Little is known about progression, short of dementia, in vascular cognitive impairment. In the Canadian Study of Health and Aging, 149 participants (79.3 +/- 6.7 years; 61% women) were found to have vascular cognitive impairment, no dementia (CIND). After 5 years, 77 participants (52%) had died and 58 (46%) had developed dementia. Women were at greater risk of dementia (OR 2.1, 1.0 to 4.5). Of 32 participants alive without dementia, cognition had deteriorated in seven and improved in four. Half of those with vascular CIND developed dementia within 5 years, suggesting a target for preventive interventions.

Failure to consider vascular cognitive impairment without dementia underestimates the prevalence of impairment and the risk for adverse outcomes associated with vascular cognitive impairment.

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...

If vascular risk factors are risk for Alzheimer's disease (AD), and if "pure" vascular dementia (VaD) is less common than has been thought, what do we make of the diagnosis of mixed dementia? We report characteristics of those with mixed dementia in a prospective, seven center, clinic-based Canadian study. Of 1,008 patients, 372 were diagnosed with AD, 149 with vascular cognitive impairment (VCI) including 76 with mixed AD/VaD, and 82 with other types of dementia. The mean age of patients with mixed AD/VaD was 78.0 +/- 7.6 years; 49% were female. These proportions differed significantly between dementia diagnosis subgroup (p < 0.001) showing a trend which is evident in all comparisons--AD/VaD patients fall in between AD and VaD. Vascular risk factors were present significantly more often in mixed AD/VaD than in AD (p < 0.001). More mixed AD/VaD (20%) than AD patients (4%) had focal signs, compared with 38% of those with vascular dementia and 12% with other types of dementia. Between the initial clinical diagnosis and the final diagnosis (which utilized neuroimaging and neuropsychological data) AD/VaD was the least stable diagnosis. Neuroimaging of ischemic lesions was the most common reason for reassignment from AD to the mixed AD/VaD diagnosis (17 cases). These data suggest that an operational definition of mixed AD/VaD can be proposed on presentation and clinical/radiographic findings, but indifferent to vascular risk factors. The concept of mixed dementia should be extended to include vascular dementia in combination with dementias, other than Alzheimer's disease.

Regular exercise in elderly people has beneficial health effects. We examined exercise frequency and intensity from the Canadian Study of Health and Aging Risk Factor Questionnaire (RFQ). The reliability and validity of these two questions individually, and when combined to form a scale, are reported. Agreement between the self-administered RFQ and an interviewer-administered Add-on Study was examined using intraclass correlations, which were 0.80 for frequency (95% CI 0.77-0.82, p < ,001) and 0.75 for intensity (95% CI 0.71-0.78, p = .012). Individuals reporting high levels of exercise frequency, intensity, and a combination of the two showed a smaller proportion of adverse health markers than those reporting no regular exercise. Predictive validity assessed by Cox proportional hazards modeling of mortality showed that the high and moderate levels of frequency, intensity, and combined exercise groups differed significantly (allp < .OOl) from the no exercise group. We have found that these exercise questions, though simple, appear reliable and valid. The finding that even comparatively crude exercise questions can demonstrate an important relationship to death suggests that the signal for exercise is a strong one, and future studies should seek to better examine mechanisms by which exercise benefit is conferred. Regular exercise in elderly people has beneficial health effects including aerobic fitness, muscle strength and feeling of vigor (Engels et al., 1998), increased physiological and cognitive functioning