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Journal of Neurochemistry Nov 2010Vascular cognitive impairment (VCI) encompasses vascular dementia and is the second most common cause of dementing illness after Alzheimer's disease. The main causes of... (Review)
Review
Vascular cognitive impairment (VCI) encompasses vascular dementia and is the second most common cause of dementing illness after Alzheimer's disease. The main causes of VCI are: cerebral small vessel disease; multi-infarct dementia; strategic infarct (i.e. located in a functionally-critical brain area); haemorrhage/microbleed; angiopathy (including cerebral amyloid angiopathy); severe hypoperfusion (e.g. cardiac arrhythmia); and hereditary vasculopathy (e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CADASIL). In this systematic analysis, we aimed to relate cognitive and neuropathological features of experimental models to clinical VCI. We extracted data from 107 studies covering 16 models. These included: brief global ischaemic insults (in rats, mice or gerbils); chronic global hypoperfusion (rats, mice, gerbils); chronic hypertension (in primates or stroke-prone, spontaneously-hypertensive rats); multiple ischaemic lesions because of intra-vascular emboli (in rodents, rabbits or primates); strategic ischaemic lesions (in rats or mini-pigs); generalised vasculopathies, because of mutant Notch3, hyperhomocysteinaemia, experimental diabetes mellitus or lack of cerebral vasodilator M(5) receptors (rats or mice). Most cognitive testing showed deficits in working and reference memory. The lesions observed were microinfarcts, diffuse white matter lesions, hippocampal neuronal death, focal ischaemic lesions and micro-haemorrhages. The most-used model was bilateral carotid artery occlusion in rats, leading to chronic hypoperfusion and white matter injury.
Topics: Animals; CADASIL; Carotid Stenosis; Cognition Disorders; Dementia, Vascular; Disease Models, Animal; Humans; Species Specificity
PubMed: 20731763
DOI: 10.1111/j.1471-4159.2010.06958.x -
Revista de NeurologiaMemory deficits are frequent in mild subcortical vascular pathology and in the early stage of Alzheimer's disease.
[Memory deficit in patients with subcortical vascular cognitive impairment versus Alzheimer-type dementia: the sensitivity of the 'word list' subtest on the Wechsler Memory Scale-III].
INTRODUCTION
Memory deficits are frequent in mild subcortical vascular pathology and in the early stage of Alzheimer's disease.
AIM
To study the memory deficits in patients with subcortical vascular cognitive impairment (SVCI) vs. mild stage Alzheimer's disease patients (AD), using the Weschler Memory Scale-III (WMS-III) word lists test, to examine the adequacy of this test to show the different memory patterns in this population, that could contribute to early differential diagnosis.
PATIENTS AND METHODS
Three groups of patients were compared: AD (n = 25), SVCI-leukoaraiosis (n = 17) and SVCI-multi infarct (n = 16). The three groups did not differ in age, education or severity of illness.
RESULTS
Patients with SVCI showed a memory impairment in free recall with an improvement in their performance on the recognition task. The AD group, however, showed low scores in free recall as in recognition tasks, with a major number of false positive errors. Significant differences were also found between the SVCI-leukoaraiosis and SVCI-multi infarct groups, with the latter showing the best performance in long term retention and a minor trend to respond with false positive errors.
CONCLUSIONS
The WMS-III word lists test is a good instrument to differentiate the memory profile between SVCI and AD, with the recognition task being the most discriminative one. The worst impairment in leukoaraiosis patients in comparison to the multi infarct group, suggests that white matter diffuse lesion could affect more directly the recall processes mediatised by the frontal lobe.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Brain Infarction; Cerebrovascular Disorders; Cognition Disorders; Diagnosis, Differential; Female; Humans; Leukoaraiosis; Male; Memory Disorders; Neuropsychological Tests; Psychomotor Performance
PubMed: 20013713
DOI: No ID Found -
Arquivos de Neuro-psiquiatria Dec 2008
Topics: Aged; Dementia, Multi-Infarct; Fatal Outcome; Humans; Male; Parkinsonian Disorders; Tomography, X-Ray Computed
PubMed: 19099140
DOI: 10.1590/s0004-282x2008000600030 -
Medicine Nov 2008Cerebrovascular accidents (CVAs) and multi-infarct dementia have rarely been reported as presenting symptoms of giant cell arteritis (GCA), although 3%-4% of patients... (Review)
Review
Cerebrovascular accidents (CVAs) and multi-infarct dementia have rarely been reported as presenting symptoms of giant cell arteritis (GCA), although 3%-4% of patients with GCA may present with CVAs during the course of the disease. We describe 7 patients with biopsy-proven GCA who presented with stroke or multi-infarct dementia. Most of them had other symptoms of GCA when the disease began that were misdiagnosed or not noticed. The internal carotid arteries were involved in 4 patients and the vertebrobasilar arteries in 3, with bilateral vertebral artery occlusion in 1. Small cerebral infarction foci on cranial computed tomography (CT) scan and magnetic resonance imaging (MRI) were found in 5 cases, and cerebellar infarction, in 2. MR angiography showed intracranial arteritis in 4 cases. Treatment with glucocorticoids and adjunctive antiplatelet or anticoagulant therapy was given in all cases, with neurologic improvement in 5. Two patients died. Necropsy demonstrated generalized GCA involving the medium and small cerebral vessels in 1 case. Central nervous system involvement is a rare complication in GCA but is important to recognize, as it can be reversible if diagnosed and treated promptly. Suspicion should arise in elderly patients suffering from strokes with a quickly progressing stepwise course and associated headache, fever, or inflammatory syndrome. In these cases, temporal artery biopsy should be performed without delay. Early diagnosis of GCA and immediate initiation of corticosteroid treatment may prevent progressive deterioration and death. Additional antiplatelet or anticoagulant therapy should be evaluated according to the individual risk and benefit to the patient under care.
Topics: Aged; Aged, 80 and over; Dementia, Multi-Infarct; Female; Giant Cell Arteritis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Stroke; Tomography, X-Ray Computed
PubMed: 19011505
DOI: 10.1097/MD.0b013e3181908e96 -
International Psychogeriatrics Feb 2009The aim of this study is to determine whether B12 replacement would ameliorate cognitive and psychiatric symptoms in elderly subjects with dementia and low serum B12...
BACKGROUND
The aim of this study is to determine whether B12 replacement would ameliorate cognitive and psychiatric symptoms in elderly subjects with dementia and low serum B12 levels.
METHODS
A test group (n = 28) of nursing home residents with low serum B12 levels (<250 pg/mL) and a matched comparison group (n = 28) with normal serum B12 levels (>300 pg/mL) were evaluated by blinded raters while the test group received intramuscular (IM) B12 replacement therapy. All subjects were assessed at baseline, 8 weeks, and 16 weeks with the Dementia Rating Scale, Brief Psychiatric Rating Scale, and Geriatric Depression Scale.
RESULTS
Although B12 replacement produced significant improvement in hematologic and metabolic parameters, it yielded no significant effect on cognitive or psychiatric variables. A few subjects evidenced notable individual treatment responses; however, these were not statistically more frequent than in the normal B12 group.
CONCLUSIONS
These results suggest that B12 replacement is unlikely to benefit cognitive or psychiatric symptoms in the vast majority of elderly dementia patients with low serum B12 levels.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Brief Psychiatric Rating Scale; Cognition Disorders; Dementia, Multi-Infarct; Female; Follow-Up Studies; Homes for the Aged; Humans; Injections, Intramuscular; Male; Mental Status Schedule; Nursing Homes; Psychometrics; Single-Blind Method; Vitamin B 12; Vitamin B 12 Deficiency
PubMed: 18925978
DOI: 10.1017/S1041610208007904 -
BMC Neurology Mar 2008In Spain, stroke is one of the major causes of death and the main cause of severe disability in people over 65 years. We analyzed the incidence of ischemic stroke,...
BACKGROUND
In Spain, stroke is one of the major causes of death and the main cause of severe disability in people over 65 years. We analyzed the incidence of ischemic stroke, stroke subtypes, case fatality and disability at 90 days after the event in a Spanish population.
METHODS
A prospective community-based register of ischemic strokes was established in Santa Coloma de Gramenet (Barcelona) [116,220 inhabitants of all ages, according to the municipal census of December 31,2001], from January 1 to December 31, 2003. Standard definitions and case finding methods were used to identify all cases in all age groups. Every patient underwent a complete clinical evaluation and systematic tests including neuroimaging (CT/MRI) and vascular studies (carotid duplex ultrasound intra and extracranial and MR angiography).
RESULTS
Over a one year period, 196 ischemic strokes were registered [107 men; median age = 76 years (range 39-98)], being the first event in 159 patients (81.1%) and a recurrent stroke in 37 (18.9%). After age-adjustment to the European population, the incidence of ischemic stroke per 100,000 inhabitants was 172 (95% CI, 148-196); 219 (176-261) in men and 133 (105-160) in women, with an annual incidence for first ischemic stroke of 139 (118-161); 165 (128-201) in men and 115 (89-140) in women. The incidence of stroke increased with age. Stroke subtypes (TOAST classification criteria) were lacunar in 28.8%, atherothrombotic in 18.6%, cardioembolic in 26.6% and undetermined in 26.0% of patients. At 90 days, the case-fatality was 12%, and among survivors, moderate-to-severe disability was present in 45 % at 3 months.
CONCLUSION
This prospective community-based study shows one of the lowest incidences of stroke in Europe, as well as one of the lowest case fatality and disability rates at 90 days after stroke.
Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Brain Ischemia; Cerebral Angiography; Cohort Studies; Dementia, Multi-Infarct; Female; Humans; Incidence; Intracranial Arteriosclerosis; Magnetic Resonance Imaging; Male; Middle Aged; Mortality; Prospective Studies; Recurrence; Registries; Sex Distribution; Spain; Stroke; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex
PubMed: 18371212
DOI: 10.1186/1471-2377-8-5 -
American Journal of Alzheimer's Disease... 2008Vascular dementia (VaD) is associated with a large amount of heterogeneity, as it groups together a broad category of patients in whom various manifestations of... (Clinical Trial)
Clinical Trial
Vascular dementia (VaD) is associated with a large amount of heterogeneity, as it groups together a broad category of patients in whom various manifestations of cognitive decline are attributed to cerebrovascular or cardiovascular disease. Thus, a study was designed to determine the effects of rivastigmine on cognitive function, global daily living performance, and behavioral disorders in VaD patients versus an active control (nimodipine), stratifying patients according to the type of VaD, subcortical vascular dementia (sVAD), and multi-infarct dementia (MID). The trial was a prospective study. This study shows that long-term treatment with rivastigmine, at dosages approved for therapeutic use in Alzheimer's disease, produces significant improvement in all behavioral symptoms in 2 forms of VaD, MID and sVaD, except delusions. It also suggests that rivastigmine may enable a reduction in concomitant neuroleptics and benzodiazepines in VaD, especially in MID. The results are discussed with an overview of the literature.
Topics: Activities of Daily Living; Aged; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Cognition; Cognition Disorders; Delusions; Dementia, Multi-Infarct; Dementia, Vascular; Female; Follow-Up Studies; Humans; Male; Muscle Contraction; Nausea; Neuroprotective Agents; Neuropsychological Tests; Nimodipine; Phenylcarbamates; Prospective Studies; Rivastigmine; Treatment Outcome; Vasodilator Agents
PubMed: 18184948
DOI: 10.1177/1533317507312558 -
Dementia and Geriatric Cognitive... 2008Although confluent white matter lesion (WML) is associated with cognitive impairment, the mechanism explaining this association is controversial. We aimed to investigate...
BACKGROUND
Although confluent white matter lesion (WML) is associated with cognitive impairment, the mechanism explaining this association is controversial. We aimed to investigate comprehensively the MRI predictors of cognitive impairment in confluent WML.
METHODS
Among 45 lacunar stroke patients who had confluent WML, we evaluated the association of executive function [Mattis Dementia Rating Scale - Initiation/Perseveration subscale (MDRS I/P)] and global cognition [Mini-Mental State Examination (MMSE)] with the volume of WML, measures of lacunes and microbleeds, and the volumes of 99 other specific brain regions.
RESULTS
Regression analyses showed that WML volume predicted performance on the MDRS I/P (beta = -0.34, p = 0.016) independent of age. Volumes of cortical gray matter (cGM; beta = 0.41, p = 0.003), the lateral fronto-orbital gyrus (beta = 0.38, p = 0.01), superior frontal gyrus (beta = 0.29, p = 0.04), lateral ventricle (beta = -0.30, p = 0.04), and posterior limb of the internal capsule (beta = 0.43, p = 0.002) predicted MDRS I/P performance independent of WML volume. Volumes of cGM, and the lateral fronto-orbital gyrus predicted MMSE performance as well.
CONCLUSION
Atrophy along the frontosubcortical pathways and cGM predict cognition in confluent WML independent of WML volume.
Topics: Activities of Daily Living; Aged; Asian People; Atrophy; Brain; Cognition Disorders; Dementia, Multi-Infarct; Female; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Severity of Illness Index; Surveys and Questionnaires
PubMed: 18042992
DOI: 10.1159/000111692 -
Psychiatry and Clinical Neurosciences Oct 2007A 92-year-old woman who suffered from dementia with psychotic feature was admitted to a psychiatric ward. She refused to eat or take any medications. After 0.5 mg i.v....
A 92-year-old woman who suffered from dementia with psychotic feature was admitted to a psychiatric ward. She refused to eat or take any medications. After 0.5 mg i.v. injection haloperidol, prolongation of QTc interval occurred in the electrocardiogram. Therefore two sessions of electroconvulsive therapy (ECT) were performed carefully after informed consent was obtained by her family. Almost no psychotic symptoms were observed after the first ECT. No cognitive side-effects were observed during and after the two ECT sessions. This demonstrates that ECT can be used as an alternative treatment when elderly dementia patients with psychotic feature cannot tolerate medication.
Topics: Aged, 80 and over; Antipsychotic Agents; Combined Modality Therapy; Dementia, Multi-Infarct; Electroconvulsive Therapy; Female; Haloperidol; Humans; Injections, Intravenous; Long QT Syndrome; Psychotic Disorders; Risperidone; Treatment Outcome
PubMed: 17875038
DOI: 10.1111/j.1440-1819.2007.01709.x -
European Neurology 2006The term 'vascular dementia' (VaD) corresponds to a clinicoradiological syndrome that can be defined with more or less restriction. VaD can result from: (1) cortical or... (Review)
Review
The term 'vascular dementia' (VaD) corresponds to a clinicoradiological syndrome that can be defined with more or less restriction. VaD can result from: (1) cortical or subcortical ischemic lesions related to the occlusion of large vessels, (2) lacunar infarcts with or without white-matter lesions at the subcortical level related to small-vessel diseases, (3) ischemic lesions related to hypoperfusion or anoxic-ischemic encephalopathy or (4) hemorrhagic lesions. The prevention of VaD is based on stroke prevention which implies risk factor manipulation and use of antithrombotic drugs among which the most widely used are antiplatelet drugs. The efficiency of these drugs to prevent cognitive impairment and dementia is not proven. Prospective studies are needed to investigate their potential in patients at risk of VaD: after ischemic stroke, in the presence of cognitive impairment of vascular origin or when MRI shows 'silent' ischemic white-matter lesions and/or infarcts.
Topics: Aged; Aged, 80 and over; Cognition Disorders; Dementia, Multi-Infarct; Dementia, Vascular; Humans; Platelet Aggregation Inhibitors; Risk Factors; Stroke
PubMed: 16534208
DOI: 10.1159/000091981