Vascular cognitive impairment in China: Epidemiology, risk factors, healthcare system, management challenges, therapeutic modalities, and prevention strategies.

Vascular cognitive impairment (VCI) is an increasingly important contributor to cognitive decline in China, where rapid population aging intersects with a substantial burden of stroke, cerebral small vessel disease, and cardiometabolic risk. This narrative review synthesizes Chinese epidemiological, clinical, health-services, and policy literature on VCI, supplemented by key international consensus and interventional evidence when directly relevant. Available evidence indicates that the vascular contribution to cognitive disorders in China is substantial but heterogeneously measured because of differences in case definition, screening tools, study setting, and follow-up design. Post-stroke cognitive impairment is especially important because it is common, clinically recognizable, and reachable through existing stroke follow-up pathways. Across studies, hypertension and cardiometabolic multimorbidity emerge as the most actionable modifiable drivers. China has strengthened its policy response through updated clinical guidance and a national dementia action plan, yet implementation remains constrained by inconsistent screening, uneven specialist capacity, fragmented referral pathways, and limited longitudinal follow-up. Therapeutically, direct evidence for interventions targeting established VCI syndromes remains limited. The strongest available support is indirect and comes from vascular risk reduction, particularly blood pressure lowering for broader dementia or cognitive decline endpoints, while multidomain and symptomatic interventions show phenotype-specific but more heterogeneous signals. A practical China-adapted response is therefore a tiered life-course model linking chronic disease management, post-stroke surveillance, specialist diagnosis, multidomain intervention, and caregiver support. Future priorities include harmonized diagnostics, clearer evidence characterization, biomarker-enabled longitudinal cohorts, and pragmatic implementation-science studies focused on adaptation, cost, and sustainability in community and rural settings.