously published by EndocrinologyNetwork. 


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, IBS and IBD, Crohn's disease, and more.

SHASTA-3/4: Plozasiran Could Cut Acute Pancreatitis Risk by 78% Across sHTG Spectrum

Research fellow at the hepatology section of the gastrointestinal department at the Cleveland Clinic. 

Mohammad Alabbas, MD, discusses real-world data comparing liver and cardiovascular outcomes with tirzepatide vs SGLT2 inhibitors in MASLD.

Obesity Management

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Tirzepatide vs SGLT2 Inhibitors in MASLD Across Disease Stages

Jörn Schattenberg, MD, is a professor of medicine and director of the Metabolic Liver Research Program at the University Medical Center Mainz in Germany.

Jörn Schattenberg, MD, discusses ESSENCE data showing semaglutide 2.4 mg improved liver markers in patients with MASH and a BMI below 27 kg/m².

Latest News

VasCog-2-WSO Vascular Dementia Criteria, With Perminder Sachdev, MD

Resmetirom Lipid Benefits and Real-World Liver Outcomes: Meena Bansal, MD

What’s New in the 2027 GOLD Report for COPD

Individualizing Oral Therapy Selection for Patients With PsO

Understanding the Pathophysiology of PsO