Background-Vascular cognitive impairment that does not fulfill dementia criteria (ie, vascular cognitive impairment, no dementia [CIND]) is common. Although progression to dementia is frequent, little is known about factors that predict progression. We examined whether performance on neuropsychological tests administered at baseline could predict incident cases of dementia in patients with vascular CIND after 5 years. Summary of Report-The Canadian Study of Health and Aging is a prospective, cohort study of 10 263 randomly selected persons aged Ն65 years. Of 149 people diagnosed with vascular CIND, 125 completed a battery of neuropsychological tests at baseline. Follow-up cognitive diagnoses were available for 102 individuals. After 5 years, 45 patients (44%) developed dementia. Low baseline scores on tests of memory and category fluency were associated with incident dementia. Key Words: cerebrovascular disorders Ⅲ dementia Ⅲ neuropsychology V ascular cognitive impairment (VCI) forms a spectrum that includes vascular dementia (VaD), Alzheimer disease (AD) with a vascular component (referred to as mixed AD), and vascular cognitive impairment that does not meet dementia criteria (referred to as vascular cognitive impairment, no dementia [CIND]). 1 In the vascular CIND subtype, dementia may be excluded because the cognitive impairment is focal and/or memory is relatively spared or because it is not sufficiently severe to cause functional impairment.
Conclusions-NeuropsychologicalIn the Canadian Study of Health and Aging (CSHA), vascular CIND was the most prevalent form of VCI (2.6% for those aged Ն65 years) and conferred an increased risk of death and institutionalization. 2 Within 5 years, approximately half of this group progressed to dementia, although no clinical or demographic factors other than sex (women were at greater risk) predicted progression to dementia. 3 However, the role of neuropsychological variables, which have been useful in predicting the development of AD from mild cognitive impairment, 4 has not yet been considered.We examined whether performance on neuropsychological tests administered at baseline could predict incident cases of dementia in this vascular CIND group. Specifically, we were interested in whether the incident dementia cases displayed the "frontal-subcortical" pattern characteristic of vascular dementia 5 or the "temporal-neocortical" pattern characteristic of AD. 6
Subjects and MethodsThe CSHA is a prospective, cohort study of 10 263 randomly selected community-and institutional-dwelling persons, aged Ն65 years. 7,8 In 19917,8 In -1992, all institutional participants and community participants who scored Ͻ78 of 100 on the Modified Mini-Mental State (3MS) 9 examination received a clinical assessment (nϭ2914). Participants were diagnosed with vascular CIND if they met the following criteria: (1) they had cognitive impairment that did not meet the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia 10 (ie, they did not hav...
The efficacy of attention rehabilitation after an acquired brain injury was examined metaanalytically. Thirty studies with a total of 359 participants met the authors' selection criteria. Studies were categorized according to whether training efficacy was evaluated by comparing pre-and posttraining scores only or included a control condition as well. Performance improved significantly (using the d + statistic) after training in pre-post only studies but not in pre-post with control studies. Further analyses showed that specific-skills training significantly improved performance of tasks requiring attention but that the cognitive-retraining methods included in the meta-analysis did not significantly affect outcomes. These findings demonstrate that acquired deficits of attention are treatable using specific-skills training. Implications of these results for rehabilitation theory and future research are discussed.
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