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Diagnosis and management of vascular cognitive impairment

Current Atherosclerosis Reports volume 9, pages 326–332 (2007)Cite this article

Abstract

Accurate diagnosis of vascular cognitive impairment (VCI) is important but may be difficult. VCI diagnoses depend on determinations of the presence of both cognitive impairment and cerebrovascular disease (CVD), temporal causal links between cognitive impairment and CVD, and the presence or absence of other potential contributors to cognitive impairment, such as Alzheimer’s disease (AD). Diagnostic criteria differ across currently utilized systems, resulting in widely differing VCI prevalence rates. Also, current systems may not be able to differentiate “pure” VCI from “mixed” AD and CVD. National Institute of Neurological Disorders and Stroke harmonization criteria for VCI have been developed for study and validation to help bridge gaps in our understanding of VCI diagnosis. VCI management begins with atherogenic risk factor control. Current VCI treatment options demonstrate statistical improvement but not consistent global clinical efficacy. Future clinical trials should concentrate on both primary risk factor control and development of new therapeutic agents to treat patients already diagnosed with VCI.

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References and Recommended Reading

  1. Broderick J, Brott T, Kothari R, et al.: The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks. Stroke 1998, 29:415–421.

    PubMed  CAS  Google Scholar 

  2. Madureira S, Guerreiro M, Ferro JM: Dementia and cognitive impairment three months after stroke. Eur J Neurol 2001, 8:621–627.

    PubMed  Article  CAS  Google Scholar 

  3. Rockwood K, Brown M, Merry H, et al.: Societal costs of vascular cognitive impairment in older adults. Stroke 2002, 33:1605–1609.

    PubMed  Article  Google Scholar 

  4. Wolfson C, Wolfson DB, Asgharian M, et al.: Clinical Progression of Dementia Study Group. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001, 344:1111–1116.

    PubMed  Article  CAS  Google Scholar 

  5. Di Carlo A, Baldereschi M, Amaducci L, et al.: Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc 2000, 48:775–782.

    PubMed  Google Scholar 

  6. Hachinski V: Vascular dementia: a radical redefinition. Dementia 1994, 5:130–132.

    PubMed  Article  CAS  Google Scholar 

  7. Pohjasvaara T, Mantyla R, Ylikoski R, et al.: Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. Stroke 2000, 31:2952–2957.

    PubMed  CAS  Google Scholar 

  8. Leblanc GG, Meschia JF, Stuss DT, Hachinski V: Genetics of vascular cognitive impairment: the opportunity and the challenges. Stroke 2006, 37:248–255.

    PubMed  Article  Google Scholar 

  9. O’Brien JT: Vascular cognitive impairment: J Geriatr Psychiatry 2006, 14:724–733.

    Article  Google Scholar 

  10. Roman GC, Tatemichi TK, Erkinjuntti T, et al.: Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993, 43:250–260.

    PubMed  CAS  Google Scholar 

  11. Gold G, Bouras C, Canuto A, et al.: Clinicopathological validation study of four sets of clinical criteria for vascular dementia. Am J Psychiatry 2002, 159:82–87.

    PubMed  Article  Google Scholar 

  12. Chui HC, Victoroff JI, Margolin D, et al.: Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centers. Neurology 1992, 42:473–480.

    PubMed  CAS  Google Scholar 

  13. Zhu L, Fratiglioni L, Guo Z, et al.: Association of stroke with dementia, cognitive impairment, and functional disability in the very old: a population-based study. Stroke 1998, 20:2094–2099.

    Google Scholar 

  14. Petersen RC: Conceptual overview. In Mild Cognitive Impairment. Edited by Petersen, RC. New York: Oxford University Press; 2003:1–14.

    Google Scholar 

  15. Zekry D, Hauw JJ, Gold G: Mixed dementia: epidemiology, diagnosis and treatment. J Am Geriatr Soc 2000, 50:1431–1438.

    Article  Google Scholar 

  16. Knopman DS, Parisi JE, Boeve BF, et al.: Vascular dementia in a population-based autopsy study. Arch Neurol 2003, 60:569–575.

    PubMed  Article  Google Scholar 

  17. Bacchetta JP, Kovari E, Merlo M, et al.: Validation of clinical criteria for possible vascular dementia in the oldest-old. Neurobiol Aging 2007, 28:579–585.

    PubMed  Article  Google Scholar 

  18. McPherson SE, Cummings JL: Neuropsychological aspects of vascular dementia. Brain Cogn 1996, 31:269–282.

    PubMed  Article  CAS  Google Scholar 

  19. Nyenhuis DL, Gorelick PB, Geenen EJ, et al.: The pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND). Clin Neuropsychol 2004, 18:41–49.

    PubMed  Article  Google Scholar 

  20. Hachinski V, Iadecola C, Petersen RC, et al.: National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006, 37:2220–2241.

    PubMed  Article  Google Scholar 

  21. Gorelick PB: Prevention. In Vascular Cognitive Impairment: Preventable Dementia. Edited by Bowler JV, Hachinksi V: New York: Oxford University Press; 2003:309–320.

    Google Scholar 

  22. Kilander L, Nyman H, Boberg M, et al.: Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 1998, 31:780–786.

    PubMed  CAS  Google Scholar 

  23. Swan GE, DeCarli C, Miller BL, et al.: Association of midlife blood pressure to late-life cognitive decline and brain morphology. Neurology 1998, 51:986–993.

    PubMed  CAS  Google Scholar 

  24. Launer LJ, Ross GW, Petrovitch H, et al.: Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000, 21:49–55.

    PubMed  Article  CAS  Google Scholar 

  25. Forette F, Seux ML, Staessen JA, et al.: Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998, 352:1347–1351.

    PubMed  Article  CAS  Google Scholar 

  26. Feigin V, Ratnasabapathy Y, Anderson C: Does blood pressure lowering treatment prevents dementia or cognitive decline in patients with cardiovascular and cerebrovascular disease? J Neurol Sci 2005, 229–230:151–155.

    PubMed  Article  Google Scholar 

  27. Desmond DW, Moroney JT, Paik MC, et al.: Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000, 54:1124–1131.

    PubMed  CAS  Google Scholar 

  28. Dufouil C, Ducimetiere P, Alperovitch A: Sex differences in the association between alcohol consumption and cognitive performance. EVA Study Group. Epidemiology of Vascular Aging. Am J Epidemiol 1997, 146:405–412.

    PubMed  CAS  Google Scholar 

  29. Ott A, Breteler MM, de Bruyne MC, et al.: Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke 1997, 28:316–321.

    PubMed  CAS  Google Scholar 

  30. Nelson MR, Reid CM, Beilin LJ, et al.: Rationale for a trial of low-dose aspirin for the primary prevention of major adverse cardiovascular events and vascular dementia in the elderly. Aspirin in Reducing Events in the Elderly [ASPREE]. Drugs Aging 2003, 20:897–903.

    PubMed  Article  CAS  Google Scholar 

  31. National Institute of Neurological Disorders and Stroke: Report of the Stroke Progress Review Group. Available at http://www.ninds.nih.gov/find_people/groups/stroke_prg/09_2006_stroke_prg_report.htm. Accessed April 3, 2007.

  32. Gorelick PB: William M. Feinberg Lecture. Cognitive vitality and the role of stroke and cardiovascular disease risk factors. Stroke 2005, 36:875–878.

    PubMed  Article  Google Scholar 

  33. Black S, Roman GC, Geldmacher DS, et al.: Efficacy and tolerability of donepezil in vascular dementia: positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial. Stroke 2003, 34:2323–2230.

    PubMed  Article  CAS  Google Scholar 

  34. Wilkinson D, Doody R, Helme R, et al.: Donepezil in vascular dementia: a randomized, placebo-controlled study. Neurology 2003, 61:479–486.

    PubMed  CAS  Google Scholar 

  35. Roman GC, Wilkinson DG, Doody RS, et al.: Donepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dement Geriatr Cogn Disord 2005, 20:338–344.

    PubMed  Article  CAS  Google Scholar 

  36. Erkinjuntti T, Kurz A, Gauthier S: Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet 2002, 359:1283–1290.

    PubMed  Article  Google Scholar 

  37. Moretti R, Torre P, Antonello RM, Cazzato G: Rivastigmine in subcortical vascular dementia: a comparison trial on efficacy and tolerability for 12 months follow-up. Eur J Neurol 2001, 8:361–362.

    PubMed  Article  CAS  Google Scholar 

  38. Potkin SG, Alva G, Gunay I, et al.: A pilot study evaluating the efficacy and safety of rivastigmine in patients with mixed dementia. Drugs Aging 2006, 23:241–249.

    PubMed  Article  CAS  Google Scholar 

  39. Wilcock G, Mobius HJ, Stoffler A; MMM 500 group: A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500). Int Clin Psychopharmacol 2002, 17:297–305.

    PubMed  Article  CAS  Google Scholar 

  40. Orgogozo JM, Rigaud AS, Stoffler A, et al.: Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke 2002, 33:1834–1839.

    PubMed  Article  CAS  Google Scholar 

  41. Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia. A review of the evidence. JAMA 2005, 293:596–608.

    PubMed  Article  CAS  Google Scholar 

  42. Klunk WE, Engler H, Nordberg A, et al.: Imaging brain amyloid in Alzheimer’s disease with Pittsburgh Compound-B. Ann Neurol 2004, 55:306–319.

    PubMed  Article  CAS  Google Scholar 

  43. Gorelick PB, Brody J, Cohen D, et al.: Risk factors for dementia associated with multiple cerebral infarcts. A case-control analysis in predominantly African-American hospital-based patients. Arch Neurol 1993, 50:714–720.

    PubMed  CAS  Google Scholar 

  44. Stolk RP, Pols HA, Lamberts SW, et al.: Diabetes mellitus, impaired glucose tolerance, and hyperinsulinemia in an elderly population. The Rotterdam Study. Am J Epidemiol 1997, 145:24–32.

    PubMed  CAS  Google Scholar 

  45. Moroney JT, Tang MX, Berglund L, et al.: Low-density lipoprotein cholesterol and the risk of dementia with stroke. JAMA 1999, 282:254–260.

    PubMed  Article  CAS  Google Scholar 

  46. Gorelick PB: Status of risk factors for dementia associated with stroke. Stroke 1997, 28:459–463.

    PubMed  CAS  Google Scholar 

  47. Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991, 22:983–988.

    PubMed  CAS  Google Scholar 

  48. Gorelick PB: Stroke prevention. An opportunity for efficient utilization of health care resources during the coming decade. Stroke 1994, 25:220–224.

    PubMed  CAS  Google Scholar 

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Affiliations

  1. Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Center for Stroke Research, 1645 West Jackson Boulevard, Suite #400, Chicago, IL, 60612, USA

    David L. Nyenhuis PhD

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  1. David L. Nyenhuis PhD
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  2. Philip B. Gorelick MD, MPH
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Correspondence to David L. Nyenhuis PhD.

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Nyenhuis, D.L., Gorelick, P.B. Diagnosis and management of vascular cognitive impairment. Curr Atheroscler Rep 9, 326–332 (2007). https://doi.org/10.1007/s11883-007-0040-5

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  • DOI: https://doi.org/10.1007/s11883-007-0040-5

Keywords

  • Dementia
  • Memantine
  • Vascular Dementia
  • Rivastigmine
  • Galantamine