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Management of Mixed Dementia

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Abstract

Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common causes of dementia in the elderly. Although AD can be diagnosed with a considerable degree of accuracy, the distinction between isolated AD, VaD and mixed dementia (MD) [when both pathologies coexist in the same patient] remains a controversial issue and one of the most difficult diagnostic challenges. MD represents a very common pathology, especially in the elderly, as reported in neuropathological studies. Accurate diagnosis of MD is of crucial significance for epidemiological purposes and for preventive and therapeutic strategies. Until recently, pharmacological studies have generally focused on pure disease, either AD or VaD, and have provided few data on the best therapeutic approach to MD. There is only one original randomized clinical trial on (acetyl)cholinesterase inhibitor therapy (GAL-INT-6, galantamine) for MD; the other studies are post hoc analyses of AD trial subgroups (AD2000, donepezil) or of VaD trial subgroups (VantagE, rivastigmine). Cholinesterase inhibitors have reproducible beneficial effects on cognitive and functional outcomes in patients with MD. These benefits are of a similar magnitude to those previously reported for the treatment of AD. It is likely that the beneficial effects of memantine (an NMDA receptor antagonist) in AD may also apply to MD, but randomized controlled trials are still lacking. Treatment of cardiovascular risk factors, especially hypertension, may protect brain function and should be included in prevention strategies for MD.

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References

  1. Henderson AS, Jorm AF. Definition and epidemiology of dementia: a review. In: Maj M, Sartorius N, editors. Dementia. Chichester: John Wiley & Sons, 2000: 1–68

    Google Scholar 

  2. Hébert R, Brayne C. Epidemiology of vascular dementia. Neuroepidemiology 1995; 14: 240–57

    PubMed  Google Scholar 

  3. Kaye JA. Diagnostic challenges in dementia. Neurology 1998; 51: S45–52

    PubMed  CAS  Google Scholar 

  4. Cummings JL, Benson DF. Dementia: a clinical approach. Boston (MA): Butterworth-Heinemann, 1989

  5. Cohen CI, Araujo L, Guerrier R, et al. “Mixed dementia”: adequate or antiquated? A critical review. Am J Geriatr Psychiatry 1997; 5: 279–83

    PubMed  CAS  Google Scholar 

  6. Zekry D, Hauw J-J, Gold G. Mixed dementia: epidemiology, diagnosis and treatment. J Am Geriatr Soc 2002; 50: 1431–8

    PubMed  Google Scholar 

  7. Jellinger KA. Alzheimer disease and cerebrovascular pathology: an update. J Neural Transm 2002; 109: 813–36

    PubMed  CAS  Google Scholar 

  8. Gold G, Giannakopoulos P, Herrmann F, et al. Identification of Alzheimer and vascular lesion thresholds for mixed dementia. Brain 2007; 130: 2830–6

    PubMed  Google Scholar 

  9. Giannakopoulos P, Gold G, Kovari E, et al. Assessing the cognitive impact of Alzheimer disease pathology and vascular burden in the aging brain: the Geneva experience. Acta Neuropathol 2007; 113: 1–12

    PubMed  Google Scholar 

  10. Gold G, Kovari E, Hof PR, et al. Sorting out the clinical consequences of ischemic lesions in brain aging: a clinicopathological approach. J Neurol Sci 2007; 257: 17–22

    PubMed  Google Scholar 

  11. Jellinger KA. Neuropathological evaluation of mixed dementia. J Neurol Sci 2007; 257: 80–7

    PubMed  CAS  Google Scholar 

  12. Zekry D, Duyckaerts C, Moulias R, et al. The vascular lesions in vascular and mixed dementia: the weight of functional neuroanatomy. Neurobiol Aging 2003; 24: 213–9

    PubMed  Google Scholar 

  13. Zekry D, Duyckaerts C, Moulias R, et al. Degenerative and vascular lesions of the brain have synergistic effects in dementia of the elderly. Acta Neuropathol 2002; 103: 481–7

    PubMed  CAS  Google Scholar 

  14. Nyenhuis DL, Gorelick PB. Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention and treatment. J Am Geriatr Soc 1998; 46: 1437–48

    PubMed  CAS  Google Scholar 

  15. Gold G, Giannakopoulos P, Bouras C. Reevaluating the role of vascular changes in the differential diagnosis of Alzheimer’s disease and vascular dementia. Eur Neurol 1998; 40: 121–9

    PubMed  CAS  Google Scholar 

  16. Reisberg B, Franssen E, Shah MA, et al. Clinical diagnosis of dementia: a review. In: Maj M, Sartorius N, editors. Dementia. Chichester: John Wiley & Sons, 2000: 69–139

    Google Scholar 

  17. Samuels SC, Davis KL. Pharmacological treatment of dementia: a review. In: Maj M, Sartorius N, editors. Dementia. Chichester: John Wiley & Sons, 2000; 199–268

    Google Scholar 

  18. Gold G, Giannakopoulos P, Bouras C. Vascular dementia. In: Hof P, Mobbs C, editors. Functional neurobiology of aging. San Diego (CA): Academic Press, 2001: 131–43

    Google Scholar 

  19. Knopman DS, Dekosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2001; 56: 1143–53

    PubMed  CAS  Google Scholar 

  20. Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2001; 56: 1154–66

    PubMed  CAS  Google Scholar 

  21. Van Duijn CM, Stijnen T, Hofman A. Risk factors for Alzheimer’s disease: overview of the EURODEM collaborative re-analysis of case-control studies. Int J Epidemiol 1991; 20Suppl. 2: S4–11

    PubMed  Google Scholar 

  22. Breteler MB. Vascular risk factors for Alzheimer’s disease: an epidemiologic perspective. Neurobiol of Aging 2000; 21: 153–60

    CAS  Google Scholar 

  23. Skoog I. Risk factors for vascular dementia: a review. Dementia 1994; 5: 137–44

    PubMed  CAS  Google Scholar 

  24. Gorelick PB. Status of risk factors for dementia associated with stroke. Stroke 1997; 28: 459–63

    PubMed  CAS  Google Scholar 

  25. Gorelick PB, Freels S, Harris Dollear BS, et al. Epidemiology of vascular and Alzheimer’s dementia among African Americans in Chicago, IL. Neurology 1994; 44: 1391–6

    PubMed  CAS  Google Scholar 

  26. Babikian U. Binswanger’s disease: a review. Stroke 1987; 18: 1–12

    Google Scholar 

  27. Rockwood K, Ebly E, Hachinski V, et al. Presence and treatment of vascular risk factors in patients with vascular cognitive impairment. Arch Neurol 1997; 54: 33–9

    PubMed  CAS  Google Scholar 

  28. Meyer J, McClintic K, Rogers R, et al. Aetiological considerations and risk factors for multi-infarct dementia. J Neurol Neurosurg Psych 1988; 51: 1489–7

    CAS  Google Scholar 

  29. Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–4

    PubMed  CAS  Google Scholar 

  30. Skoog I. Status of risk factors for vascular dementia. Neuroepidemiology 1998; 17: 2–9

    PubMed  CAS  Google Scholar 

  31. Skoog I. The interaction between vascular disorders and Alzheimer’s disease. In: Iqbal K, Swaab DF, Winblad B, et al., editors. Alzheimer’s disease and related disorders: etiology, pathogenesis and therapeutics. Chichester: John Wiley & Sons, 1998: 523–30

    Google Scholar 

  32. Lindsay J, Hebert R, Rockwood K. The Canadian study of health and aging-risk factors for vascular dementia. Stroke 1997; 28: 526–30

    PubMed  CAS  Google Scholar 

  33. Ueda K, Kawano H, Hasuo Y, et al. Prevalence and etiology of dementia in a Japanese community. Stroke 1992; 23: 798–803

    PubMed  CAS  Google Scholar 

  34. Kotsoris H, Barclay LL, Kheyferts S, et al. Urinary and gait disturbances as markers for early multi-infarct dementia. J Neurol Neurosurg Psychiatry 1988; 1: 138–41

    Google Scholar 

  35. Ratcliffe PJ, Wilcock CK. Cerebrovascular disease in dementia: the importance of atrial fibrillation. Postgrad Med J 1985; 61: 201–4

    PubMed  CAS  Google Scholar 

  36. 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: 1347–51

    PubMed  CAS  Google Scholar 

  37. Skoog I, Kalaria RN, Breteler MM. Vascular factors and Alzheimer disease. Alzheimer Dis Assoc Disord 1999; 13: S106–14

    PubMed  Google Scholar 

  38. Vogel T, Dali-Youcef N, Kaltenbach G, et al. Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the literature. Int J Clin Pract Int J Clin Pract 2009; 63: 1061–7

    CAS  Google Scholar 

  39. Corey-Bloom J, Galasko D, Hofstetter CR, et al. Clinical features distinguishing large cohorts with possible AD, probable AD, and mixed dementia. J Am Geriatr Soc 1993; 41: 31–7

    PubMed  CAS  Google Scholar 

  40. Rockwood K, Macknight C, Wentzel C, et al. The diagnosis of “mixed dementia” in the Consortium for the Investigation of Vascular Impairment of Cognition (CIVIC). Ann N Y Acad Sci 2000; 903: 522–8

    PubMed  CAS  Google Scholar 

  41. Whitmer RA, Sidney S, Selby J, et al. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology 2005; 64: 277–81

    PubMed  CAS  Google Scholar 

  42. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3225–64

    Google Scholar 

  43. Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment of older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64

    PubMed  CAS  Google Scholar 

  44. 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; 24: 1347–51

    Google Scholar 

  45. Lithell H, Hansson L, Skoog I, et al., SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86

    PubMed  CAS  Google Scholar 

  46. Trenkwalder P. The Study on COgnition and Prognosis in the Elderly (SCOPE): recent analyses. J Hypertens Suppl 2006; 24: S107–14

    PubMed  CAS  Google Scholar 

  47. Zanchetti A, Elmfeldt D. Findings and implications of the Study on COgnition and Prognosis in the Elderly (SCOPE): a review. Blood Press 2006; 15: 71–9

    PubMed  Google Scholar 

  48. in’t Veld BA, Ruitenberg A, Hofman A, et al. Antihypertensive drugs and incidence of dementia: the Rotterdam Study. Neurobiol Aging 2001; 22: 407–12

    PubMed  Google Scholar 

  49. Beckett NS, Peters R, Fletcher AE. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–98

    PubMed  CAS  Google Scholar 

  50. Peters R, Beckett N, Forette F, et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVETCOG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683–9

    PubMed  CAS  Google Scholar 

  51. Peters R, Beckett N, Forette F, et al. Vascular risk factors and cognitive function among 3763 participants in the Hypertension in the Very Elderly Trial (HYVET): a cross-sectional analysis. Int Psychogeriatr 2009; 2: 359–68

    Google Scholar 

  52. McGuinness B, Todd S, Passmore P, et al. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev 2009; (4): CD004034

    Google Scholar 

  53. Amarenco P, Bogousslavsky J, et al., Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549–59

    PubMed  CAS  Google Scholar 

  54. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 7–22

    Google Scholar 

  55. Shepherd J, Blauw GJ, Murphy MB, et al., PROSPER study group. PROspective Study of Pravastatin in the Elderly at Risk. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623–30

    PubMed  CAS  Google Scholar 

  56. Bernick C, Katz R, Smith NL, et al., Cardiovascular Health Study Collaborative Research Group. Statins and cognitive function in the elderly: the Cardiovascular Health Study. Neurology 2005; 65: 1388–94

    PubMed  CAS  Google Scholar 

  57. Rea TD, Breitner JC, Psaty BM, et al. Statin use and the risk of incident dementia: the Cardiovascular Health Study. Arch Neurol 2005; 62: 1047–51

    PubMed  Google Scholar 

  58. Li G, Higdon R, Kukull WA, et al. Statin therapy and risk of dementia in the elderly: a community-based prospective cohort study. Neurology 2004; 63: 1624–8

    PubMed  CAS  Google Scholar 

  59. Zandi PP, Sparks DL, Khachaturian AS, et al., Cache County Study investigators. Do statins reduce risk of incident dementia and Alzheimer disease? The Cache County Study. Arch Gen Psychiatry 2005; 62: 217–24

    PubMed  CAS  Google Scholar 

  60. Nelson MR, Reid CM, Ames DA, et al. Feasibility of conducting a primary prevention trial of low-dose aspirin for major adverse cardiovascular events in older people in Australia: results from the ASPirin in Reducing Events in the Elderly (ASPREE) pilot study. Med J Aust 2008; 189: 105–9

    PubMed  Google Scholar 

  61. Kivipelto M, Ngandu T, Laatikainen T, et al. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol 2006; 5: 735–41

    PubMed  Google Scholar 

  62. Tzourio C, Anderson C, Chapman N, et al., PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003; 163: 1069–75

    PubMed  CAS  Google Scholar 

  63. Dufouil C, Chalmers J, Coskun O, et al., PROGRESS MRI Substudy Investigators. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy. Circulation 2005; 112: 1644–50

    PubMed  Google Scholar 

  64. Grantham C, Geerts H. The rationale behind cholinergic drug treatment for dementia related to cerebrovascular disease. J Neurol Sci 2002; 203: 131–6

    PubMed  Google Scholar 

  65. Roman G, Kalaria R. Vascular determinants of cholinergic deficits in Alzheimer disease and vascular dementia. Neurobiol Aging 2006; 27: 1769–85

    PubMed  CAS  Google Scholar 

  66. Saito H, Togashi H, Yoshioka M, et al. Animal models of vascular dementia with emphasis on stroke prone spontaneously hypertensive rats. Clin Exp Pharmacol Physiol Suppl 1995; 22: S257–9

    PubMed  CAS  Google Scholar 

  67. Kimura S, Saito H, Minami M, et al. Pathogenesis of vascular dementia in stroke-prone spontaneously hypertensive rats. Toxicology 2000; 153: 167–78

    PubMed  CAS  Google Scholar 

  68. Togashi H, Kimura S, Matsumoto M, et al. Cholinergic changes in the hippocampus of stroke-prone spontaneously hypertensive rats. Stroke 1996; 27: 520–5

    PubMed  CAS  Google Scholar 

  69. Togashi H, Matsumoto M, Yoshioka M, et al. Neurochemical profiles in cerebrospinal fluid of stroke-prone spontaneously hypertensive rats. Neurosci Lett 1994; 166: 117–20

    PubMed  CAS  Google Scholar 

  70. Ferrari R, Frasoldati A, Leo G, et al. Changes in nicotinic acetylcholine receptor subunit mRNAs and nicotinic binding in spontaneously hypertensive stroke prone rats. Neurosci Lett 1999; 277: 169–72

    PubMed  CAS  Google Scholar 

  71. Gottfries CG, Blennow K, Karlsson I, et al. The neurochemistry of vascular dementia. Dementia 1994; 5: 163–7

    PubMed  CAS  Google Scholar 

  72. Wallin A, Alafuzoff I, Carlsson A, et al. Neurotransmitter deficits in a nonmulti-infarct category of vascular dementia. Acta Neurol Scand 1989; 79: 397–06

    PubMed  CAS  Google Scholar 

  73. Tohgi H, Abe T, Kimura M, et al. Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J Neural Transm 1996; 103: 1211–20

    PubMed  CAS  Google Scholar 

  74. Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol 2007; 6: 782–92

    PubMed  CAS  Google Scholar 

  75. Erkinjuntti T. Galantamine shows efficacy in patients with Alzheimer’s disease with cerebrovascular components or probable vascular dementia [abstract]. Neurology 2001; 56 Suppl.: A340

    Google Scholar 

  76. Erkinjuntti T, Gauthier S, Bullock R, et al. Galantamine treatment in Alzheimer’s disease with cerebrovascular disease: responder analyses from a randomized, controlled trial (GAL-INT-6). J Psychopharmacol 2008; 7: 761–8

    Google Scholar 

  77. Small G, Erkinjuntti T, Kurz A, et al. Galantamine in the treatment of cognitive decline in patients with vascular dementia or Alzheimer’s disease with cerebrovascular disease. CNS Drugs 2003; 17: 905–14

    PubMed  CAS  Google Scholar 

  78. Bullock R, Erkinjuntti T, Lilienfeld S, GAL-INT-6 Study Group. Management of patients with Alzheimer’s disease plus cerebrovascular disease: 12-month treatment with galantamine. Dement Geriatr Cogn Disord 2004; 17: 29–34

    PubMed  CAS  Google Scholar 

  79. Kumar V, Anand R, Messina J, et al. An efficacy and safety analysis of Exelon® in Alzheimer’s disease patients with concurrent vascular risk factors. Eur J Neurol 2000; 7: 159–69

    PubMed  CAS  Google Scholar 

  80. 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: 241–9

    PubMed  CAS  Google Scholar 

  81. Reisberg B, Schneider L, Doody R, et al. Clinical global measures of dementia: position paper from the International Working Group on Harmonization of Dementia Drug Guidelines. Alzheimer Dis Assoc Disord 1997; 11: 8–18

    PubMed  Google Scholar 

  82. McKahn G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939–44

    Google Scholar 

  83. 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: 250–60

    PubMed  CAS  Google Scholar 

  84. DeJong R, Osterlund OW, Roy GW. Measurement of quality-of-life changes in patients with Alzheimer’s disease. Clin Ther 1989; 11: 545–54

    PubMed  CAS  Google Scholar 

  85. Kurz A. Galantamine improves cognitive and global abilities in Alzheimer’s disease with cerebrovascular components and probable vascular dementia: preliminary results [abstract]. Neurology 2001; 56 Suppl.: A340

    Google Scholar 

  86. Erkinjuntti T, Kurz A, Gauthier S, et al. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet 2002; 359: 1283–90

    PubMed  Google Scholar 

  87. Rosen W, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984; 141: 1356–64

    PubMed  CAS  Google Scholar 

  88. Schneider LS, Olin JT, Doody RS, et al. Validity and reliability of the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997; 1Suppl. 2: S22–32

    Google Scholar 

  89. Gélinas I, Gauthier L, McIntyre M, et al. Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther 1999; 53: 471–81

    PubMed  Google Scholar 

  90. Erkinjuntti T, Kurz A, Small GW, et al. An open-label extension trial of galantamine in patients with probable vascular dementia and mixed dementia. Clin Ther 2003; 25: 1765–82

    PubMed  CAS  Google Scholar 

  91. Kurz AF, Erkinjuntti T, Small GW, et al. Long-term safety and cognitive effects of galantamine in the treatment of probable vascular dementia or Alzheimer’s disease with cerebrovascular disease. Eur J Neurol 2003; 10: 633–40

    PubMed  CAS  Google Scholar 

  92. Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–14

    PubMed  CAS  Google Scholar 

  93. Rosen WG, Terry RD, Fuld PA, et al. Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980; 7: 486–8

    PubMed  CAS  Google Scholar 

  94. Erkinjuntti T, Skoog I, Lane R, et al. Rivastigmine in patients with Alzheimer’s disease and concurrent hypertension. Int J Clin Pract 2002; 56: 791–6

    PubMed  CAS  Google Scholar 

  95. Erkinjuntti T, Skoog I, Lane R, et al. Potential long-term effects of rivastigmine on disease progression may be linked to drug effects on vascular changes in Alzheimer brains. Int J Clin Pract 2003; 57: 756–60

    PubMed  CAS  Google Scholar 

  96. Ballard C, Sauter M, Scheltens P, et al. Efficacy, safety and tolerability of rivastigmine capsules in patients with probable VaD: the VantagE study. Curr Med Res Opin 2008; 24: 2561–74

    PubMed  CAS  Google Scholar 

  97. Courtney C, Farrell D, Gray R, et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 2004; 363: 2105–15

    PubMed  CAS  Google Scholar 

  98. Obering C, Obering C, Batrash A. Case report: combined use of donepezil and galantamine in mixed dementia. J Am Geriatr Soc 2009; 57: 1934–5

    PubMed  Google Scholar 

  99. Shua-Haim J, Smith J, Amin S, et al. Comparison of combination therapy with rivastigmine (Exelon) and donepezil (Aricept) versus rivastigmine alone for treatment of Alzheimer’s disease: safety, tolerability and clinical experience after one year of treatment (a cross-sectional study). Neurobiol Aging 2002; 1: 76–7

    Google Scholar 

  100. Mobius HJ. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med 2003; 348: 1333–41

    PubMed  Google Scholar 

  101. Orgogozo JM, Rigaud AS, Stöffler 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: 1834–9

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  103. Kovari E, Gold G, Herrmann FR, et al. Cortical microinfarcts and demyelination affect cognition in cases of high risk of dementia. Neurology 2007; 68: 927–31

    PubMed  CAS  Google Scholar 

  104. Bastos-Leite AJ, van der Flier WM, van Straaten EC, et al. The contribution of medial temporal lobe atrophy and vascular pathology to cognitive impairment in vascular dementia. Stroke 2007; 38: 3182–5

    PubMed  Google Scholar 

  105. Benisty S, Gouw AA, Porcher R, et al., 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

    PubMed  CAS  Google Scholar 

  106. Mungas D, Jagust WJ, Reed BR, et al. MRI predictors of cognition in subcortical ischemic vascular disease and Alzheimer’s disease. Neurology 2001; 57: 2229–35

    PubMed  CAS  Google Scholar 

  107. Madureira S, Verdelho A, Ferro J, et al., on behalf of the LADIS Study Group. Development of a neuropsychological battery for the Leukoaraiosis and Disability in the Elderly Study (LADIS): experience and baseline data. Neuroepidemiology 2006; 27: 101–16

    PubMed  Google Scholar 

  108. Ferris SH. General measures of cognition. Int Psychogeriatr 2003; 15Suppl. 1: 215–7

    PubMed  Google Scholar 

  109. Ylikoski R, Jokinen H, Andersen P, et al., LADIS Study Group. Comparison of the Alzheimer’s Disease Assessment Scale Cognitive Subscale and the Vascular Dementia Assessment Scale in differentiating elderly individuals with different degrees of white matter changes. The LADIS Study. Dement Geriatr Cogn Disord 2007; 24: 73–81

    PubMed  Google Scholar 

  110. Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004; 292: 2901–8

    PubMed  CAS  Google Scholar 

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  1. Rehabilitation and Geriatrics Department, Geneva University, 3 Chemin du Pont-Bochet, Thônex, Switzerland

    Dina Zekry & Gabriel Gold

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Zekry, D., Gold, G. Management of Mixed Dementia. Drugs Aging 27, 715–728 (2010). https://doi.org/10.2165/11538250-000000000-00000

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