The Dutch Vascular Factors in Dementia Study: rationale and design

Abstract

Dementia is a rapidly increasing health problem in the industrialized countries. With the ageing of the population the number of demented persons increases both in relative and absolute terms. Obviously, there is a need for prevention and intervention strategies. We describe the methods and baseline findings of a large study aimed at identifying potentially modifiable vascular, thrombogenic, and metabolic determinants of dementia. The study population consists of subjects 55 years of age or older. Since the vascular wall of the cerebral vessels is different from that of the coronary or peripheral vessels, we formed three subgroups in which vascular risk factors for dementia are studied. Subjects with stroke were distinguished from subjects with coronary or peripheral artery disease, and from subjects without stroke or coronary or peripheral artery disease. To obtain a large enough number of subjects with stroke, cases and controls from a stroke registry were combined with cases and controls of a population-based study from the same region. For the diagnosis of dementia the DSM-III-R criteria were used. Extensive information on cardiovascular risk factors was collected, including indicators of atherosclerosis. Blood and urine were sampled to study platelet function and thrombogenic and metabolic factors. The study population consists of 7,466 subjects, of whom 300 were recruited from a hospital-based stroke registry. Coronary or peripheral artery disease was present in 956 subjects and stroke in 617. Dementia was present in 434 (5.8%) of all subjects. The prevalence of dementia was 3.0, 24.0, and 4.4% in subjects with a history of coronary or peripheral artery disease, a history of stroke, and subjects without a history of coronary or peripheral artery disease or stroke, respectively. The study will allow us to investigate the role of vascular factors in dementia, irrespective of its cause.

Increased Platelet Activation in the Chronic Phase After Cerebral Ischemia and Intracerebral Hemorrhage

“…This procedure was part of the protocol. 4 Although the number of patients is small and the samples were taken after the recurrent event, the findings are in line with those of Davì et al 8 in a different clinical setting. Whether persistent platelet activation is a risk factor for recurrent ischemic events in patients with ischemic and hemorrhagic stroke remains to be investigated in larger studies with longer follow-up.…”

“…4 The most important inclusion criteria for this study were that patients (1) had had ischemic stroke, intracerebral hemorrhage, or TIA with neurological deficit on admission to the hospital; (2) had a reasonable life expectancy and were alive at follow-up; (3) were Ն55 years of age at time of stroke onset; (4) were native Dutch speakers; and (5) were not aphasic or were only mildly aphasic (Ͻ3 on the Aphasia Severity Rating Scale of the Boston Diagnostic Aphasia Examination). Of the 300 patients who met these criteria, we used data from all nondemented patients for whom urinary samples were available.…”

Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related?☆

“…Vascular factors, which may contribute to the development of dementia, have gained growing attention in recent years [10,55]. Particularly hypertension, being a frequently occurring condition with advancing age has come into focus for its major role in the development of stroke and its association with atherosclerosis.…”

A Short Screening Instrument for Poststroke Dementia

“…From March 1, 1993, until January 15, 1996, all consecutive patients who met the criteria for enrolment in The Dutch Vascular Factors in Dementia study were included in the present study. 3 Patients had to be aged Ն55 years and experienced a transient ischemic attack, ischemic stroke, or intracerebral hemorrhage. Patients were excluded when a reliable assessment of dementia could not be made because of aphasia (ie, a score of Ͻ3 on the Aphasia Severity Rating Scale from the Boston Diagnostic Aphasia Examination [BDAE]), 9 severe sensory handicaps (eg, deaf or blind), lowered consciousness level, severe psychiatric symptoms, or insufficient command of the Dutch language.…”

“…[1][2][3] From both a clinical and research perspective, it is therefore important to assess cognitive functioning after stroke. An extended neuropsychological examination, however, may not be necessary in all patients to establish a diagnosis and will be time consuming and costly.…”