Behavioural and Psychological Symptoms in Poststroke Vascular Cognitive Impairment

Abstract

Background. Behavioural and psychological symptoms of dementia (BPSD) cause significant patient and caregiver morbidity in vascular cognitive impairment (VCI). Objectives. To study and compare the occurrence and severity of BPSD between multi-infarct dementia (MID), subcortical ischaemic vascular disease (SIVD), and strategic infarct subtypes of poststroke VCI and to evaluate the relationship of these symptoms with the severity of cognitive impairment. Methods. Sixty patients with poststroke VCI were classified into MID, SIVD, and strategic infarct subtypes. BPSD were studied by the neuropsychiatric inventory (NPI). The severity of cognitive impairment was evaluated by the clinical dementia rating scale (CDR). Results. 95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI. Strategic infarct patients had the lowest frequency of all symptoms. SIVD showed a higher frequency and severity of apathy and higher total NPI scores, compared to MID. Apathy and appetite disturbances occurred more commonly with increasing CDR scores. The total NPI score correlated positively with the CDR score. Conclusion. Depression was the commonest neuropsychiatric symptom in VCI. The neuropsychiatric profiles of MID and SIVD were similar. The frequency and severity of apathy and the net burden of BPSD increased with increasing cognitive impairment.

Progressively Disrupted Brain Functional Connectivity Network in Subcortical Ischemic Vascular Cognitive Impairment Patients

“…Structural abnormality evidence has shown that the cortex thins in the parietal and temporal cortices as cognitive impairment worsens ( 4 ). Thus, this finding is compatible with previous studies, and the gradual progression of decreased nodal efficiency in parietal/temporal areas suggested that their lower capacity for information exchange with other nodes in the network presumably occurred in response to non-cognitive consequences such as apathy and slower motor function in patients with cognitive impairment caused by SIVD ( 3 , 41 , 42 ).…”

Disrupted Brain Structural Connectivity Network in Subcortical Ischemic Vascular Cognitive Impairment With No Dementia

“…Moreover, Thong et al (2014) found that the parietal and temporal cortices thin as cognitive impairment worsens in patients with cognitive impairment caused by SIVD, showing evidence of structural alterations in SIVCIND patients. Additionally, decreased nodal efficiency in the parietal/temporal areas suggests that their lower capacity for information exchange in the structural connectivity network is presumably associated with non-cognitive symptoms such as apathy and decreased motor function in SIVCIND patients (Gupta and Dasgupta, 2014).…”

Vascular cognitive impairment and dementia

“…Depression scales that have been shown to be sensitive to stroke-related mood disturbance include the Beck Depression Inventory and the Center for Epidemiologic Studies Depression Scale (CES-D) [126,127]. The Frontal Systems Behavior Scale (FrSBe) examines for the presence of dysexecutive, disinhibitive and apathetic behaviors both before and after a stroke, and has been found to be useful in this population [128], as has the Neuropsychiatric Inventory [129]. Both scales utilize a collateral source who knows the patient well as an informant for behavioral change and/or mood disturbance.…”