Abstract
Vascular cognitive impairment (VCI) is a term that describes all the forms of cognitive decline deriving from, or associated with, vascular diseases. The brain changes of vascular origin that may cause deficits in cognitive functions are various in terms of underlying pathology and territorial distribution. For this reason, the cognitive profile in VCI is not homogeneous and strongly depends on the pathological subtype. In addition to cognitive deficits, brain vascular diseases may cause also several psychiatric disturbances that may or may not coexist with the cognitive disturbances.
In the first part of this chapter, we discuss the concept of VCI, while in the second part, the cognitive and psychiatric manifestations of VCI are illustrated. This overview emphasizes the need of additional research to better understand the exact impact of cerebral vascular lesions, and the role of their distribution and severity, on the occurrence of cognitive and psychiatric symptoms in VCI. This approach might require tools more specifically developed for cerebrovascular diseases.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
O’Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST. Vascular cognitive impairment. Lancet Neurol. 2003;2:89–98.
Hachinski VC. The decline and resurgence of vascular dementia. Can Med Assoc J. 1990;142:107–11.
Román GC. Facts, myths, and controversies in vascular dementia. J Neurol Sci. 2004;226:49–52.
Pantoni L. Subtypes of vascular dementia and their pathogenesis: a critical overview. In: Bowler J, Hachinski V, editors. Vascular cognitive impairment: preventable dementia. Oxford: Oxford University Press; 2003. p. 217–29.
Hachinski VC, Bowler JV. Vascular dementia. Neurology. 1993;43:2159–60.
Romàn GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research study. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43:250–60.
Rockwood K, Wentzel C, Hachinski V, Hogan DB, MacKnight C, McDowell I. Prevalence and outcomes of vascular cognitive impairment. Vascular Cognitive Impairment investigators of the Canadian Study of Health and Aging. Neurology. 2000;54:447–51.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701.
Ciolli L, Poggesi A, Salvadori E, Valenti R, Nannucci S, Pasi M, Pescini F, Inzitari D, Pantoni L. The VAS-COG clinic: an out-patient service for patients with cognitive and behavioral consequences of cerebrovascular diseases. Neurol Sci. 2012;33:1277–83.
Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100.
Desmond DW. The neuropsychology of vascular cognitive impairment: is there a specific cognitive deficit? J Neurol Sci. 2004;226:3–7.
van de Pol L, Gertz H-J, Scheltens P, Wolf H. Hippocampal atrophy in subcortical vascular dementia. Neurodegener Dis. 2011;8:465–9.
Qiu C, Zhang Y, Bronge L, Herlitz A, Aspelin P, Bäckman L, Fratiglioni L, Wahlund LO. Medial temporal lobe is vulnerable to vascular risk factors in men: a population-based study. Eur J Neurol. 2012;19:876–83.
Gemmell E, Bosomworth H, Allan L, Hall R, Khundakar A, Oakley AE, Deramecourt V, Polvikoski TM, O’Brien JT, Kalaria RN. Hippocampal neuronal atrophy and cognitive function in delayed poststroke and aging-related dementias. Stroke. 2012;43:808–14.
Pantoni L, Basile AM, Romanelli M, Piccini C, Sarti C, Nencini P, Inzitari D. Abulia and cognitive impairment in two patients with capsular genu infarct. Acta Neurol Scand. 2001;104:185–90.
Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, Stern Y. Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome? Neurology. 1992;42:1966–79.
Benisty S, Gouw AA, Porcher R, Madureira S, Hernandez K, Poggesi A, van der Flier WM, Van Straaten EC, Verdelho A, Ferro J, Pantoni L, Inzitari D, Barkhof F, Fazekas F, Chabriat H, LADIS Study Group. Location of lacunar infarcts correlates with cognition in a sample of non-disabled subjects with age-related white-matter changes: the LADIS study. J Neurol Neurosurg Psychiatry. 2009;80:478–83.
Vermeer SE, Longstreth Jr WT, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.
Pantoni L, Poggesi A, Inzitari D. The relation between white-matter lesions and cognition. Curr Opin Neurol. 2007;20:390–7.
Gunning-Dixon FM, Raz N. The cognitive correlates of white matter abnormalities in normal aging: a quantitative review. Neuropsychology. 2000;14:224–32.
Ferro JM, Madureira S. Age-related white matter changes and cognitive impairment. J Neurol Sci. 2002;203–204:221–5.
Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Cerebral white matter lesions and the risk of dementia. Arch Neurol. 2004;61:1531–4.
Schmidt R, Petrovic K, Ropele S, Enzinger C, Fazekas F. Progression of leukoaraiosis and cognition. Stroke. 2007;38:2619–25.
Savva GM, Wharton SB, Ince PG, Forster G, Matthews FE, Brayne C, Medical Research Council Cognitive Function and Ageing Study. Age, neuropathology, and dementia. N Engl J Med. 2009;360:2302–9.
Poels MM, Ikram MA, van der Lugt A, Hofman A, Niessen WJ, Krestin GP, Breteler MM, Vernooij MW. Cerebral microbleeds are associated with worse cognitive function: the Rotterdam Scan Study. Neurology. 2012;78:326–33.
Werring DJ, Gregoire SM, Cipolotti L. Cerebral microbleeds and vascular cognitive impairment. J Neurol Sci. 2010;299:131–5.
Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L, LADIS Study Group. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. 2009;339:b2477. doi:10.1136/bmj.b2477.
Gouw AA, Seewann A, van der Flier WM, Barkhof F, Rozemuller AM, Scheltens P, Geurts JJ. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry. 2011;82:126–35.
Schmidt R, Ropele S, Ferro J, Madureira S, Verdelho A, Petrovic K, Gouw A, van der Flier WM, Enzinger C, Pantoni L, Inzitari D, Erkinjuntti T, Scheltens P, Wahlund LO, Waldemar G, Rostrup E, Wallin A, Barkhof F, Fazekas F, LADIS Study Group. Diffusion-weighted imaging and cognition in the leukoaraiosis and disability in the elderly study. Stroke. 2010;41:e402–8.
Azermai M, Petrovic M, Elseviers MM, Bourgeois J, Van Bortel LM, Vander Stichele RH. Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Res Rev. 2012;11:78–86.
Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr. 1996;8(Suppl3):497–500.
Bettney L, Butt S, Morris J, Connolly A, McCollum C, Burns A, Purandare N. Investigating the stability of neuropsychiatric sub-syndromes with progression of dementia: a 2-year prospective study. Int J Geriatr Psychiatry. 2012;27:1118–23.
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288:1475–83.
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease I: disorders of thought content. Br J Psychiatry. 1990;157:72–6.
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease II: disorders of perception. Br J Psychiatry. 1990;157:76–81.
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease. III: disorders of mood. Br J Psychiatry. 1990;157:81–6.
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease. IV: disorders of behaviour. Br J Psychiatry. 1990;157:86–94.
Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157:708–14.
Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord. 2000;59:97–106.
Srikanth S, Nagaraja AV, Ratnavalli E. Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer’s disease, vascular dementia and frontotemporal dementia. J Neurol Sci. 2005;236:43–8.
Aharon-Peretz J, Kliot D, Tomer R. Behavioral differences between white matter lacunar dementia and Alzheimer’s disease: a comparison on the neuropsychiatric inventory. Dement Geriatr Cogn Disord. 2000;11:294–8.
Kim JM, Lyons D, Shin IS, Yoon JS. Differences in the behavioral and psychological symptoms between Alzheimer’s disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Hum Psychopharmacol. 2003;18:215–20.
Johnson DK, Watts AS, Chapin BA, Anderson R, Burns JM. Neuropsychiatric profiles in dementia. Alzheimer Dis Assoc Disord. 2011;25:326–32.
Starkstein SE, Sabe L, Vazquez S, Teson A, Petracca G, Chemerinski E, Di Lorenzo G, Leiguarda R. Neuropsychological, psychiatric, and cerebral blood flow findings in vascular dementia and Alzheimer’s disease. Stroke. 1996;27:408–14.
Ikeda M, Fukuhara R, Shigenobu K, Hokoishi K, Maki N, Nebu A, et al. Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. J Neurol Neurosurg Psychiatry. 2004;75:146–8.
Fuh JL, Wang SJ, Cummings JL. Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry. 2005;76:1337–41.
Pinto C, Seethalakshmi R. Behavioral and psychological symptoms of dementia in an Indian population: comparison between Alzheimer’s disease and vascular dementia. Int Psychogeriatr. 2006;18:87–93.
Chiu PY, Liu CH, Tsai CH. Neuropsychiatric manifestations in vascular cognitive impairment patients with and without dementia. Acta Neurol Taiwan. 2007;16:86–91.
Fernández-Martínez M, Castro J, Molano A, Zarranz JJ, Rodrigo RM, Ortega R. Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Curr Alzheimer Res. 2008;5:61–9.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.
Staekenborg SS, Su T, van Straaten EC, Lane R, Scheltens P, Barkhof F, van der Flier WM. Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease. J Neurol Neurosurg Psychiatry. 2010;81:547–51.
Andin U, Gustafson L, Brun A, Passant U. Clinical manifestations in neuropathologically defined subgroups of vascular dementia. Int J Geriatr Psychiatry. 2006;21:688–97.
Botez SA, Carrera E, Maeder P, et al. Aggressive behavior and posterior cerebral artery stroke. Arch Neurol. 2007;64:1029–33.
Kim JS, Choi S, Kwon SU, et al. Inability to control anger or aggression after stroke. Neurology. 2002;58:1106–8.
Staekenborg SS, Gillissen F, Romkes R, Pijnenburg YA, Barkhof F, Scheltens P, van der Flier WM. Behavioural and psychological symptoms are not related to white matter hyperintensities and medial temporal lobe atrophy in Alzheimer’s disease. Int J Geriatr Psychiatry. 2008;23:387–92.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Poggesi, A., Pantoni, L. (2013). Neuropsychiatric Aspects of Vascular Cognitive Impairment. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_11
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2428-3_11
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2427-6
Online ISBN: 978-1-4471-2428-3
eBook Packages: MedicineMedicine (R0)