Urinary and gait disturbances as markers for early multi-infarct dementia.

Abstract

In a retrospective study of 84 outpatients with multiinfarct dementia, urinary and gait disturbances were found in 50% and 27%, respectively, and often preceded dementia and discrete stroke-like episodes by more than 5 years. Compared to patients without urinary disturbance, those with urinary dysfunction were predominantly male and more behaviorally impaired, but were similar in age, cognitive score, depression score, computerized tomography findings, and relative survival. Compared to patients without gait disturbance, those with gait abnormality had a higher Hachinski iscbemic score and depression score and were more behaviorally impaired. Urinary and gait abnormalities may be markers for cerebrovascular disease and vascular dementia even in the absence of frank stroke. Damage to bifrontal outflow tracts may be the common pathophysiological mechanism underlying the behavioral and motor symptoms characteristic of vascular dementias. 4 There is presently no accepted treatment for this disease, but there is some rationale for the prevention of MID via the control of risk factors for stroke and by the prophylactic administration of aspirin to patients at risk. Identification of clinical markers for early MID might allow early recognition of highrisk groups so that prophylactic treatment might prevent or delay the development of this fulminant disorder.We therefore examined the prevalence of various risk factors for stroke and vascular disease in our patients with clinical MID. Patients with MID may have a long history of gait or urinary disturbances preceding overt dementia and discrete cerebrovascular events, and we sought to investigate this relation in a retrospective series. Subjects and MethodsThe Geriatric Evaluation Service at The Burke Rehabilitation Center in White Plains, New York, is an outpatient dementia clinic that has studied more than 700 patients over the last 6 years, as described previously.3 All patients had a complete medical, neurological, psychiatric, and neuropsychological evaluation, with laboratory work, brain computerized tomography (CT), and EEG to rule out treatable causes and a modified Hachinski score 6 of 2 6. Patients thought to have a mixed dementia or a multiinfarct state coexistent with Alzheimer's disease were excluded, as were patients with dementias of other etiologies such as head trauma, alcohol abuse, or metabolic encephalopathies. Each patient's record was reviewed for 1) risk factors for and manifestations of vascular disease, 2) family history of hypertension, diabetes mellitus, coronary artery disease, myocardial infarction, and cerebrovascular accident, 3) manifestations of cerebrovascular disease such as stroke, carotid disease or surgery, and transient ischemic attacks (TIA's), 4) neurologic history and examination, 5) scores for ischemic dementia (modified Hachinski score 6 ), cognitive impairment ("mental status quotient" 7 ), behavioral impairment (Haycox score 8 ), and depression (Hamilton score), and 6) brain CT findings.Subgroups with urinary and/or gait dis...

Vascular Dementia

“…This study confirms previous studies relating VaD to diabetes, 27,30 -33 heart disease, [31][32]34 and hypertension. 27,31-32,34 -38 However, the sex interactions for heart condition and high blood pressure are surprising.…”

Reevaluating the Role of Vascular Changes in the Differential Diagnosis of Alzheimer’s Disease and Vascular Dementia

“…Other vascular risk factors have also been associated with VaD. These include advanced age [10,11], male sex [5,10], diabetes mellitus [3,5,12], smoking [5,12], a history of heart disease [8] and atrial fibrillation [3,13].…”

Vascular and Subcortical Dementia

“…WMH is associated with greater risk of stroke, cognitive impairment [30] and cognitive decline [31] as well as an increased risk of developing dementia [32] and cerebrovascular disease. Small vessel disease constitutes a "disruption of the frontalsubcortical or medial temporal limbic circuits" [33,34], which is the cause of the aforementioned disabilities, as well as a marked loss of balance [35]. Especially when resulting in leukoaraiosis, SVD may produce subcortical vascular dementia, characterized by slowed cognition, memory impairment, visual spatial deficits, EF deficits and mood/affect disturbance.…”