Epidemiology of Vascular Dementia

Leys, Didier; Pasquier, Florence; Parnetti, Lucilla

doi:10.1159/000022425

Cited by 24 publications

(20 citation statements)

References 144 publications

(208 reference statements)

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“…A major difficulty for any clinical study on VaD is the lack of a strict and reliable definition [20] anchored in neuropathology [2]. Several clinical criteria for VaD have been developed.…”

Section: Discussionmentioning

confidence: 99%

A Clinico-Pathological Study of Heart and Brain Lesions in Vascular Dementia

Andin¹,

Gustafson²,

Passant³

et al. 2005

Dement Geriatr Cogn Disord

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All vascular dementia (VaD) cases, neuropathologically verified in a longitudinal prospective dementia project, were classified according to the vascular brain lesion type and related to the dementia type and cardiovascular pathology. From 1976 to 1995, there were 175 VaD cases, 49 of which were pure, without Alzheimer pathology and only one type of cerebrovascular lesion. Furthermore, it was found that 6 cases suffered hypoxic hypoperfusive disease, while 7 were found to have large vessel disease and 36 small vessel disease. In addition to Alzheimer pathology, more than one type of vascular brain pathology was found in the remaining 126 cases. In these cases, diagnosed in accordance with the predominant type of VaD, hypoxic-hypoperfusive lesions were found in 55, large vessel lesions in 50 and small vessel lesions in 110 cases. It should be stressed that 87% of all cases with hypoxic hypoperfusive lesions also had Alzheimer pathology. Cardiovascular and aortic pathologies were more prevalent in small vessel dementia than in the other VaD groups. Clinically diagnosed arterial hypertension was significantly associated with small vessel dementia, but not with hypoxic-hypoperfusive dementia. Cardiovascular symptoms varied considerably in frequency between different dementia groups. VaD is a heterogeneous group regarding lesions caused by different pathophysiological mechanisms and with different combinations of brain pathologies. It is therefore necessary to identify the various types of vascular brain lesions for a correlation with clinical symptoms and for diagnostic purposes in the search for risk factors and therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

A Clinico-Pathological Study of Heart and Brain Lesions in Vascular Dementia

Andin¹,

Gustafson²,

Passant³

et al. 2005

Dement Geriatr Cogn Disord

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“…5 A similar trend for male gender is observed for the prevalence and incidence of vascular dementia. 6,7 Accumulating evidence suggests that these differences may be related to female hormones that can both modify the excitability of the cortex 8,9 and exert major neuroprotective effects. 10,11 CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a hereditary small vessel disease of the brain caused by mutations of the Notch3 gene on chromosome 19.…”

mentioning

confidence: 99%

Effects of Gender on the Phenotype of CADASIL

Gunda

Hervé

Godin

et al. 2012

Stroke

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Background and Purpose-In the general population, migraine, cerebrovascular diseases, and vascular dementia differ in many aspects between men and women. CADASIL is considered a unique model to investigate migraine with aura, stroke, and dementia related to ischemic small vessel disease. This study aims to evaluate the effect of gender on the main clinical and neuroimaging characteristics of CADASIL. Methods-Cross-sectional data from 313 CADASIL patients including various clinical and cognitive scores and MRI parameters were compared between men and women, and between those younger and older than the median age of the population corresponding to the usual age of menopause (51 years). Results-At younger than 51 years, migraine with aura was 50% more prevalent in women and stroke was 75% more prevalent in men. After the fifth decade, men had higher National Institutes of Health Stroke Scale and Rankin scores than women and more severe executive dysfunction, although global cognitive scores were similar. Age at first stroke, the number of stroke events, and the prevalence of dementia and psychiatric symptoms did not differ between men and women. Brain volume was lower in men with a trend for a larger volume of lacunar infarcts. Conclusions-In CADASIL, migraine with aura is more frequent in women and stroke is more frequent in men before the age of menopause. This difference seems to vanish after this age limit but may result in a higher degree of cognitive impairment and cerebral atrophy in men at the late stage of the disease. The presumable role of ovarian hormones in these gender-related differences remains to be explored. (Stroke. 2012;43:137-141.)

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“…Cerebrovascular disease was recognized as an important cause of dementia more than 1 century ago 1 and is considered to be the second most common cause of dementia. [2][3][4] Vascular dementia is considered one of the rare preventable dementias, 5 and research is needed on its causes and consequences.…”

mentioning

confidence: 99%

Previous and Incident Dementia as Risk Factors for Mortality in Stroke Patients

Barba

Morin

Cemillán

et al. 2002

Stroke

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Background and Purpose-We sought to determine whether previous or incident dementia increases the risk of mortality after stroke. Methods-We assessed clinical, functional, and cognitive status in 324 consecutive stroke patients who were followed up for 24 months. Prestroke dementia was diagnosed at admission (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria) and poststroke dementia 3 months after stroke (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The proportion of patients surviving in the groups with and without dementia and the relative risk of mortality were calculated with Kaplan-Meier and with Cox proportional hazards analyses, respectively, for prestroke, stroke-related, and poststroke dementia. Results-Forty-nine patients (15.1% of the total sample) were found to have prestroke dementia. Three months after stroke, 75 cases had poststroke dementia: 50 incident cases (20% of 251 reexamined cases) with stroke-related dementia and 25 already demented before the stroke. After a mean follow-up of 16.1Ϯ9.9 months, the proportion of survivors was 20.4% in patients with and 72.6% in those without prestroke dementia. After a mean follow-up of 22.1Ϯ6.7 months, the proportion of survivors was 58.3% in patients with and 95.4% in those without stroke-related dementia. Using multivariate analysis and adjusting for age, sex, hypertension, diabetes, previous stroke, heart disease, and severity and recurrence of stroke, we found the relative risk of mortality associated with prestroke dementia to be 2.1 (95% CI, 1.2 to 3.6), with stroke-related dementia 6.3 (95% CI, 2.3 to 17.3), and with poststroke dementia 8.5 (95% CI, 3.4 to 20.9). Conclusions-Both previous dementia and incident dementia adversely influence long-term survival after stroke, even after adjustment for other predictors of stroke mortality. (Stroke.

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Epidemiology of Vascular Dementia

Cited by 24 publications

References 144 publications

A Clinico-Pathological Study of Heart and Brain Lesions in Vascular Dementia

A Clinico-Pathological Study of Heart and Brain Lesions in Vascular Dementia

Effects of Gender on the Phenotype of CADASIL

Previous and Incident Dementia as Risk Factors for Mortality in Stroke Patients

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