Abstract
Objective
The aim of this study was a cross-sectional comparison of clinical and MRI characteristics and risk factor profiles between patients with small vessel disease (lacunae and white matter hyperintensities) and large vessel disease (large territorial or strategical infarcts) in a large cohort of VaD patients.
Methods
Patients with VaD (NINDS-AIREN) were included in a large multicenter treatment trial (the VantagE study). All patients were examined by a neurologist and interviewed about their medical history. Based on MRI, patients were classified as having large vessel VaD, small vessel VaD, or a combination. Other MRI characteristics included white matter hyperintensities (WMH), medial temporal lobe atrophy (MTA) and general cortical atrophy.
Results
Of the 706 patients, 522 (74 %) had small vessel disease, 126 (18 %) had large vessel disease and 58 (8 %) had both. Patients with small vessel disease were older and less educated, and showed more cortical and medial temporal lobe atrophy than patients with large vessel disease. The most prevalent vascular risk factors (hypertension, diabetes and smoking) were equally distributed between the different types of VaD. However, patients with large vessel disease had more hypercholesterolemia and cardiac risk factors compared to patients with small vessel disease.
Conclusion
Cerebrovascular disease underlying VaD consists in the majority of small vessel disease and in about one fifth of large vessel disease. This study demonstrates heterogeneity between these two groups with regard to risk factor profile and atrophy scores on MRI.
Similar content being viewed by others
References
Hachinski VC, Lassen NA, Marshall J (1974) Multi-infarct dementia. A cause of mental deterioration in the elderly. Lancet 2:207–210
Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260
Scheltens P, Launer LJ, Barkhof F, Weinstein HC, van Gool WA (1995) Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol 242:557–560
Bresciani L, Rossi R, Testa C, Geroldi C, Galluzzi S, Laakso MP, Beltramello A, Soininen H, Frisoni GB (2005) Visual assessment of medial temporal atrophy on MR films in Alzheimer’s disease: comparison with volumetry. Aging Clin Exp Res 17:8–13
Barber R, Gholkar A, Scheltens P, Ballard C, McKeith IG, O’Brien JT (1999) Medial temporal lobe atrophy on MRI in dementia with Lewy bodies. Neurology 52:1153–1158
Laakso MP, Partanen K, Riekkinen P, Lehtovirta M, Helkala EL, Hallikainen M, Hanninen T, Vainio P, Soininen H (1996) Hippocampal volumes in Alzheimer’s disease, Parkinson’s disease with and without dementia, and in vascular dementia: An MRI study. Neurology 46:678–681
Du AT, Schuff N, Laakso MP, Zhu XP, Jagust WJ, Yaffe K, Kramer JH, Miller BL, Reed BR, Norman D, Chui HC, Weiner MW (2002) Effects of subcortical ischemic vascular dementia and AD on entorhinal cortex and hippocampus. Neurology 58:1635–1641
Kuller LH, Lopez OL, Jagust WJ, Becker JT, DeKosky ST, Lyketsos C, Kawas C, Breitner JC, Fitzpatrick A, Dulberg C (2005) Determinants of vascular dementia in the Cardiovascular Health Cognition Study. Neurology 64:1548–1552
Barba R, Martinez-Espinosa S, Rodriguez- Garcia E, Pondal M, Vivancos J, Del ST (2000) Poststroke dementia : clinical features and risk factors. Stroke 31:1494–1501
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M (1997) Dementia three months after stroke. Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 28:785–792
Hayden KM, Zandi PP, Lyketsos CG, Khachaturian AS, Bastian LA, Charoonruk G, Tschanz JT, Norton MC, Pieper CF, Munger RG, Breitner JC, Welsh-Bohmer KA (2006) Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County study. Alzheimer Dis Assoc Disord 20:93–100
Birkenhager WH, Forette F, Seux ML, Wang JG, Staessen JA (2001) Blood pressure, cognitive functions, and prevention of dementias in older patients with hypertension. Arch Intern Med 161:152–156
Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson LA, Nilsson L, Persson G, Oden A, Svanborg A (1996) 15-year longitudinal study of blood pressure and dementia. Lancet 347:1141–1145
Ott A, Stolk RP, van HF, Pols HA, Hofman A, Breteler MM (1999) Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 53:1937–1942
Reitz C, Tang MX, Luchsinger J, Mayeux R (2004) Relation of plasma lipids to Alzheimer disease and vascular dementia. Arch Neurol 61:705–714
Ott A, Slooter AJ, Hofman A, van HF, Witteman JC, Van BC, van Duijn CM, Breteler MM (1998) Smoking and risk of dementia and Alzheimer’s disease in a population-based cohort study: the Rotterdam Study. Lancet 351:1840–1843
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 (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
van Straaten EC, Scheltens P, Knol DL, van Buchem MA, van Dijk EJ, Hofman PA, Karas G, Kjartansson O, de Leeuw FE, Prins ND, Schmidt R, Visser MC, Weinstein HC, Barkhof F (2003) Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke 34:1907–1912
Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, Wallin A, Ader H, Leys D, Pantoni L, Pasquier F, Erkinjuntti T, Scheltens P (2001) A new rating scale for agerelated white matter changes applicable to MRI and CT. Stroke 32:1318–1322
Bastos Leite AJ, van Straaten EC, Scheltens P, Lycklama G, Barkhof F (2004) Thalamic lesions in vascular dementia: low sensitivity of fluidattenuated inversion recovery (FLAIR) imaging. Stroke 35:415–419
Pasquier F, Leys D, Weerts JG, Mounier- Vehier F, Barkhof F, Scheltens P (1996) Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts. Eur Neurol 36:268–272
Bastos Leite AJ, van der Flier WM, van Straaten EC, Scheltens P, Barkhof F (2006) Infratentorial abnormalities in vascular dementia. Stroke 37:105–110
Ross GW, Petrovitch H, White LR, Masaki KH, Li CY, Curb JD, Yano K, Rodriguez BL, Foley DJ, Blanchette PL, Havlik R (1999) Characterization of risk factors for vascular dementia: the Honolulu-Asia Aging Study. Neurology 53:337–343
Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju CV (2002) Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet 359:1283–1290
Esiri MM, Wilcock GK, Morris JH (1997) Neuropathological assessment of the lesions of significance in vascular dementia. J Neurol Neurosurg Psychiatry 63:749–753
de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R, Hofman A, Jolles J, van GJ, Breteler MM (2001) Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatry 70:9–14
Barber R, Scheltens P, Gholkar A, Ballard C, McKeith I, Ince P, Perry R, O’Brien J (1999) White matter lesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer’s disease, vascular dementia, and normal aging. J Neurol Neurosurg Psychiatry 67:66–72
Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, Enright PL, O’Leary D, Fried L (1996) Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 27:1274–1282
Basile AM, Pantoni L, Pracucci G, Asplund K, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D (2006) Age, hypertension, and lacunar stroke are the major determinants of the severity of agerelated white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly) Study. Cerebrovasc Dis 21:315–322
Roman GC, Erkinjuntti T, Wallin A, Pantoni L, Chui HC (2002) Subcortical ischaemic vascular dementia. Lancet Neurol 1:426–436
Scheltens P, Erkinjunti T, Leys D, Wahlund LO, Inzitari D, Del ST, Pasquier F, Barkhof F, Mantyla R, Bowler J, Wallin A, Ghika J, Fazekas F, Pantoni L (1998) White matter changes on CT and MRI: an overview of visual rating scales. European Task Force on Age-Related White Matter Changes. Eur Neurol 39:80–89
Firbank MJ, Burton EJ, Barber R, Stephens S, Kenny RA, Ballard C, Kalaria RN, O’Brien JT (2006) Medial temporal atrophy rather than white matter hyperintensities predict cognitive decline in stroke survivors. Neurobiol Aging
Gorelick PB, Nyenhuis DL, Garron DC, Cochran E (1996) Is vascular dementia really Alzheimer’s disease or mixed dementia? Neuroepidemiology 15:286–290
Gold G, Giannakopoulos P, Montes- Paixao JC, Herrmann FR, Mulligan R, Michel JP, Bouras C (1997) Sensitivity and specificity of newly proposed clinical criteria for possible vascular dementia. Neurology 49:690–694
Fein G, Di S, V, Tanabe J, Cardenas V, Weiner MW, Jagust WJ, Reed BR, Norman D, Schuff N, Kusdra L, Greenfield T, Chui H (2000) Hippocampal and cortical atrophy predict dementia in subcortical ischemic vascular disease. Neurology 55:1626–1635
Zekry D, Duyckaerts C, Belmin J, Geoffre C, Herrmann F, Moulias R, Hauw JJ (2003) The vascular lesions in vascular and mixed dementia: the weight of functional neuroanatomy. Neurobiol Aging 24:213–219
Posner HB, Tang MX, Luchsinger J, Lantigua R, Stern Y, Mayeux R (2002) The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology 58:1175–1181
Chimowitz MI, Poole RM, Starling MR, Schwaiger M, Gross MD (1997) Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke. Stroke 28:941–945
Alamowitch S, Eliasziw M, Algra A, Meldrum H, Barnett HJ (2001) Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis. Lancet 357:1154–1160
Khan U, Porteous L, Hassan A, Markus HS (2007) Risk factor profile of cerebral small vessel disease and its subtypes. J Neurol Neurosurg Psychiatry 78:702–706
Andin U, Gustafson L, Brun A, Passant U (2006) Clinical manifestations in neuropathologically defined subgroups of vascular dementia. Int J Geriatr Psychiatry 21:688–697
Pohjasvaara T, Mantyla R, Ylikoski R, Kaste M, Erkinjuntti T (2000) Comparison of different clinical criteria (DSMIII, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences. Stroke 31:2952–2957
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE III (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Staekenborg, S.S., van Straaten, E.C.W., van der Flier, W.M. et al. Small vessel versus large vessel vascular dementia. J Neurol 255, 1644–1651 (2008). https://doi.org/10.1007/s00415-008-0944-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-008-0944-1