1
|
Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnosis of vascular cognitive impairment: recommendations of the scientific department of cognitive neurology and aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s104en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.
Collapse
Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnóstico do comprometimento cognitivo vascular: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:53-72. [DOI: 10.1590/1980-5764-dn-2022-s104pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 12/14/2022] Open
Abstract
RESUMO Desde a publicação das últimas recomendações para o diagnóstico e tratamento da Demência Vascular pela Academia Brasileira de Neurologia em 2011, avanços significativos ocorreram na terminologia e critérios diagnósticos. O presente manuscrito é resultado do consenso entre especialistas indicados pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia (2020-2022). O objetivo foi atualizar as recomendações práticas para a identificação, classificação e diagnóstico do Comprometimento Cognitivo Vascular (CCV). As buscas foram realizadas nas plataformas MEDLINE, Scopus, Scielo e LILACS. As recomendações buscam fornecer uma ampla revisão sobre o tema, então sintetizar as evidências para o diagnóstico do CCV não apenas para neurologistas, mas também para outros profissionais de saúde envolvidos na avaliação e nos cuidados ao paciente com CCV, considerando as diferentes realidades dos níveis de atenção à saúde (primário, secundário e terciário) no Brasil.
Collapse
Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Rundek T, Tolea M, Ariko T, Fagerli EA, Camargo CJ. Vascular Cognitive Impairment (VCI). Neurotherapeutics 2022; 19:68-88. [PMID: 34939171 PMCID: PMC9130444 DOI: 10.1007/s13311-021-01170-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.
Collapse
Affiliation(s)
- Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Magdalena Tolea
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor Ariko
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Fagerli
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J Camargo
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
4
|
Badran A, Hollocks MJ, Brookes RL, Morris RG, Markus HS. Framingham vascular age is associated with worse cognitive performance in the middle-aged and elderly. AGING NEUROPSYCHOLOGY AND COGNITION 2018; 26:531-540. [DOI: 10.1080/13825585.2018.1499866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Abdul Badran
- Churchill College, University of Cambridge, Cambridge, UK
| | - Matthew J. Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, UK
| | - Rebecca L. Brookes
- Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, UK
| | - Robin G. Morris
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, UK
| |
Collapse
|
5
|
Parker KG, Lirette ST, Deardorff DS, Bielak LF, Peyser PA, Carr JJ, Terry JG, Fornage M, Benjamin EJ, Turner ST, Mosley TH, Griswold ME, Windham BG. Relationships of Clinical and Computed Tomography-Imaged Adiposity with Cognition in Middle-Aged and Older African Americans. J Gerontol A Biol Sci Med Sci 2018; 73:492-498. [PMID: 28958070 PMCID: PMC5861889 DOI: 10.1093/gerona/glx163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Adiposity depots may differentially affect cognition. African Americans (AA) have higher rates of obesity and dementia but lower visceral adipose tissue (VAT) than whites, yet are underrepresented in studies of adiposity and cognition. Our study compared relations of cognitive function to clinical adiposity measures and computed tomography (CT)-imaged abdominal adiposity in AA. Methods CT-imaged subcutaneous adipose tissue (SAT) and VAT measurements were obtained in the AA cohort of the Genetic Epidemiology Network of Arteriopathy Study (N = 652, mean age 68 ± 8.4 years, 74% females, 59% obese, 82% hypertensive). Clinical adiposity measures included waist circumference (WC) and body mass index (BMI). Global cognition was operationalized as a global cognitive z-score generated from the average of four cognitive domain z-scores. Generalized estimating equations were used to examine cross-sectional associations between individual standardized adiposity measures and cognition, accounting for age, sex, education, smoking status, and familial clustering. A collective model was constructed including multiple supported adiposity measures and age-by-adiposity interactions. Results In the collective model, higher WC was associated with worse global cognition, β = -0.12 (95%CI: -0.21, -0.03); higher SAT was associated with better cognition, β = 0.09 (0.01, 0.18); higher BMI was associated with worse cognition at younger ages with attenuation at older ages (BMI-by-age-interaction p = .004). VAT was not significantly associated with global cognition, β = -0.03 (-0.07, 0.02). Conclusions WC may be the simplest and most efficient measure of adiposity to assess with respect to cognition in clinical settings, although studies to determine mechanistic effects of subcutaneous and other adiposity depots on cognition are warranted.
Collapse
Affiliation(s)
- Kirby G Parker
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson
- Department of Data Science, University of Mississippi Medical Center, Jackson
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson
| | - David S Deardorff
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson
| | - Lawrence F Bielak
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Patricia A Peyser
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James G Terry
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Myriam Fornage
- Institute of Molecular Medicine, Health Science Center at Houston, University of Texas
| | | | | | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson
| | - Michael E Griswold
- Department of Data Science, University of Mississippi Medical Center, Jackson
| | - B Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson
| |
Collapse
|
6
|
Abstract
BACKGROUND/AIMS The issue of whether sex offenders have cognitive deficits remains controversial. The objective of this study was to compare the neuropsychological function of older adult first time sex-offenders (FTSO), who had not previously been charged with a sexual offence prior to the age of 50, to historical long-term sex offenders (HSO) and non-sex offenders (NSO). The hypotheses were (a) that FTSO would demonstrate greater deficits in executive function, decision-making, and memory compared to non-sex offenders; and (b) the HSOs would present similar neuropsychological deficits to non-sex offenders. METHOD A battery of neuropsychological measures was administered to 100 participants comprising 32 FTSOs, 36 HSOs, and 32 NSOs. RESULTS Both FTSOs and HSOs showed significant impairment on tests of executive function (including verbal fluency, trail-making, and the Hayling test of response inhibition) as well as on tests of verbal and verbal memory compared to NSOs; however, there was no difference between the two sex offender groups. CONCLUSIONS Older adult sex offenders, overall, demonstrated poorer neuropsychological performance than older adult non-sex offenders did, although there was no difference between older first-time and historical offenders. Cognitive deficits may increase the risk of sexual offending due to impaired capacity in self-regulation, planning, judgment, and inhibition. A proportion of older adult sex offenders may be harboring acquired frontal lobe pathology.
Collapse
Affiliation(s)
| | - Philip Boyce
- b Sydney Medical School , University of Sydney , Australia
| | - John Hodges
- b Sydney Medical School , University of Sydney , Australia
| |
Collapse
|
7
|
Pietrzak RH, Laws SM, Lim YY, Bender SJ, Porter T, Doecke J, Ames D, Fowler C, Masters CL, Milicic L, Rainey-Smith S, Villemagne VL, Rowe CC, Martins RN, Maruff P. Plasma Cortisol, Brain Amyloid-β, and Cognitive Decline in Preclinical Alzheimer's Disease: A 6-Year Prospective Cohort Study. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 2:45-52. [PMID: 29560886 DOI: 10.1016/j.bpsc.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/17/2016] [Accepted: 08/29/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal axis dysregulation, which is typically assessed by measuring cortisol levels, is associated with cognitive dysfunction, hippocampal atrophy, and increased risk for mild cognitive impairment and Alzheimer's disease (AD). However, little is known about the role of hypothalamic-pituitary-adrenal axis dysregulation in moderating the effect of high levels of amyloid-β (Aβ+) on cognitive decline in the preclinical phase of AD, which is often protracted, and thus offers opportunities for prevention and early intervention. METHODS Using data from a 6-year multicenter prospective cohort study, we evaluated the relation between Aβ level, plasma cortisol level, and cognitive decline in 416 cognitively normal older adults. RESULTS Results revealed that Aβ+ older adults experienced faster decline than Aβ- older adults in all cognitive domains (Cohen's d at 6-year assessment = 0.37-0.65). They further indicated a significant interaction between Aβ and cortisol levels for global cognition (d = 0.32), episodic memory (d = 0.50), and executive function (d = 0.59) scores, with Aβ+ older adults with high cortisol levels having significantly faster decline in these domains compared with Aβ+ older adults with low cortisol levels. These effects were independent of age, sex, APOE genotype, anxiety symptoms, and radiotracer type. CONCLUSIONS In cognitively healthy older adults, Aβ+ is associated with greater cognitive decline and high plasma cortisol levels may accelerate the effect of Aβ+ on decline in global cognition, episodic memory, and executive function. These results suggest that therapies targeted toward lowering plasma cortisol and Aβ levels may be helpful in mitigating cognitive decline in the preclinical phase of AD.
Collapse
Affiliation(s)
- Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| | - Simon M Laws
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Co-operative Research Centre for Mental Health
| | - Yen Ying Lim
- The Florey Institute, The University of Melbourne, Parkville, Victoria
| | - Sophie J Bender
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia
| | - Tenielle Porter
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Co-operative Research Centre for Mental Health
| | - James Doecke
- The Commonwealth Scientific and Industrial Research Organization, Canberra
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, The University of Melbourne, Kew; National Ageing Research Institute, Parkville, Victoria
| | | | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria
| | - Lidija Milicic
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia
| | - Stephanie Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia
| | - Victor L Villemagne
- The Florey Institute, The University of Melbourne, Parkville, Victoria; Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia; Department of Nuclear Medicine and Centre for PET, Austin Health
| | - Christopher C Rowe
- Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia; Department of Nuclear Medicine and Centre for PET, Austin Health
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, Victoria; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg; Cogstate Ltd., Melbourne, Victoria, Australia
| | | |
Collapse
|
8
|
West RK, Moshier E, Lubitz I, Schmeidler J, Godbold J, Cai W, Uribarri J, Vlassara H, Silverman JM, Beeri MS. Dietary advanced glycation end products are associated with decline in memory in young elderly. Mech Ageing Dev 2014; 140:10-2. [PMID: 25037023 DOI: 10.1016/j.mad.2014.07.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/04/2014] [Accepted: 07/08/2014] [Indexed: 12/28/2022]
Abstract
We recently reported that serum methylglyoxal (sMG) is associated with a faster rate of decline in a global measure of cognition in the very elderly. We here provide for the first time evidence in which high levels of dietary AGE (dAGE) are associated with faster rate of decline in memory in 49 initially non-demented young elderly (p=0.012 in mixed regression models adjusting for sociodemographic and cardiovascular factors). Since modifying the levels of AGEs in the diet may be relatively easy, these preliminary results suggest a simple strategy to diminish cognitive compromise in the elderly and warrant further investigation.
Collapse
Affiliation(s)
- Rebecca K West
- The Icahn School of Medicine at Mount Sinai, New York, NY, US.
| | - Erin Moshier
- The Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Irit Lubitz
- The Sheba Medical Center, The Joseph Sagol Neuroscience Center, Ramat Gan, Israel
| | | | - James Godbold
- The Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Weijing Cai
- The Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Jaime Uribarri
- The Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Helen Vlassara
- The Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Jeremy M Silverman
- The Icahn School of Medicine at Mount Sinai, New York, NY, US; The James J Peters Veterans Affairs Medical Center, Bronx, NY, US
| | - Michal Schnaider Beeri
- The Icahn School of Medicine at Mount Sinai, New York, NY, US; The Sheba Medical Center, The Joseph Sagol Neuroscience Center, Ramat Gan, Israel
| |
Collapse
|
9
|
Young-Bernier M, Kamil Y, Tremblay F, Davidson PSR. Associations between a neurophysiological marker of central cholinergic activity and cognitive functions in young and older adults. Behav Brain Funct 2012; 8:17. [PMID: 22537877 PMCID: PMC3379946 DOI: 10.1186/1744-9081-8-17] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/26/2012] [Indexed: 12/02/2022] Open
Abstract
Background The deterioration of the central cholinergic system in aging is hypothesized to underlie declines in several cognitive domains, including memory and executive functions. However, there is surprisingly little direct evidence regarding acetylcholine’s specific role(s) in normal human cognitive aging. Methods We used short-latency afferent inhibition (SAI) with transcranial magnetic stimulation (TMS) as a putative marker of cholinergic activity in vivo in young (n = 24) and older adults (n = 31). Results We found a significant age difference in SAI, concordant with other evidence of cholinergic decline in normal aging. We also found clear age differences on several of the memory and one of the executive function measures. Individual differences in SAI levels predicted memory but not executive functions. Conclusion Individual differences in SAI levels were better predictors of memory than executive functions. We discuss cases in which the relations between SAI and cognition might be even stronger, and refer to other age-related biological changes that may interact with cholinergic activity in cognitive aging.
Collapse
Affiliation(s)
- Marielle Young-Bernier
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | | | | | | |
Collapse
|
10
|
Yaneva-Sirakova T, Tarnovska-Kadreva R, Traykov L. The role of suboptimal home-measured blood pressure control for cognitive decline. Dement Geriatr Cogn Dis Extra 2012; 2:112-9. [PMID: 22590472 PMCID: PMC3347878 DOI: 10.1159/000337502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM We aim to analyze if there is any correlation between suboptimal home-/self-measured blood pressure values and the results from neuropsychological screening tests for early cognitive impairment. METHODS We studied 325 patients with treated hypertension. Mean age was 66.12 (±10.1) years. There were 119 (36.6%) male and 206 (63.4%) female patients, among them 52 (16%) with atrial fibrillation. Neuropsychological tests performed were the Mini-Mental State Examination, Montreal Cognitive Assessment, and Hachinski Ischemic Score; additionally, home-measured blood pressure was used. RESULTS There is a nonlinear age- and risk factor-dependent correlation between early stages of cognitive impairment and suboptimal home-measured blood pressure. CONCLUSION The use of specific and sensitive neuropsychological tests for early cognitive impairment in patients with suboptimal home-measured blood pressure is effective in the everyday practice.
Collapse
|
11
|
Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLDS. Vascular dementia: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I. Dement Neuropsychol 2011; 5:251-263. [PMID: 29213752 PMCID: PMC5619038 DOI: 10.1590/s1980-57642011dn05040003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the
second most common of all dementias. The present paper aims to define guidelines
on the basic principles for treating patients with suspected VaD (and vascular
cognitive impairment - no dementia) using an evidence-based, systematized
approach. The knowledge used to define these guidelines was retrieved from
searches of several databases (Medline, Scielo, Lilacs) containing scientific
articles, systematic reviews, meta-analyses, largely published within the last
15 years or earlier when pertinent. Information retrieved and selected for
relevance was used to analyze diagnostic criteria and to propose a diagnostic
system encompassing diagnostic criteria, anamnesis, as well as supplementary and
clinical exams (neuroimaging and laboratory). Wherever possible, instruments
were selected that had versions previously adapted and validated for use in
Brazil that take into account both schooling and age. This task led to proposed
protocols for supplementary exams based on degree of priority, for application
in clinical practice and research settings.
Collapse
Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired) - UFRJ, Coordinator of the Cognitive Neurology and Behavior Sector, INDC, CDA/IPUB, UFRJ, Rio de Janeiro RJ, Brazil
| | - Carla Tocquer
- Neurologist, Masters and PhD in Neuropsychology, Claude Bernard University, France
| | - Charles André
- Associate Professor of Neurology, Faculty of Medicine, UFRJ. Medical Director of SINAPSE Rehabilitation and Neurophysiology, Rio de Janeiro RJ, Brazil
| | - Denise Madeira Moreira
- Adjunct Professor of Radiology, School of Medicine, UFRJ. Head of Radiology Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | - Ivan Hideyo Okamoto
- Department of Neurology Neurosurgery, UNIFESP, Institute of Memory, UNIFESP, São Paulo SP, Brazil
| | - José Luiz de Sá Cavalcanti
- Adjunct Professor of Neurology, INDC, UFRJ. Cognitive Neurology and Behavior Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | | |
Collapse
|
12
|
Legge SD, Hachinski V. Vascular cognitive impairment (VCI): Progress towards knowledge and treatment. Dement Neuropsychol 2010; 4:4-13. [PMID: 29213654 PMCID: PMC5619524 DOI: 10.1590/s1980-57642010dn40100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 12/17/2009] [Indexed: 01/08/2023] Open
Abstract
Until recently, the study of cognitive impairment as a manifestation of cerebrovascular disease (CVD) has been hampered by the lack of common standards for assessment. The term vascular cognitive impairment (VCI) encompasses all levels of cognitive decline associated with CVD from mild deficits in one or more cognitive domains to crude dementia syndrome. VCI incorporates the complex interactions among classic vascular risk factors (i.e. arterial hypertension, high cholesterol, and diabetes), CVD subtypes, and Alzheimer's Disease (AD) pathology. VCI may be the earliest, commonest, and subtlest manifestation of CVD and can be regarded as a highly prevalent and preventable syndrome. However, cognition is not a standardized outcome measure in clinical trials assessing functional ability after stroke. Furthermore, with the exception of anti-hypertensive medications, the impact of either preventive or acute stroke treatments on cognitive outcome is not known. Although clinical, epidemiological, neuroimaging, and experimental data support the VCI concept, there is a lack of integrated knowledge on the role played by the most relevant pathophysiological mechanisms involved in several neurological conditions including stroke and cognitive impairment such as excitotoxicity, apoptosis, mitochondrial DNA damage, oxidative stress, disturbed neurotransmitter release, and inflammation. For this reason, in 2006 the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) defined a set of data elements to be collected in future studies aimed at defining VCI etiology, clinical manifestations, predictive factors, and treatment. These recommendations represent the first step toward developing diagnostic criteria for VCI based on sound knowledge rather than on hypotheses. The second step will be to integrate all studies using the agreed methodologies. This is likely to accelerate the search for answers.
Collapse
Affiliation(s)
- Silvia Di Legge
- MD, PhD, Stroke Unit, Department of Neuroscience,
University Tor Vergata, Rome, Italy
| | - Vladimir Hachinski
- MD, FRCPC, DSc, Department of Clinical Neurological
Sciences, London Health Sciences Centre (LHSC) and University of Western Ontario
(UWO), London, ON, Canada
| |
Collapse
|