Vascular dementia--still overdiagnosed.

Brust, James C.M.

doi:10.1161/01.str.14.2.298

Cited by 40 publications

(13 citation statements)

References 35 publications

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“…AD may often have an atypical course, including focal symptoms [5], abrupt onset [31] and stepwise deterioration [31], suggesting MID, and MID often has an insidious onset and gradual course [5,[31][32][33] and may be mistaken for AD. Furthermore, VAD may be overdiagnosed [13], by both histological [26] and clinical [26] criteria, as neither clinical nor pathological evidence of stroke or vascular disease necessarily means that they caused the dementia [9,27]. However, MID may also be underdiagnosed [32,33] as many infarctions are clinically silent, without evidence of stroke or focal neurological symptoms and signs [7,14,33].…”

Section: Clinical Diagnosismentioning

confidence: 99%

Risk Factors for Vascular Dementia: A Review

Skoog¹

1994

Dement Geriatr Cogn Disord

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In recent years, interest in vascular causes of dementia has increased and it has been proposed that vascular dementia (VAD) may be more common than previously supposed. This may have important implications, because VAD at present may be more amenable to prevention and treatment than Alzheimer''s disease (AD). Several vascular factors have been related to cognitive decline and dementia in the elderly, including stroke and white matter disease. However, while numerous case-control studies have been concerned with the risk factors for AD, studies on risk factors for VADs are rare. The problems inherent in the diagnostic criteria make it difficult to interpret the results from the few studies that have been performed. Generally, risk factors for multi-infarct dementia are supposed to be the same as those for stroke, and include hypertension, diabetes mellitus, advanced age, male sex, smoking and cardiac diseases. White matter dementia has mainly been related to hypertension. Recent research suggests that vascular factors may also be important in AD, especially in the late-onset type. In stroke patients, dementia has been associated with higher age, less formal education, cerebral atrophy, left-sided or bilateral infarcts, volume of macroscopic infarcts, bilateral symptoms, previous stroke and white matter lesions. The pathogenetic mechanism through which these factors cause dementia is still not clear. Furthermore, it is not known if risk factors for VAD differ from those found in stroke patients. There is now an urgent need for further research on risk factors for VAD and on factors related to dementia in subjects with cerebrovascular disorders.

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Section: Clinical Diagnosismentioning

confidence: 99%

Risk Factors for Vascular Dementia: A Review

Skoog¹

1994

Dement Geriatr Cogn Disord

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“…Their number and position were recorded, and their volume was calculated from serial photographs of the posterior surface of the coronal slices, using computer aided planimetry. In five cases (2,6,14,16,18) the volume was calculated from direct measurement of the macroscopic infarcts in the brain sections. The degree of macroscopic status cribriformis in the white matter and the severity of atherosclerosis in the circle of Willis were visually rated as absent, mild, moderate or severe.…”

Section: Neuropathological Evaluationmentioning

confidence: 99%

Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study.

Erkinjuntti

Haltia

Palo

et al. 1988

Journal of Neurology, Neurosurgery & Psychiatry

231

118

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SUMMARY Brains from a prospective study of demented patients were investigated post mortem. Of the 27 patients with clinical diagnosis of vascular dementia, 23 showed multiple cerebral infarcts but senile plaques and neurofibrillary tangles were absent or in insignificant numbers. This gives an accuracy of 85%, a figure higher than previously documented.The two most common causes of dementia are Alzheimer's disease and widespread ischaemic lesions of the brain, commonly referred to as multi-infarct dementia (MID).1 2 Dementia may also be due to a combination of these two conditions,34 and to a number of other disorders.5Few studies have been published on the accuracy of the clinical diagnosis of these diseases as verified post mortem.6-12 For Alzheimer's disease the accuracy has varied from 52 to 85%6-12 and for multi-infarct dementia from 21 to 82%.6-8 10 11 The low accuracy of the clinical diagnosis of multi-infarct dementia has led researchers to question the reliability of its antemortem diagnosis.'3 14 We carried out a post mortem neuropathological investigation of demented patients admitted to departments of internal medicine and neurology. The patients had all been subjected to extensive clinical investigations, including psychometric analysis and computed tomography of the head (CT). The value of CT scans and ischaemic scores4 15 in the differential diagnosis between Alzheimer's disease and multiinfarct dementia was also investigated. Patients and methods Clinical evaluationThis prospective study is a follow-up of 233 consecutively admitted patients recruited from a study on

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“…The significance of silent infarcts for predicting possible future cognitive decline and risk of recurrent stroke deserves further study. 47 One large study included a control group for comparison but selected only transient ischemic attack or minor stroke patients without atrial fibrillation, restricting conclusions to this subgroup. 12 Some studies of unselected stroke patients were small or retrospective, not allowing any firm conclusions.…”

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confidence: 99%

“…However, this view was more often based on flawed inferences than on the results of prospective evaluation of patients being compared with those without silent brain infarcts. 47 - 60 Patients with multiple asymptomatic lesions in the NINDS study were "free of overt symptoms in cognitive or behavioural spheres." 2 - 45 Jorgensen et al 1 found silent infarcts to have no effect on Mini-Mental State Examination ratings.…”

mentioning

confidence: 99%

Silent brain infarcts in 755 consecutive patients with a first-ever supratentorial ischemic stroke. Relationship with index-stroke subtype, vascular risk factors, and mortality.

Boon

Lodder

Raak

et al. 1994

Stroke

117

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Background and PurposeWe wanted to establish independent associations of various clinical variables, computed tomographic (CT) scan features, presenting stroke subtypes, and outcome with the presence of silent infarcts on CT.Methods We studied 755 consecutive patients in a prospective registration of patients with first-ever supratentorial atherothrombotic, cardioembolic, or lacunar stroke or stroke of undetermined cause by multiple logistic regression analysis.Results Two hundred six patients (27%) with a first symptomatic territorial or small deep ischemic stroke had one or more silent infarcts on CT. Of all silent lesions, 169 (82%) were small and deep. Silent infarcts were significantly more strongly associated with a lacunar than atherothrombotic (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.02 to 2.47; P=.O39) or cardioembolic (OR, 1.89; 95% CI, 1.2 to 2.99; P=.OO5) index stroke. Silent territorial lesions were more strongly associated with cardioembolic than with lacunar stroke but not with atherothrombotic stroke. In this respect, no differences were found between the atherothrombotic and undetermined-cause group. Advanced age and hypertension were the only risk factors that were significantly associated with silent infarcts (OR, 1.76; 95% CI, 1.14 to 2.71; P=.0U; and OR, 1.58; 95% CI, 1.13 to 2.21; P=.001; respectively), mainly because of a strong independent association of these risk factors with silent small deep infarcts (OR, 1.75; 95% CI,

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Vascular dementia--still overdiagnosed.

Cited by 40 publications

References 35 publications

Risk Factors for Vascular Dementia: A Review

Risk Factors for Vascular Dementia: A Review

Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study.

Silent brain infarcts in 755 consecutive patients with a first-ever supratentorial ischemic stroke. Relationship with index-stroke subtype, vascular risk factors, and mortality.

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