Summary
Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer’s disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from “severe dementia”. Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. p]A pilot study has demonstrated the feasibility of the trial. The main study is in progress.
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References
Roman G.C.: Lacunar dementia. In: J. Thomas Hutton, A.D. Kenny (Eds.), Senile dementia of the Alzheimer type. Alan R. Liss Inc., 1985, pp. 131-151.
Bousser M.G.: Démences vasculaires. Psychol Med. 19: 1737–1742, 1987.
Scheinberg P.: Dementia due to vascular disease. A multifactorial disorder. Stroke 19: 1291–1299, 1988.
Alexander M.P., Geschwind N.: Dementia in the elderly. In: Albert M. (Ed.), Clinical Neurology of Aging. Oxford University Press, 1984, pp. 254-276.
Kay D.W.K., Beamish P., Roth M.: Old age mental disorders in Newcastle upon Tyne. I. A study of prevalence. Br. J. Psychiatry 110: 146–158, 1964.
Mortimer J.A., Schuman L.M., French L.R.: Epidemiology of dementing illness. In: Mortimer J.A., Schuman L.M. (Eds.), The Epidemiology of Dementias. Oxford University Press, New York, 1981, pp. 3–23.
Broe G.A., Aktar A.J., Andrews G.R., Caird F.I., Gilmore J.J., McLennan W.S.: Neurological disorders in the elderly at home. J. Neurol. Neurosurg. Psychiatry 32: 362–366, 1976.
Roth M.: Epidemiological studies. In: Katzman R., Terry R.D., Bick K.L. (Eds.), Aging Series vol. 7, Alzheimer’s disease; Senile dementia and related disorders. Raven Press, New York, 1978, pp. 337–339.
Terry R.D.: Dementia. Arch. Neurol. 33: 1–4, 1976.
Folstein M., Anthony J.C., Parhad I., Duffy B., Gruenberg E.M.: The meaning of cognitive impairment in the elderly. J. Am. Geriatr. Soc. 33: 228–235, 1985.
Hasegawa K., Homma A., Imai Y.: An epidemiologic study of age-related dementia in the community. Int. J. Geriatr. Psychiatry 1: 45–55, 1986.
Jorm A.F., Körten A.E., Henderson A.S.: The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr. Scand. 76: 465–479, 1987.
Rocca W.A., Bonaiuto S., Lippi A., Luciani P., Turtù F., Cavarzeran F., Amaducci L.: Prevalence of clinically diagnosed Alzheimer’s disease and other dementing disorders: a door-to-door survey in Appignano, Macerata province, Italy. Neurology 40: 626–631, 1990.
Zhang M., Katzman R., Salmon D., Jin H., Cai G., Wang Z., Qu C., Grant I., Yu E., Levy P., Klauber M.R., Liu W.T.: The prevalence of dementia and Alzheimer’s disease in Shangai, China: impact of age, sex and education. Ann. Neurol. 27: 428–437, 1990.
Eastwood M.R., Rifat S.L., Roberts D.: The Epidemiology of Dementia in North America. Eur. Arch. Psychiatr. Clin. Neuros. 240: 207–211, 1991.
Tomlinson B.E., Blessed G., Roth M.: Observations on the brain of demented old people. J. Neurol. Sci. 11: 205–242, 1970.
Tomlinson B.E., Henderson G.: Some quantitative cerebral findings in normal and demented old people. In: Terry R., Gershon S. (Eds.), Neurobiology of Aging. Raven Press Publishers, New York, 1976, pp. 183–204.
Erkinjuntti T., Wikstrom J., Palo J., Autio L.: Dementia among medical inpatients: evaluation of 2,000 consecutive admissions. Arch. Intern. Med. 146: 1923–1926, 1986.
Loeb C., Gandolfo C.: Methodological Problems of Clinical Trials in Multi-Infarct Dementia. Neuroepidemiology 9: 223–227, 1990.
Hagnell O., Lanke J., Rorsman B., Ohman R., Ojesjo L.: Current trends in the incidence of senile and multi infarct dementia. A prospective study of a total population followed over 25 years: the Lundby Study. Arch. Psychiatr. Nervenkr. 233: 423–438, 1983.
Rorsman B., Hagnell O., Lanke J.: Prevalence and incidence of senile and multi infarct dementia in the Lundby Study: A comparison between the time periods 1947-1957 and 1957-1972. Neuropsychology 15: 122–129,1986.
Jorm F.A.: Cross-national comparisons of the occurrence of Alzheimer’s and vascular dementias. Eur. Arch. Psychiatr. Clin. Neuros. 240: 218–222, 1991.
Homma A., Hasegawa K.: Recent developments in gerontopsychiatric research on age-associated dementia in Japan. International Psychogeriatrics 1: 31–49, 1989.
Li G., Shen Y.C., Zhau Y.W., Li S.R., Lu M.: A three-year follow-up study of age-related dementia in an urban area of Beijing. Acta Psychiatr. Scand. 83: 99–104, 1991.
Nilson L.V.: Incidence of severe dementia in an urban sample followed from 70 to 79 years of age. Acta Psychiatr. Scand. 70: 478–486, 1984.
Molsa P.K., Paljarvi L., Rinne V., Sako E.: Validity of clinical diagnosis in dementia: a prospective clinico-pathological study. J. Neurol. Neurosurg. Psychiatry 48: 1085–1090, 1985.
Schoenberg B.S.: Epidemiology of Alzheimer’s disease and other dementing illnesses. J. Chronic Dis. 39: 1095–1104, 1986.
Katzman R., Aronson M., Fuld P., Kawas C., Brown T., Morgenstern H., Frisman W., Gidez L., Eder H., Ooi W.L.: Development of dementing illnesses in an 80-year-old volunteer cohort. Ann. Neurol. 25: 317–324, 1989.
Kokmen E., Chandra V., Schoenberg B.S.: Trends in incidence of dementing illness in Rochester, Minnesota, in three quinquennial periods, 1960-1974. Neurology 38: 975–980, 1988.
Rogers R.L., Meyer J.S., Mortel K.: Decreased cerebral blood flow precedes multi infarct dementia but follows senile dementia of Alzheimer type. Neurology 36: 1–6, 1986.
Meyer J.S., McClintic K.R., Rogers R.L., Sims P., Mortel K.F.: Aetiological considerations and risk factors for multi infarct dementia. J. Neurol Neurosurg. Psychiatry 51: 1489–1497, 1988.
Fischer C.M.: Lacunes: small deep cerebral infarcts. Neurology 15: 774–784, 1965.
Fischer C.M.: Dementia in cerebral vascular disease. In: Siekert R., Wisnant J.P. (Eds.), Cerebral Vascular disease. VIth conference. Grune and Stratton, New York, 1968, pp. 232–236.
Fischer C.M.: Lacunar strokes and infarcts: A review. Neurology 32: 871–876, 1982.
Fischer C.M.: Binswanger’s encephalopathy: A review. J. Neurol 236: 65–79,1989.
Babikian U., Ropper A.H.: Binswanger’s disease: A review. Stroke 18: 2–12, 1987.
Shekelle R.B., Ostfeld A.M., Klawans H.L.: Hypertension and risk of stroke in an elderly population. Stroke 5: 71–75, 1974.
Kannel W.B., Dawber T.R., Sorlie P., Wolf P.A.: Component of blood pressure and risk of artherothrombotic brain infarct. The Framingham Study. Stroke 7: 327–331, 1976.
Kannel W.B., Gordon T.: Evaluation of cardiovascular risk in the elderly. Bull. N.Y. Acad. Med. 54: 573–591, 1978.
Forette F., De La Fuente J., Golmard J.L., Henry J.F., Hervy M.P.: The pronostic significance of isolated systolic hypertension in the elderly. Results of a ten year longitudinal survey. Clin. Exp. Hypertens. A4: 1177–1191, 1982.
Forette F., De La Fuente J., Golmard J.L., Henry J.F., Hervy M.P.: HTA et risque d’accident vasculaire cérébral chez le sujet âgé. Résultats d’une surveillance longitudinale de 10 ans. Nouv. Presse Med 12: 3036–3038, 1983.
Report on the National Survey of Stroke by the National Institute of Neurological and Communicative disorders and stroke. Stroke (supplement 1) 12,1981.
V.A. Cooperative study Group on Antihypertensive Agents: Effect of treatment on morbidity in Hypertension. III. Influence of age, diastolic blood pressure and prior cardiovascular disease further analysis of side effects. Circulation 45: 991–1004, 1972.
Hypertension Detection and Follow-up Program Cooperative Group: Five year findings of the Hypertension Detection and Follow-up program. II. Mortality by race, sex and age. JAMA 242: 2572–2579, 1979.
Australian Therapeutic Trial on Mild Hypertension: Report by the management committee. Lancet 1:1261–1269, 1980.
Amery A., Birkenhäger W.A., Brixho P., Bulpitt C., Clément D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry J.F., Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Pétrie J., Strasser T., Tuomilehto J., Williams B.: Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet I: 1349–1354, 1985.
Medical Research Council Working Party: MRC trial on mild hypertension; principal results. Br. Med. J. 291: 97–104, 1985.
Coope J., Warrander T.S.: Randomized trial of treatment of hypertension in primary care. Br. Med. J. 293: 1145–1151,1986.
Staessen J., Fagard R., Van Hoof R., Amery A.: Mortality in various intervention trials in elderly hypertensive patients: a review. Eur. Heart J. 9: 215- 222, 1988.
Amery A., Birkenhäger W., Bulpitt C.J., Clément D., De Leew P., Dollery CT., Fagard R., Fletcher A., Forette F., Leonetti G., O’Brien ET., O’Malley ET., Rodicio J.L., Rosenfeld J., Staessen J., Strasser T., Terzoli L., Thijs L., Tuomilehto J., Webster J.: Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol, and organization. Aging 3: 287–302, 1991.
Folstein M.F., Folstein S.E., McHugh P.R.: “Mini Mental State” a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.
Forette F., Henry J.F., Orgogozo J.M., Pere J.F., Hugonot L., Israel I., Loria Y., Goulley F., Lalle-mand A., Boiler F.: The reliability of clinical criteria for the diagnosis of dementia: A longitudinal multi-centric study. Arch. Neurol. 46: 646–648, 1989.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Revised Edition. American Psychiatric Association, Washington DC, 1987.
Hachinski V.C., Iliff L.D., Zilkha E., Du Boulay G.H., McAllister U.L., Marshall J., Rüssel R.W.R., Symon L.: Cerebral blood flow in dementia. Arch. Neurol. 32: 632–637, 1975.
Loeb C., Gandolfo C: Diagnostic evaluation of degenerative and vascular dementia. Stroke 14: 399–401, 1983.
Wang H.S.: Prognosis in dementia and related disorders in the aged. In: Katzman R., Terry R.D., Bick K.L. (Eds.), Aging Series Vol. 7. Alzheimer’s disease; Senile dementia and related disorders. Raven Press, New York, 1978, pp. 309–313.
Caplan L.R., Schoene W.C.: Clinical features of sub-cortical arteriosclerotic encephalopathy (Binswanger’s disease). Neurology 28: 1206–1215, 1978.
Barclay L.L., Zemcov A., Blass J.P., Sansone J.: Survival in Alzheimer’s disease and vascular dementias. Neurology 35: 834–840, 1985.
Orgogozo J.M., Spiegel R.: Critical Review of clinical trials in senile dementia. Postgrad. Med. J. 63: 237 and 337, 1987.
Besson J.A.O., Palin A.F., Ebmeier K.P., Eagles J.M., Smith F.W.: Calcium antagonists and multi infarct dementia: a trial involving sequential NMR and psychometric assessment. Int. J. Geriatr. Psychiatry 3: 99–105, 1988.
Nadeau S.E., Malloy P.F., Andrew M.E.: A crossover trial of Bromocriptine in the treatment of vascular dementia. Ann. Neurol. 24: 270–272, 1988.
Meyer J.S., Rogers R.L., McClintic K., Mortel K.F., Lofti J.: Randomized clinical trial of Daily Aspirin Therapy in multi infarct dementia. A pilot study. J. Am. Geriatr. Soc. 37: 549–555, 1989.
Katzman R., Lasker B., Bernstein N.: Advances in the diagnosis of dementia: accuracy of diagnosis and consequences of Misdiagnosis of disorders causing Dementia. In: Terry R.D. (Ed.), Aging and the brain Raven Press, New York, 1988, pp. 17–62.
Blessed G., Tomlinson B.E., Roth M.: The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects. Br. J. Psychiatry 114: 797–811, 1968.
Katzman R., Brown T., Fuld P., Peck A., Schechter R., Schimmel H.: Validation of a short orientation-memory-concentration test of cognitive impairment. Am. J. Psychiatry 140: 734–739, 1983.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed. 3. Washington DC, 1980.
Rosen W.G., Terry R.D., Fuld P.A., Katzman R., Peck A.: Pathological verification of ischemic score in differentiation of dementias. Ann. Neurol. 7: 486–488, 1980.
Loeb C., Gandolfo C., Bino G.: Intellectual impairment and cerebral lesions in multiple cerebral infarcts. A clinical computed tomography study. Stroke 19: 560–565, 1988.
Brust J.C.: Dementia in cerebrovascular disease. In: Mayeux R., Rosen W.G. (Eds.), The dementias. Raven Press, New York, 1983, pp. 131–147.
Erkinjuntti T., Sipponem J.T., Iivanainen M., Ketonen L., Sulkawa R., Sebbonem R.: Cerebral NMR and CT imaging in dementia. J. Comput. Assist. Tomogr. 8: 614–618, 1984.
Erkinjuntti T.: Differential diagnosis between Alzheimer’s disease and vascular dementia: evaluation of common clinical methods. Acta Neurol. Scand. 76: 433–442, 1987.
Erkinjuntti T., Haltia M., Sulkava R., Paetan A.: Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study. J. Neurol Neurosurg. Psychiatry 51: 1037–1044, 1988.
Gurland B.J., Teresi J., Mc Fate Smith W., Black D., Hughes G., Edlavitch S.: Effects of treatment of isolated systolic hypertension on cognitive status and depression in the elderly. J. Am. Geriatr. Soc. 36: 1015–1022, 1988.
Gengo F.M., Fagan S.G., De Padova A., Miller J.K., Kinkel P.R.: The effect of beta-blockers on mental performances on older hypertensive patients. Arch. Intern. Med. 148: 779–784, 1988.
Baethmann A., Jansen M.: Possible role of calcium entry blockers in brain protection. Eur. Neurol. 25 (suppl. 1): 102–111, 1986.
Forette F., McClaran J., Delesale M.C., Hervy M.P., Bouchacourt P., Henry-Amar M., Santoni J.P.: Value of angiotensin converting enzyme inhibitors in the elderly: the Example of Perindopril. Clin. Exp. Hypertens. All (suppl. 2): 587–603, 1989.
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The present side project is part of a Concerted Action of the European Community’s Medical and Health Research Programme.
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Forette, F., Amery, A., Staessen, J. et al. Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project. Aging Clin Exp Res 3, 373–382 (1991). https://doi.org/10.1007/BF03324039
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DOI: https://doi.org/10.1007/BF03324039