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Hachinski and co-workers have used the term vascular cognitive impairment-no dementia (VaCIND) to represent the earliest stages of cognitive decline associated with vascular changes [Neurology 57 (4) (2001) 714]. However, the neuropsychological profile of vascular CIND remains unclear. Twenty-five healthy elders, 29 individuals at risk for cerebrovascular disease (R-CVD), 18 individuals with VaCIND, and 26 individuals with vascular dementia (VaD) were examined to determine whether patterns of neuropsychological assessment performance can assist in the differentiation of patients at varying levels of risk and severity for cerebrovascular disease and VaD. The R-CVD group performed within normal expectations on most cognitive measures as compared to the elderly control sample and published clinical norms. Relative to elderly controls, the VaCIND group demonstrated significant difficulties on measures of cognitive flexibility, verbal retrieval, and verbal recognition memory, but not on measures of confrontational naming or verbal fluency. The VaD group was impaired on all cognitive measures assessed. The current findings suggest that poor cognitive flexibility and verbal retrieval in the context of preserved function in other domains may characterize the prodromal stage of VaD.

The study focused on the role of traditional and computer-administered visual attention and executive measures in the prediction of driving competence in older individuals with early-stage cognitive decline. A group of 23 patients with questionable dementia by Clinical Dementia Rating (CDR=0.5) was evaluated with a group of 23 age-matched controls. For the patient group, correlational analyses revealed that road-test performance was significantly related to a number of executive and visual attention measures but not to other neuropsychological measures. For the control group, road-test performance was only significantly related to age. A hierarchical regression procedure was utilized to further explore the contribution of specific executive and visual attention measures and 46% of the variance in road-test performance was attributable to these measures for the patient group. A discriminant function analysis utilizing executive and visual attention measures for the entire group of participants classified those who passed and failed the road test with 80% accuracy. Neuropsychological executive and visual attention measures may play a useful role in determining competence to drive in older individuals with early-stage cognitive decline.

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