Cognitive Functioning in Preclinical Vascular Dementia

Abstract

Background and Purpose-Recent studies have shown that cognitive deficits are present during the years preceding a diagnosis of vascular dementia (VaD). The aims of this study were to (1) extend previous research by examining whether cognitive deficits are already present 6 years before diagnosis, and (2) examine the strength of the association between cognitive performance and a future VaD diagnosis after controlling for previous vascular disorders. Methods-Subjects from a population-based study of very old persons (Ն75) were examined with a test of global cognitive functioning (the Mini-Mental State Examination [MMSE]) at 3 occasions over a 6-year period. The study sample was nondemented the first 2 measurement times. On the last occasion, 22 individuals were diagnosed with VaD, and 450 persons remained nondemented. Results-The preclinical VaD group showed no MMSE deficits 6 years before diagnosis (PϾ0.10) compared with the controls. However, 3 years before diagnosis, poor cognitive performance was significantly associated with forthcoming VaD after controlling for demographic factors and prior vascular disorders (odds ratio, 2.55; 95% CI, 1.67 to 3.89). Conclusions-This study extends previous findings on preclinical cognitive deficits in VaD and suggests that cognitive measures can be useful in the process of recognizing individuals at risk for developing VaD to initiate early treatment.

Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease

“…Previous longitudinal studies that mostly used MMSE as a screening instrument indicated that cognitive deficits may be present during the years before a diagnosis of vascular dementia is established [36][37][38][39]. Meyer et al reported faster cognitive decline during the six-month period in cognitively impaired persons who developed VaD an average of 4 years later, compared with a group with stable cognitive impairment [38].…”

“…Meyer et al reported faster cognitive decline during the six-month period in cognitively impaired persons who developed VaD an average of 4 years later, compared with a group with stable cognitive impairment [38]. Laukka et al observed preclinical cognitive deficits preceding VaD during the six-year period and found no MMSE deficits 6 years before the diagnosis, but 3 years before the occurrence of VaD poor MMSE scores were significantly related to the future dementia [39]. In our study, MoCA scores showed that one-third of individuals with increased vascular risk but without stroke or TIA had cognitive impairment after the six-month follow-up period.…”

MRI confirms mild cognitive impairments prodromal for Alzheimer's, vascular and Parkinson-Lewy body dementias

“…When vascular neuropathology is confined to subcortical regions of the brain, often termed subcortical ischemic vascular dementia (SIVD), the onset and progressive course of resultant dementing processes are often insidious and mimic DAT [62]. Recent studies have revealed that VaD, especially SIVD, have prodromal stages similar to DAT, which have been termed vascular MCI, with distinctive cognitive profiles different from amnestic MCI, and reminiscent of, but less severe when compared with VaD [12,45,46,[63][64][65]. Few studies have described MRI features of vascular MCI compared with other MCI subtypes and with converted dementia subtypes [30][31][32].…”

Cognitive Status, Stroke Symptom Reports, and Modifiable Risk Factors Among Individuals With No Diagnosis of Stroke or Transient Ischemic Attack in the RE asons for G eographic and R acial D ifferences in S troke (REGARDS) Study

“…These deficits, which can be detected with brief screenings of cognitive function 9 such as the Mini Mental State examination 10 and the Six-item Screener, 11 are related to diagnosed and preclinical vascular disorders 6 -8,12,13 (Wood FB, et al, unpublished data) and are predictive of vascular, neurodegenerative, and mixed dementia up to 3 years before diagnosis. 9,14 This study extends previous research by capitalizing on the large, geographically dispersed, race-and gender-balanced sample of REGARDS subjects. Using stroke symptom reports as a marker of stroke risk and possible undiagnosed stroke, we posited that those reporting stroke symptoms would have worse cognitive status than those without symptoms.…”