The first steps to create an organisation devoted to vascular causes of cognitive and behavioural disorders were taken during autumn 2001 when researchers started to discuss the need to have a society which could organise meetings and working groups. The discussions became more formal at a meeting in Madrid later that year in November on Vascular Burden of the Brain: New Therapeutic Directions, organised by the International Psychogeriatric Association.
At that meeting a manifesto was drafted (see below) and sent out to researchers interested in the subject. This manifesto was soon signed by a large number of researchers from different parts of the world (see Founding members). It was also decided that the first meeting was to be held in Gothenburg, Sweden in August 2003 (VasCog 2003).
During spring 2002, after discussions and a final voting among the founding members, it was decided that the name of the society should be the International Society for Vascular Behavioural and Cognitive Disorders (VasCog). In April 2002, at the 3rd World Congress on Vascular factors in Alzheimer’s Disease held in Kyoto, Japan, it was decided that in future this Congress should be incorporated into the VasCog meetings.
During autumn 2002 the members of the Society discussed and finally approved the by-laws of the society, first drafted by Julien Bogousslavsky and Ingmar Skoog.
During Spring 2003 the members decided after voting that the 2nd Congress should be held in Florence, Italy 2005. The first Executive Committee of VasCog was elected during the summer of 2003, and had its first meeting during VasCog 2003 in Gothenburg.
mission
To investigate vascular factors related to brain injury and dysfunction through their manifold causes and presentations and to strive for consensus on vascular involvement in psychiatric, psychological, cognitive, behavioural, and functional symptoms.
The principle goal of the society is to raise awareness through regular scientific meetings on the topic and facilitate the attendance of younger researchers at such meetings.
vision
- Encourage worldwide representation
- Involve a multidisciplinary approach
- Stimulate research and debate
- Encourage integration and participation of young researchers
- Disseminate and translate results to clinical practice
- Advance public education and awareness
- Develop liaison with caregivers
strategy
- Organise and host biennial international meetings
- Hold focused workshops
One in three individuals will end up with a stroke, dementia or both (1) unless we improve prevention. Moreover, for each person over the age of 65 years who has had a stroke or dementia, two have some cognitive problem short of dementia (2). At the moment, the major emphasis is on the late stages, and the extremes i.e. stroke and dementia. That leaves a neglected majority whose problems are seldom addressed, because they may not be severe enough to prompt medical attention or if the complaints are aired, they may be dismissed as attributable to old age.
Although it is becoming increasingly evident that depression can be associated with certain types of cerebral infarcts and white matter changes, we are yet to work out an anatomy of melancholy and provide a neuroscientific bases for addressing what remains a major problem.
What VasCog can do
- Integration
Most knowledge accrues in pieces but is understood in patterns. Most organizations specialize in areas that themselves get subdivided “ad infinitum”. VasCog may be the only organization that tries to integrate knowledge and understand the broad spectrum of cognitive disorders. It emphasizes the vascular factors, which are potentially treatable and provide means towards preventing, mitigating or delaying all types of cognitive disorders, including Alzheimer disease. Cerebrovascular and Alzheimer disease share the same vascular risk factors.
- Communication
Focusing on stroke and dementia has been achieved to the relative neglect of the prodromal and intermediate stages. Stroke investigators have little interest in cognition, and dementia investigators even less in stroke.
Even if stroke and dementia investigators did have a reciprocal interest in the two areas, there has been no agreement on common data elements. Dementia criteria can vary in their identification of the same set of patients by a factor of 10! (3).
VasCog established working groups to try to develop common minimal standards. This endeavor took a leap forward when Dr. Gabrielle Leblanc, Dr. Costantino Iadecola and Dr. Vladimir Hachinski organized a symposium with the leadership, participation or contributions from members of the different working groups of VasCog, so that now exist minimum recommended standards for the whole spectrum of cognitive impairment (4). The advantage of using common data elements is that several provisional criteria can be tested simultaneously and modified many times according to outcomes, as knowledge grows.
The San Antonio Congress in July 11-14, 2007 proved extensive, intensive and very interactive. Through the initiative of Dr. Gustavo Roman, a Declaration of San Antonio was issued calling for the public, the drug industry, government, investigators and patients to become aware of the growing burden of brain disease attributed to vascular injury and to do something about it. (below)
- Application
The emphasis needs to shift from effects to causes of cognitive and behavioural disorders. Therein lie the best hopes of treatment and prevention.
It may be time for a trial in prevention and/or delay of cerebrovascular and Alzheimer disease by randomizing family practices and/or communities to usual care or optimal care of vascular risk and protective factors. VasCog has established a working group with the specific task of producing a proposal and discussion paper for publication that outlines the need and means of implementing such a study.
What can you do?
1. Join VasCog.
2. After you have joined, have someone else join.
3. Join a working group.
In addition to a working group on prevention, there are working groups on neuropsychology and mechanisms of vascular cognitive impairment. If you have an idea for another working group, please write me with suggestions about the topic and individuals who may lead it.
Advances occur not by breakthroughs alone, but also by many people making small advances cumulatively contributing as much as the few who make major advances. No-one’s work is important simply because it is sophisticated, nor valueless because it is humble. We can all improve what we do. We can all make a difference. Let’s make a difference!
Vladimir Hachinski, MD, FRCPC, DSc
Chairman
REFERENCES
1. Shahadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, Wolf PA. The lifetime risk of stroke: estimates from the Framingham Study. Stroke. 2006;37:345-350.
2. Jin YP, Di Legge S, Ostbye T, Feightner JW, Hachinski V. The reciprocal risks of stroke and cognitive impairment in an elderly population. Alzheimer’s & Dementia. 2006;2:171-178.
3. Erkinjunntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Demaraju CV. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomized trial. The Lancet. 2002;359:1283-90
4. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006;37(9):2220-41.
Statutes of the Vascular Behavioural and Cognitive Disorders (VasCog)
Article 1: Name and domicile
Under the name International Society for Vascular Behavioural and Cognitive Disorders (VasCog), an Association of individual persons according to articles of the “Country” Civil Code is formed. The Council has its domicile in “City, Country” (to be decided by the executive committee).
Article 2: Objectives
Advancement and promotion of knowledge and treatment of behavioural, psychiatric and cognitive disorders associated with cardiovascular and cerebrovascular diseases.
Article 3: Plans of action
The Society shall endeavour to realize this objective by
a) promotion of
- education
- data banks
- research
b) standardization of methods for
- experimental work
- clinical studies and trials
c) developing recommendations for diagnosis and treatment
d) raising funds and bursaries
e) promoting international exchanges
f) encourage worldwide representation
g) encouraging integration and participation of young researchers
h) disseminating and translating results to clinical practice
i) appointing committees for specific tasks or purposes
j) advancing public education and awareness
k) developing liaison with caregivers
l) liaising with other relevant organisations
m) arranging its own meetings, work shops and satellite meetings in connection with relevant other meetings
n) producing overviews and supplements related to the objectives of the Society
o) giving advice to other agents when requested
p) developing a home page
q) other actions defined by the Executive Committee
Article 4: Membership
4.1 The Society shall be composed of active members
4.2 As a new active member may be accepted any individual who has:
1) a past and present record of clinical activity or research in the field
2) a letter of support by 2 active members of the society
Persons interested in becoming active member shall send to the Secretary General their full application material for approval by the Executive Committee (short CV, list of published papers, letter of support)
4.3 Other memberships. The Society may subsequently decide to establish different categories of membership, which will appear in addenda to the by laws (see addendum).
4.4 Subscriptions. Active members may be asked to pay annual subscriptions in the amounts and within the periods set by the Executive Committee.
4.5 Rights and Privileges. Active members may participate in the business sessions of the Society and may vote.
All active members are eligible for election to office in the Council. This will not be the case for other memberships, if established by the Society.
4.6 Cessation of membership. Membership shall cease upon:
a) death
b) written notice by the member, in which case membership shall cease as of the following calendar year
c) expulsion in accordance with a decision of the General Assembly.
Article 5 Executive Committee
5.1 Membership to the Executive Committee. The Executive Committee shall consist of 11 persons (the Chairperson, the Treasurer, the Secretary-General, 7 Directors in charge of the plans of action defined in Article 3, and one representative for the Research Student Section). The respective functions within the Executive Committee shall be decided by the Executive Committee itself, including nominating the Chairperson (who shall have to rotate every two years), the Treasurer, and the Secretary-General. The attribution of other tasks to each member of the Executive Committee shall be decided within the Executive Committee. The Chairperson organizes and chairs the debates but has no particular power of decision.
5.2 Duration of office. The duration of office in the Executive Committee shall be 4 years. Re-election of half of the Executive committee every second year avoids that the whole committee is changed at the same time. Officers may be re-elected but they may not serve for more than 8 consecutive years (2 election periods). The representative of the Research Student Section should be re-elected every second year and may not serve more than 4 years.
5.3 Elections and eligibility. The General Assembly of active members shall elect the officers among its own members on the proposal of the Nominating Committee (see article 6.2 and 9.1). Other active members may also candidate to the election if suggested by at least 20 active members. Candidates to the election should be announced at least 1 month before the voting. No more than 2 residents of the same country may be elected to the Executive Committee.
The research student is elected by the Research Student Section of the Society.
5.4 Duties and activities of the Executive Committee.
The Executive Committee shall direct and conduct the general activities of the Society.
The Executive Committee is authorized to carry out tasks not allocated to the General Assembly. In legal actions, the Society shall be represented by the Chairperson, the Treasurer and the Secretary-General.
The Executive Committee shall make decisions by majority vote. In case of equal vote, the vote of the Chairperson shall prevail.
The Executive Committee shall make decisions about affiliations to other organizations.
The Executive Committee shall report on its activities and decisions to the active members at least every 6 months.
5.6 Meetings. The Executive Committee shall meet at regular intervals, at least once a year.
5.7 Administrative Secretariat. The Society shall have a permanent Administrative
Secretariat, which will be supervised by the Secretary-General.
Article 6: General Assembly
6.1 The General Assembly is formed by all active members of the Society.
6.2 The General Assembly may vote in writing (mail or electronic mail), on request of the Executive Committee, or during the business meeting. Voting by e-mail should be announced at least one month before the voting starts and should be open for voting during at least 2 weeks. Votes are sent to the Secretary-General. Individual votes will be kept strictly confidential. The secretary-General will keep the votes for at least one year in case that an active member request recounting. All counting is based on those who votes.
6.3 The General Assembly votes for members of the Executive Committee, members of the Nominating Committee, the location of the Society Conference, amendments to the Statutes, the dissolution of the Society, expulsion of a member and any other business suggested by the Executive Committee or by writing to the Secretary General by 30 or more active members.
6.4 The General Assembly should meet at least every second year at a business meeting, which may be arranged by the Executive Committee during the sessions of the Society Conference. The invitation to the business meeting shall be announced to the members at least 3 months before the date of the meeting.
Article 7: Amendments to the StatutesArticle 9: Other committees
Amendments to the Statutes must be proposed by the Executive Committee or in writing to the Secretary General by 30 or more active members and must be acted upon within the year following the receipt of this proposal. An amendment shall require for its adoption an affirmative vote by three-fourths of the votes.
Article 8: Society Scientific Congress
8.1 A scientific congress will be organized by the Society at intervals decided by the Assembly upon suggestion by the Executive Committee. The venue should normally rotate between continents. The scientific congress is also open for non-members of the Society.
8.2 Candidates to organize the meeting should send in their detailed application to the Executive Committee, which distributes the application to the General Assembly of active members before the voting. The General Assembly of active members should decide on the venue by voting. The candidate with at least 50% of the votes shall have the next meeting. If no candidate receives more than 50% of the votes, a re-voting shall take place among the two candidates with most votes. The voting shall take place at least 4 years before the scheduled congress (rules for voting, see Article 6.2).
8.3 A local congress chair is appointed in advance by the Assembly, upon proposal of the Executive Committee. The congress chair is responsible for appointing a local organizing Committee. The Executive Committee plus the congress chair and two representatives of research students will serve as Program Committee and will appoint an International Scientific Committee.
8.4 The Program Committee (see 8.3) is responsible for the program format and content, and for the rules applied to delegates, sponsors and guests.
8.5 The Scientific Committee (see 8.3) serves as an advisory board and assesses the abstracts submissions upon directions of the program committee.
8.6 The local organizing committee is responsible for the local facilities of the venue and all other local logistic aspects.
8.7 The financial and organizational responsibility of the congress, as well as the handling of profits and deficits of the congress, will be the subject of a contract between the Society (through its Executive Committee), the local committee, and an organizing company. The split of profits and deficits between the local organizers and the Society will be directed by an addendum to the by-laws.
Article 9: Other committees
Nominating committee. The nominating committee comprises 5 members elected and suggested by the General Assembly among its active members. The duration of office shall be 4 years. The nominating committee nominates its own chair. The Nominating committee should suggest candidates for the election of the Executive Committee.
Research students section. The Society should develop a section for research students, with its own Coordinating Committee. Membership to this section is only open to research students. This section shall work under the same statutes as the parent organization, and advise the Society regarding matters of importance for young researchers. The Research Students Section shall have a representative on the Executive Committee and two on the Program Committee.
Addendum to the by-laws
5.1 Among other tasks given to members of the executive committee could be editor of home page, responsible for raising funds, chair of scientific committee, responsible for educational matter etc.
5.1 The first election will thus be on 10 persons, out of whom 5 have to be re-elected after 2 years. In the first election it should be stated which candidates who are going to be subject to re-election after 2 years.
5.1. It is recommended that, if possible, each gender should be represented by at least 3 members, that all continents with a substantial number of members should be represented and that one member should be a research student.
5.1 In addition to the 11 voted persons for office in the executive committee, the chairs of forthcoming Vas-Cog congresses, voted by the members, should be full members of the executive committee until two months after the congress has taken place.
5.1 In addition, the chairs of the scientific committee for forthcoming Vas-Cog congresses should be full members of the executive committee until one month after the congress has taken place.
5.1 The General assembly January 16, 2009, in Singapore, approved that Monique Breteler could be chair and member of executive committee from 2009-2011, despite not being member of the Executive Committee, and that she as such could become voting member of the Executive Committee during that period.
5.1 The General assembly January 16, 2009, in Singapore, decided to make Vladimir Hachinski Founding President for the Society for the rest of his life.
5.1 The General assembly September 14, 2011, approved the addendum that the number of Student Members in the Executive Committee should be three.
Singapore, approved retrospectively that Vladimir Hachinski was Chair of the Society for 6 years.
Article 8
8.5 It is recommended that, if possible, each gender should be represented by at least 3 members, that all continents with a substantial number of members should be represented and that one member should be a research student.
Article 9
Singapore, approved that for the election of Executive Committee 2009-2013, the Executive Committee suggested Nominating Committee (Srikanth, Philip Wolf, Ken Rockwood, Geerlings). The fifth, Alida Gouwe, was selected by the Student section.