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5 results

  • Periventricular white matter hyperintensities and the risk of dementia: a CREDOS study

  • Sangha Kim, Seong Hye Choi, Young Min Lee, Min Ji Kim, Young Don Kim, Jin Young Kim, Jin Hong Park, Woojae Myung, Hae Ri Na, Hyun Jeong Han, Yong S. Shim, Jong Hun Kim, Soo Jin Yoon, Sang Yun Kim, Doh Kwan Kim
  • Journal:
    International Psychogeriatrics / Volume 27 / Issue 12 / December 2015
    Published online by Cambridge University Press:
    27 July 2015, pp. 2069-2077
  • Background:

    Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia.

    Methods:

    Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model.

    Results:

    Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0–36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43–3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12–3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97–132.06) and DWMH (HR 8.77; 95% CI 1.77–43.49) in more severe form (≥ 10 mm).

    Conclusions:

    WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.

  • 12 - Role of vascular risk factors in dementia

  • from Section 2 - Pathophysiology
  • Edited by Lars-Olof Wahlund, Karolinska Institutet, Stockholm, Timo Erkinjuntti, University of Helsinki, Serge Gauthier, McGill University, Montréal
  • Book:
    Vascular Cognitive Impairment in Clinical Practice
    Published online:
    15 September 2009
    Print publication:
    12 February 2009, pp 155-165

  • Summary

    This chapter focuses on cognitive functioning in multi-infarct dementia (MID) and subcortical (small-vessel disease) vascular dementia (VaD), the most extensively studied subtypes. An important difference in the manifestation of subcortical VaD compared to MID is the effect of a single infarct on cognition. Frontal-executive function and episodic memory are two cognitive domains frequently assessed when trying to discriminate between VaD and other dementia types, and between different VaD subtypes. The chapter describes these domains in more detail, as well as their manifestation in VaD. One of the challenges in clinical practice is to separate between VaD and other dementia types, most often Alzheimer's disease (AD). Future studies should seek to study the whole range of cognitive impairments associated with cerebrovascular disease (CVD), especially the earlier stages when the person still does not fulfill the criteria for dementia. This is where interventions would render the largest benefits.

  • 18 - Control of vascular risk factors

  • from Section 3 - Treatment
  • Edited by Lars-Olof Wahlund, Karolinska Institutet, Stockholm, Timo Erkinjuntti, University of Helsinki, Serge Gauthier, McGill University, Montréal
  • Book:
    Vascular Cognitive Impairment in Clinical Practice
    Published online:
    15 September 2009
    Print publication:
    12 February 2009, pp 220-234

  • Summary

    Small-vessel disease related to subcortical dementia is one of the main subtypes of the vascular dementia (VaD) syndrome. The early cognitive features of subcortical vascular dementia (SVD) are characterized by a dysexecutive syndrome with slowed information processing, usually mild memory deficit and behavioral symptoms. SVD incorporates two entities "the lacunar state" and "Binswanger's disease". Cerebral amyloid angiopathy (CAA) falls into the category of small-vessel diseases and contributes to the SVD syndrome. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary small-vessel diseases leading to cognitive decline and dementia. Small-vessel diseases of the brain may also manifest in progressive visual impairment. Hereditary endotheliopathy with retinopathy, nephropathy and stroke (HERNS), cerebroretinal vasculopathy (CRV) and hereditary vascular retinopathy (HVR) were reported independently, but are different phenotypes in the same disease spectrum.

  • Vascular smooth muscle function is associated with initiation and processing speed in patients with atherosclerotic vascular disease

  • DAVID J. MOSER, IVY N. MILLER, KARIN F. HOTH, MARCELO CORREIA, STEPHAN ARNDT, WILLIAM G. HAYNES
  • Journal:
    Journal of the International Neuropsychological Society / Volume 14 / Issue 4 / July 2008
    Published online by Cambridge University Press:
    25 June 2008, pp. 535-541
    • Article
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  • We previously reported a relationship between forearm resistance vessel function and global neuropsychological performance in patients with atherosclerotic vascular disease (AVD). This study was conducted to determine the relationships among vascular smooth muscle function, endothelial function, and initiation and processing speed in this sample. Participants were 80 individuals with AVD. Resistance vessel function was measured before and after infusion of vasoactive agents. Neuropsychological assessment included measures of estimated premorbid cognitive function, current global cognitive function, initiation, and processing speed. Vascular smooth muscle function was significantly associated with the initiation/processing speed composite score [R-Square Change = .152; F Change (1,71) = 16.61; p < .001], above and beyond the variance accounted for by age, education, premorbid cognitive function, and endothelium-dependent vascular function. This relationship remained significant when controlling for current level of global cognitive functioning and 10 vascular risk factors. Endothelium-dependent vascular function was not significantly associated with test performance. Decreased vascular smooth muscle function in forearm resistance vessels was significantly associated with relatively poor initiation and processing speed in individuals with AVD. With additional research, measures of vascular function might become useful in the early identification of those individuals at greatest risk for vascular-related cognitive dysfunction. (JINS, 2008, 14, 535–541.)

  • Classification and Subtypes of Vascular Dementia

  • Anders Wallin, Veronica Milos, Magnus Sjögren, Leonardo Pantoni, Timo Erkinjuntti
  • Journal:
    International Psychogeriatrics / Volume 15 / Issue S1 / July 2003
    Published online by Cambridge University Press:
    10 January 2005, pp. 27-37

  • Vascular dementia (VaD) is a heterogeneous entity with a large clinicopathological spectrum. It has been classified and subclassified in many different ways. The difficulty in identifying the various subtypes is a problem in the diagnostic process. For clinical purposes, it is desirable to find subtypes of VaD that are homogeneous enough to allow meaningful comparisons across studies. This article presents candidates for such subtypes: poststroke dementia, subcortical VaD, and combined Alzheimer's disease and VaD (AD + VaD). The first two candidates are easy to identify. Poststroke dementia occurs with cognitive decline in close temporal relation to a transient ischemic attack. Subcortical VaD has a relatively homogeneous clinical picture for which detailed criteria are suggested. AD + VaD is more difficult to identify but is possible, sometimes with the aid of neuroimaging and/or biological markers.