Review Article | DOI: https://doi.org/10.31579/2578-8868/419

Vascular Dementia An Over View

  • K. Satya Rao *

Senior Consultant Neurologist, Medicover Hospitals, Vizag Andrapradesh, India.

*Corresponding Author: K. Satya Rao, Senior Consultant Neurologist, Medicover Hospitals, Vizag Andrapradesh, India.

Citation: K. Satya Rao (2026), Vascular Dementia An Over View, J. Neuroscience and Neurological Surgery, 19(5) ; DOI :10.31579/2578-8868/419

Copyright: © 2026, K. Satya Rao. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Received: 04 May 2026 | Accepted: 12 May 2026 | Published: 21 May 2026

Keywords: hypertension ; diabetes mellitus ; smoking ; hyperlipidemia

Abstract

Vascular dementia is the second most common cause of dementia after Alzheimer's disease. This represents a heterogeneous group of cognitive disorders resulting from cerebro vascular pathology. It is characterized by cognitive impairment severe enough to interfere with daily functioning and is often associated with focal neurological deficit and a step wise clinical progress. Early diagnosis is crucial as vascular dementia is preventable and partially modifiable.This review provides an overview of Vascular Dementia, it's definition, classification, clinical features, diagnostic criteria and the role of imaging. In this review I bring out important aspects of genetically mediated dementias which are of early onset and current approach of the diagnosis and management strategies.

Introduction

Dementia is defined as a decline in mental function from primary high level severe enough to interfere with daily living. There will be two or more specific difficulties of MEMORY, REASONING, LANGUAGE, COORDINATION, MOOD AND BEHAVIOUR.

Vascular dementia is the second most common cause of dementia after Alzheimer's disease. This is because of diminished blood supply to the brain. Mainly classified in to post stroke dementia involving large vessels, Multi infarct dementia and small vessel ischemic changes in sub cortical regions resulting in Binswangers disease.

The incidence comes to about 2.5 to 3.8 per one thousand people per year. There are certain risk factors identified which are responsible for vascular dementia. These are Hypertension, Diabetes Mellitus, Smoking and hyperlipidemia. Control of these risk factors Will prevent the development of this dementia. There are certain dementias of early onset like CADASIL and CARASIL which are genetically mediated are specifically discussed in this review. Various modes of investigations and management strategies are discussed in detail.

Classification:

Dementias are broadly classified into: [4].

Primary Dementias: where these is direct damage to the neurons and it is irreversible these are:

  1. Alzheimer's disease
  2. VASCULAR dementia
  3. Lewvy body dementia
  4. Mixed dementia
  5. Dementia associated with Parkinson's disease

Secondary Dementias: Dementias arising from some other underlying conditions or external factors. These are sometimes reversible or altered if the underlying causes are treated.

Such conditions are:

  1. Normal pressure hydrocephalus
  2. Subdural haematomas
  3. Infections
  4. Metabolic and endocrine disorders like Addison's disease and Cushing syndrome
  5. Heavy metal toxicity
  6. Brain tumors
  7. Drug induced cognitive impairment
  8. Traumatic brain injury
  9. Vitamin deficiencies like B1, B6, ANDB12
  10. Alcohol abuse

Identifications of reversible dementias is critical as timely treatment will significantly improve the cognitive function.

Vascular Dementia

This is the second most common cause of primay dementias second to Alzheimer's Dementia.

Types Of Vascular Dementias [2].

  1. POST STROKE DEMENTIA
  2. MULTI INFARCT DEMENTIA
  3. BINSWANGERS DISEASE
  4. MIXED DEMENTIA

Pathophysiology:

Vascular Dementia may be because of ischemic stroke or haemorrhagic stroke. The main pathology lies in the VASCULAR damage because of atheromatous change in the vessel wall. May be large vessels involvement involving large area of brain or sometimes the intracerebral haemorrhage producing post stroke dementia. It may be because of involvement of multiple vessels involving multiple strategic areas of brain producing Multi infarct dementia.

Sometimes small vessel involvement producing micro vascular ischemic changes producing so called Binswangers disease.

It's not rare to come across amyloid angiopathy which may be responsible for lobar haematomas and Dementia.

One moreimportant cause of Vascular Dementia is Thromboembolic manifestation of cardiac origin which is responsible for Multi infarct Dementia.

If we take the early onset dementia in to consideration CADASIL AND CARASIL will come into the picture.

The main etiology in CADASIL is genetic mediation such as NOTCH 3 Gene which is responsible for the maintenance of the integrity of the vascular endothelium. The mutation in this gene produces recurrent strokes in young individuals.

Coming to CARASIL it's because of the mutation in HTRA 1 gene which is responsible for dementia from childhood itself and is progressive.

Symptoms Of   Vascular Dementias [2].

Confusion, sleeping issues, Memory loss. Trouble in understanding and using words. Personality and behavioural changes.

Urinary Incontinence, Trouble in concentration

Emotional incontinence and Dawn phenomenon where the patient feels worse in the evening and night.

Step wise progression of the symptoms is an important manifestation. These are the common manifestations with which these patients present.

Stages Of Dementia [3].

1.             Early stage where there is mild cognitive change and memory disturbances

2.             Middle stage where there is increased confusion, worsening of memory loss and difficulty in performing daily activities.

3.             Late stage: sever cognitive impairment, loss of physical abilities and dependence on daily care.

Diagnosis:

Clinical: Diagnosis of Vascular Dementia is primarily clinical and supported by neuroimaging and in rare circumstances genetic analysis.

A key diagnostic tool is the HACHINSKI ISCHEMIC SCORE with a total score of 18.

Score less than 4 indicates Alzheimer's Dementia. Score more than 7 suggests Vascular Dementia.

Major components carrying two points each include:

Abrupt onset Fluctuating course History of stroke

Focal neurological symptoms Focal neurological signs

Additional features such as hypertension, depression, emotional incontinence, personality changes, atherosclerosis, and somatic complaints, Nocturnal confusion, and step wise determination carry one point each which further aid in the diagnosis.

Imaging: CT scan and MRI brain confirms recent Stroke involving large vessel, Multiple infafrcts involving different strategic areas responsible for Multi infarct dementia. In addition, small vessel ischemic changes in the subcortical regions in Binswangers disease. MRI Plays a great role in identifying the various types of vascular dementia.

PET CT is one important investigation in identifying other dementias. CSF Analysis is a useful tool in the diagnosis of other primary dementias.

Genetic Analysis: This is useful in the diagnosis of CADASIL (CEREBRAL AUTOSOMAL DOMINANT ARTERIOPATHY WITH SUBCORTICAL ISCHEMIC LEUKOENCEPHALOPATHY) Where we find mutation in NOTCH 3 Gene and CARASIL (CEREBRAL AUTOSOMAL RECESSIVE ARTERIOPATHY WITH SUBCORTICAL ISCHEMIC

LEUKOENCEPHALOPATHY) where we find mutation in HTRA 1 gene.

Causes of Dementia:

Age after 60 yrs Atrial fibrillation

Diabetes Mellitus, Hypertension Hyperlipidemia, Smoking History of stroke

Narrowing of blood vessels and capillaries in the brain. Haemorrhages [5].

Diagnostic criteria:

  • Neuro cognitive testing to confirm MCI or Dementia
  • Brain imaging: To confirm recent Stroke or other vascular brain changes To rule out other factors which contribute to cognitive impairment.

Diagnostic tests:

  • CSF: For auto immune conditions or other neuro degenerative conditions
  • Brain Imaging: CT SCAN and MRI BRAIN To identify strokes, Haemorrhages or tumours
  • Clinical Diagnosis: USING HACHINSKI score gives good aid in the diagnosis of Vascular Dementia.

Binswangers Disease [2].

A type of vascular cognitive impairment

Extensive white matter hyper intensities with gradual subcortical ischemia

Patients develop neurological findings like cognitive impairment and gait disturbances.

Clinical features:

Cognitive impairment

Slowed processing speed and executive functioning are most affected. Pyramidal and Extra pyramidal signs and ataxia are associated.

Which are all progressive

Imaging features:

  • White matter hyper intensities in T2 more than 25 %.
  • Brain atrophy mild to moderate
  • Lacunar infafrcts and micro bleeds
  • Enlarged peri ventricular spaces
  • Intracranial atherosclerosis

Differential diagnosis:

  • Amyloid angiopathy, CNS vasculitis
  • CADASIL AND CARASIL
  • Late onset M S
  • Adult Leukodystrophy
  • Border zone strokes and
  • NPH (Normal pressure hydrocephalus)

The role of imaging:

  • MRI Sequences play useful role in the diagnosis
  • White matter hyper intensities subcortical both peri ventricular and deep are associated.
  • Lacunar strokes are extremely frequent.
  • Enlarged peri ventricular spaces, micro bleeds, Atherosclerosis with dolichectasis of intra cerebral vessels is common.

Other ancillary studies:

  • CSF Albumin index and increase in MMP9
  • Normal or decreased levels of amyloid BETA 1-42
  • Transcranial Doppler
  • Perfusion imaging of white matter shows decreased blood flow in white matter.
  • Spectroscopy of white matter shows decreased NAA and creatinin.             

Treatment:

Control of blood pressure

Antiplatelet therapy with Aspirin and Statins

Continued physical activities prevent cognitive impairment. Rehabilitation is useful.

Acetyl choline receptor antagonists like Donepezil and NMDA antagonists like Memantine are useful in preventing the progress of the disease.

Anticoagulants are useful in some cardiac diseases.

Cadasil Dementia: (Cerebral Autosomal dominant arteriopathy with subcortical ischemic leukoencephalopathy) [8].

It is a hereditary form of vascular dementia

Pathogenesis: Mutation in NOTCH 3 Gene is responsible in resulting in thickening of small vessels. This Gene is responsible for maintaining integrity ofthe vascular endothelium the absence of which will produce the abnormality and blockage of small vessels. This results in recurrent strokes, lacunar infafrcts and Leukoencephathy.

Small areas of bleeding may be there.

There is a progressive decline in mental function.

Symptoms: Migraine with Aura

Strokes from childhood to late adult hood.

Progressive decline in thinking and executive functioning Mood and behavioural changes are seen.

Gait disturbances and bladder incontinence are common manifestations. Pseudo bulbar palsy, seizures and visual problems are seen.

Parkinsonism is an important assosiation and aids as clue in the diagnosis. Vertigo and abnormal gait are the associated findings.

Treatment: There is no cure Needs symptomatic treatment.

Prevent further strokes by controlling vascular risk factors.

Life style modification is needed for leading near normal life as far as possible. Diagnosis: Blood test and skin biopsy for NOTCH 3 Gene.

Carasil: (Cerebral autosomal recessive arteriopathy with subcortical ischemic leukoencephalopathy) [8].

It is a rare hereditary small vessel disease leading to vascular dementia.

Symptoms: Starts in early to mid-child hood. Progressive dementia.

Premature hair loss and low back ache are common association.

Muscle spasticity and gait disturbances are associated. Mood changes are very common. PATHOLOGY: Genetic mutation in HTRA 1 gene is responsible for the changes in the vessel wall and blockage resulting in progressive damage in brain.

Treatment: No cure.

Supportive and symptomatic treatment is needed

Treatment of Spasticity and prevention of further strokes prevent further deterioration.

Management of vascular dementias:

Pharmocologic treatment:

  • Management of comorbid conditions like
  • Control of Hypertension, Diabetes Mellitus and Hyperlipidemia.
  • Antiplatelet therapy Where ever it's indicated.

Non pharmocologic treatment:

  • Cognitive rehabilitation
  • Physical activities.
  • Life style modification

Prognosis:

Depends on the amount of vascular damage and the areas of involvement of the brain Effective control of risk factors

Prevention remains the corner stone in the management of vascular dementia.

Discussion

Dementia is defined as decline in mental function from primary high level severe enough to interfere with Norma daily living. They will have two or more specific difficulties of memory, reasoning, language, coordination, mood and behaviour.

VASCULAR dementia is the second most common cause of dementia after Alzheimer's disease. Most of the times it's because of diminished blood supply to the brain and rarely Intracerebral haemorrhages.

Dementias are mainly devided in to primary and secondary Dementias.

Secondary Dementias are because of external factors responsible for the destruction of the neurons and removal or control of the responsible factors improves the dementia, where as in the primary dementias there is direct damage or neuro degeneration and are often irreversible.

Most of the primary dementias are either treatable or preventable such as vascular dementia. None of them are curable.

Vascular Dementias Are Classified Into: [1].

  1. Post stroke dementia where large vessel involvement producing damage to larger area of brain
  2. Multi infarct dementia where multiple infarcts in different areas of brain is responsible for the dementia.
  3. Small vessel ischemic changes or Binswangers disease resulting in micro vascular ischemic encephalopathy and sub cortical dementia where the connecting system in the brain is damaged producing Binswangers disease.
  4. Mixed dementia where Vascular Dementia is associated with Alzheimer's disease

There are certain risk factors which are responsible for these dementias. These are mainly Hyper tension, Diabetes Mellitus, Hyper lipidaemia, Smoking,and Alcoholism.

Apart from these dementias there are certain

5.             Genetic dementias like CADASIL [8], and CARASIL which are genetically mediated and the responsible genes being NOTCH 3 GENE Mutation in the former and HTRA 1 gene mutation in the later. These genetically mediated dementias occur in the early age group with different clinical manifestations and

6.             One more addition of cysteine C Amyloid angiopathy [6], where in the patients have recurrent cerebral haemorrhages before the age of 40 yrs which lead to dementia.

All the vascular dementias can be diagnosed by clinical examination using Hackinschi score, imaging like CT SCAN and more appropriately MRI BRAIN and MRI diffusion abnormality in Binswangers disease. Genetic analysis aids in the diagnosis of the above two genetic dementias.

Various clinical manifestations of different types of vascular dementias have been discussed in detail previously. The important clinical differentiation between Vascular Dementia and other dementias is there is delayed thinking and reasoning rather than memory impairment in vascular dementias.

Laboratory evaluation for haematological abnormalities can identify the Hyper lipidaemia, and hyper glycemia. Cardiac evaluation by 2D ECHO gives a clue for the cardio embolic strokes. Neck vessel Doppler and Neck and brain 4 vessel angio aids in identifying the vascular risk factors.

The risk factor identification gives the clinician the idea of prevention of further progression of Dementia.

When once the diagnosis is made and risk factors are identified the Dementia can be prevented from further progress and disability.

The management strstegies include:

Risk factor manegement like:

Control of Hypertension Control of Diabetes Mellitus Avoid Smoking and Alcohol Treatment of Hyper lipidaemia

Life style modification and rehabilitation.

Medical management:

Acetyl choline receptor antagonists like Donepezil and

NMDA RECEPTOR antagonist like Mimantine are useful for prevention of further progress of the dementia.

Antiplatelets in ischemic strokes and anti-coagulants in some cardio embolic strokes are highly useful in preventing further progress of the disease.

Symptomatic management of some of the symptoms in genetic dementias is useful.

Take home message:

VASCULAR dementias are treatable and preventable

Diagnosis can be done by clinical examination using Hackinschi score and using CT scan brain and MRI BRAIN along with haematological and cardiac evaluation.

Risk factor identification makes the clinician to prevent further progress of the dementia. A note should be made of genetic analysis to identify genetically mediated dementias.

References

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig