Longitudinal measurements of cognitive ability measured by serial testing using the Cognitive Capacity Screening Examination (CCSE) were correlated with cerebral blood flow (CBF) throughout (mean ± SD) 19.9 ± 12.6 months among 57 patients with multi-infarct dementia, 17 with dementia of the Alzheimer's type, 10 with both, and among 32 age-matched elderly normal controls. Longitudinal CCSE and CBF measurements among controls yielded stable normative values. Reduced mean CCSE scores correlated directly with CBF reductions in patients with multi-infarct dementia (p<0.0005) and dementia of the Alzheimer's type (p<0.028). Patients with multi-infarct dementia had CCSE scores with retest variability exceeding those of controls (p<0.001) and of patients with dementia of the Alzheimer's type (p<0.003). CCSE scores and CBF changed together 78.6% (jXO.001) of the time in patients with multi-infarct dementia compared with 66.2% of the time (jKO.Ol) in those with both, 62.9% of the time (/X0.05) in those with dementia of the Alzheimer's type, and 47.7% of the time (NS) in controls. Further analyses indicated that changes in CCSE scores and CBF were predominantly progressive declines in patients with dementia of the Alzheimer's type, whereas the changes were more bidirectional (both increases and decreases) in patients with multi-infarct dementia; these differences were also significant. Results support the diagnostic usefulness of the Hachinski ischemic scale and confirm that both cognition and CBF fluctuate together among patients with multi-infarct dementia, whereas patients with dementia of the Alzheimer's type exhibit a more stable course, with progressive declines in cognition and CBF. (Stroke 1988;19:163-169) A lthough carefully controlled prospective studies of large numbers of well-identified cases are lacking, clinical experience with patients suffering from dementia suggest that dementia of the Alzheimer's type (DAT) is characterized by an insidious onset that is followed by slow, progressive declines in cognitive performance.1 " 3 Impairments of recent memory are the hallmarks of DAT, although there are usually acompanying declines in communication skills, interpersonal relationships, and behavior.'" 3 Multi-infarct dementia (MID) characteristically begins with more abrupt onset, followed by a stepwise and fluctuating course. 4 Sometimes there may be sustained improvements, particularly if risk factors for stroke such as hypertension and smoking are controlled.6 These risk factors are frequently present in patients with MID, and hypertension is the most prevalent.
A cohort of 52 patients (30 men and 22 women) with multi-infarct dementia (MID) has been followed up prospectively for a mean interval of 22.2 months. Clinical course has been documented by serial history taking and interviews and neurological, medical, and psychological examinations, and correlated with measurements of cerebral blood flow. The clinical course and cognitive performance have been compared with those of age-matched normal volunteers and patients with Alzheimer's disease. Patients with MID were subdivided into hypertensive and normotensive groups, and also into those displaying stabilized or improved cognition and those whose condition deteriorated. Among hypertensive patients with MID, improved cognition and clinical course correlated with control of systolic blood pressure within upper limits of normal (135 to 150 mm Hg), but if systolic blood pressure was reduced below this level, patients with MID deteriorated. Among normotensive patients with MID, improved cognition was associated with cessation of smoking cigarettes.
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