Background/Aims: To describe the natural history of the prodromal stages of ischemic vascular dementia (pVaD). Methods: A sample of 314 inpatients with pVaD or a clini- cal diagnosis of vascular dementia (VaD; lacunar state, Binswanger’s disease, pure cortical VaD, corticosubcortical and strategic infarctions) admitted to a teaching tertiary center during a 13-year period was assessed (retrospectively n = 88, prospectively n = 226). Prospective neuropsychological assessment consisted of Mini Mental State Examination, Revised Wechsler Adult Intelligence Scale, Exit-25, Trail Making tests, Blessed Dementia Scale and Camdex H, Global Depression Scale and Hamilton Depression Rating Scale tests. Univariate analysis and logistic regressions are displayed. Results: An unrecognized pVaD was related with a clinical onset with cognitive impairment no dementia (CIND) versus symptomatic cerebrovascular events (p < 0.0001), and with being under therapy with anticoagulant or antiplatelet agents (p < 0.01). Age <85 years at diagnosis of VaD (p < 0.01) correlated with a delayed pVaD diagnosis. CIND onset was associated with a longer prodromal stage (p < 0.01), no clinical strokes during pVaD (p < 0.001), silent ischemia (p < 0.01) and Binswanger’s disease (p < 0.01). Conclusions: Vascular cognitive impairment remains an underdiagnosed, yet treatable entity. A brief neuropsychological examination and informant interviews should become standard practice in elderly populations with vascular risk factors. Small-vessel disease is a prevalent condition with a distinct natural history.
This article studies the trend in wage discrimination in Spain from 1995 to 2002, when the third plan for equal opportunities for men and women was in action. To account for the criticism of Heckman, Lochner, and Todd (2008), we first introduce a novel approach to the analysis of wage discrimination with methods that are robust to model (mis-) specification. Following their idea, we apply semiparametric methods for the Oaxaca-Blinder decomposition of wage differentials between men and women. We extend the methodology to semiparametric quantile estimation. The study is completed by some descriptive analysis, also based on nonparametric techniques. We find that, while the wage gap has diminished from 1995 to 2002 this is mainly due the smaller gap in returns of endowments for wages above the median, and due to the endowments of women for lower and particularly high wages. Respective the quantiles, in contrast to other EU member states, the Spanish wage gap is widest for low wages but almost U-shaped in 2002 whereas this was not that evident in 1995.
Large- and small-vessel cerebrovascular diseases are common and costly conditions. Vascular cognitive impairment presenting with stroke may incur greater expenses than VCI onset without stroke. Thus, patients with large-vessel disease incurred higher costs during the VCI stage. Care became more onerous at an advanced VaD stage in all groups. During the VaD stage, the expenditures of patients with Binswanger's disease were significantly higher and eventually counterbalanced the initially lower costs seen during the VCI stage.
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