Neuropsychological Predictors of Incident Dementia in Patients With Vascular Cognitive Impairment, Without Dementia

Abstract

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...

Prospective Follow-Up Study Between 3 and 15 Months After Stroke

“…The association with impairment of language expression is consistent with a report from the Canadian Study for Health and Aging, which focused on a broader group of patients with vascular CIND. 34 Initial memory performance was associated with subsequent decline in the Canadian study but not the present report. This may be explained by the broader group of vascular CIND patients incorporated into the Canadian study or the different time frame of follow-up, with atrophy becoming more important over a 5-year period.…”

Cognitive Functioning in Preclinical Vascular Dementia

“…This is an interesting pattern of results because studies on AD have consistently found episodic memory functioning to be impaired preclinically. 4,16 The present findings confirm previous observations that cognitive impairment might be an early sign of VaD as well as AD [5][6][7][8][9][10] and provide further evidence of similarities in the pattern of cognitive deficits before diagnosis in these dementia disorders. 6,7 At time of diagnosis, the incident VaD group showed deficits on all MMSE subscales except reading and writing.…”

“…3,4 A more recent observation is that cognitive deficits may be present during the years before a VaD diagnosis. [5][6][7][8][9][10] In 2 previous studies, we found deficits in global cognitive functioning, 6 as measured by the MiniMental State Examination (MMSE), 11 as well as in episodic memory 7 in persons who developed VaD 3 years later compared with normal controls. Relatedly, using the MMSE, Meyer et al 9 observed deficits and a faster decline during the following 6 months in a group of cognitively impaired persons who developed VaD an average of 4 years later compared with a group with stable cognitive impairment.…”

“…Relatedly, using the MMSE, Meyer et al 9 observed deficits and a faster decline during the following 6 months in a group of cognitively impaired persons who developed VaD an average of 4 years later compared with a group with stable cognitive impairment. Ingles et al 5 found that worse episodic memory and category fluency performance predicted dementia incidence within 5 years in a group classified with vascular cognitive impairment, no dementia (CIND). Thus, in addition to risk factors such as old age and various vascular conditions, degree of cognitive impairment may be predictive of future VaD.…”

Rate of progression of mild cognitive impairment to dementia – meta‐analysis of 41 robust inception cohort studies

“…Equally, we excluded studies where the sample size of cases or controls was less than 20 subjects (26,27). We excluded studies of cognitive impairment that were dependent upon specific aetiological factors such as alcohol (Wernicke-Korsakoff dementia), vitamin or metabolic deficiencies or infections, unless other types of dementia were measured (28,29). We excluded case-control studies, which had no longitudinal period of observation (30,31).…”