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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.
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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
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2
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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.
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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
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Celle S, Boutet C, Annweiler C, Ceresetti R, Pichot V, Barthélémy JC, Roche F. Leukoaraiosis and Gray Matter Volume Alteration in Older Adults: The PROOF Study. Front Neurosci 2022; 15:747569. [PMID: 35095388 PMCID: PMC8793339 DOI: 10.3389/fnins.2021.747569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose: Leukoaraiosis, also called white matter hyperintensities (WMH), is frequently encountered in the brain of older adults. During aging, gray matter structure is also highly affected. WMH or gray matter defects are commonly associated with a higher prevalence of mild cognitive impairment. However, little is known about the relationship between WMH and gray matter. Our aim was thus to explore the relationship between leukoaraiosis severity and gray matter volume in a cohort of healthy older adults. Methods: Leukoaraiosis was rated in participants from the PROOF cohort using the Fazekas scale. Voxel-based morphometry was performed on brain scans to examine the potential link between WMH and changes of local brain volume. A neuropsychological evaluation including attentional, executive, and memory tests was also performed to explore cognition. Results: Out of 315 75-year-old subjects, 228 had punctuate foci of leukoaraiosis and 62 had begun the confluence of foci. Leukoaraiosis was associated with a decrease of gray matter in the middle temporal gyrus, in the right medial frontal gyrus, and in the left parahippocampal gyrus. It was also associated with decreased performances in memory recall, executive functioning, and depression. Conclusion: In a population of healthy older adults, leukoaraiosis was associated with gray matter defects and reduced cognitive performance. Controlling vascular risk factors and detecting early cerebrovascular disease may prevent, at least in part, dementia onset and progression.
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Affiliation(s)
- Sébastien Celle
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
- *Correspondence: Sébastien Celle,
| | - Claire Boutet
- Department of Radiology, University Hospital, Saint Etienne, France
- EA7423 TAPE, UJM, Saint-Étienne, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UPRES EA4638, University of Angers, Angers, France
| | - Romain Ceresetti
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Vincent Pichot
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Jean-Claude Barthélémy
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
| | - Frédéric Roche
- Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France
- INSERM, U1059, SAINBIOSE, DVH, Saint-Étienne, France
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Zhang X, Xue C, Cao X, Yuan Q, Qi W, Xu W, Zhang S, Huang Q. Altered Patterns of Amplitude of Low-Frequency Fluctuations and Fractional Amplitude of Low-Frequency Fluctuations Between Amnestic and Vascular Mild Cognitive Impairment: An ALE-Based Comparative Meta-Analysis. Front Aging Neurosci 2021; 13:711023. [PMID: 34531735 PMCID: PMC8438295 DOI: 10.3389/fnagi.2021.711023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Changes in the amplitude of low-frequency fluctuations (ALFF) and the fractional amplitude of low-frequency fluctuations (fALFF) have provided stronger evidence for the pathophysiology of cognitive impairment. Whether the altered patterns of ALFF and fALFF differ in amnestic cognitive impairment (aMCI) and vascular mild cognitive impairment (vMCI) is largely unknown. The purpose of this study was to explore the ALFF/fALFF changes in the two diseases and to further explore whether they contribute to the diagnosis and differentiation of these diseases. Methods: We searched PubMed, Ovid, and Web of Science databases for articles on studies using the ALFF/fALFF method in patients with aMCI and vMCI. Based on the activation likelihood estimation (ALE) method, connectivity modeling based on coordinate meta-analysis and functional meta-analysis was carried out. Results: Compared with healthy controls (HCs), patients with aMCI showed increased ALFF/fALFF in the bilateral parahippocampal gyrus/hippocampus (PHG/HG), right amygdala, right cerebellum anterior lobe (CAL), left middle temporal gyrus (MTG), left cerebrum temporal lobe sub-gyral, left inferior temporal gyrus (ITG), and left cerebrum limbic lobe uncus. Meanwhile, decreased ALFF/fALFF values were also revealed in the bilateral precuneus (PCUN), bilateral cuneus (CUN), and bilateral posterior cingulate (PC) in patients with aMCI. Compared with HCs, patients with vMCI predominantly showed decreased ALFF/fALFF in the bilateral CUN, left PCUN, left PC, and right cingulate gyrus (CG). Conclusions: The present findings suggest that ALFF and fALFF displayed remarkable altered patterns between aMCI and vMCI when compared with HCs. Thus, the findings of this study may serve as a reliable tool for distinguishing aMCI from vMCI, which may help understand the pathophysiological mechanisms of these diseases.
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Affiliation(s)
- Xulian Zhang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Xue
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Cao
- Division of Statistics and Data Science, Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Qianqian Yuan
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenzhang Qi
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwen Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shaojun Zhang
- Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Qingling Huang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Limoncu H, Boz HE, Zygouris S, Tsolaki M, Giakoumis D, Votis K, Tzovaras D, Öztürk V, Yener GG. A Virtual Reality-Based Screening Test for Cognitive Impairment in Small Vessel Disease. J Alzheimers Dis Rep 2021; 5:161-169. [PMID: 33981953 PMCID: PMC8075552 DOI: 10.3233/adr-200257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: There is a need for new practical tools to assess the cognitive impairment of small vessel disease (SVD) patients in the clinic. Objective: This study aimed to examine cognitive functioning by administering the Virtual Supermarket (VST) in patients with SVD with cognitive impairment (SVD-CI, N = 32), cognitively normal SVD (SVD-CN, N = 37), and age-and education-matched healthy controls (HC, N = 30). Methods: The tablet-based VST application and comprehensive traditional pencil-and-paper neuropsychological tests assessing memory, attention, executive function, visuospatial function, and language were administered to all participants. Results: A moderate correlation was found between the “Duration” and “Correct Quantities” variables of VST and visuospatial function and general cognitive status composite Z scores across SVD-CI patients. “Duration” and “Correct Money” variables were moderately related to memory, executive functions, and visuospatial function composite Z scores across SVD-CN patients. A combination of all VST variables discriminated SVD-CI and HC with a correct classification rate of 81%, a sensitivity of 78%, and a specificity of 84%. Conclusion: This study is the first to evaluate cognitive functions employing the VST in SVD with and without cognitive impairment. It provides encouraging preliminary findings of the utility of the VST as a screening tool in the assessment of cognitive impairment and the differentiation of SVD patients from HC. In the future, validation studies of the VST with larger samples are needed.
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Affiliation(s)
- Hatice Limoncu
- Department of Neurology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hatice Eraslan Boz
- Department of Neurology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.,Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Stelios Zygouris
- Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Greece.,Network Aging Research, Heidelberg University, Germany
| | - Magda Tsolaki
- Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Greece.,Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Dimitrios Giakoumis
- Center for Research & Technology Hellas/Information Technologies Institute (CERTH/ITI), Thessaloniki, Greece
| | - Konstantinos Votis
- Center for Research & Technology Hellas/Information Technologies Institute (CERTH/ITI), Thessaloniki, Greece
| | - Dimitrios Tzovaras
- Center for Research & Technology Hellas/Information Technologies Institute (CERTH/ITI), Thessaloniki, Greece
| | - Vesile Öztürk
- Department of Neurology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Görsev Gülmen Yener
- Department of Neurology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.,Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey.,Izmir Biomedicine and Genome Center, Izmir, Turkey
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Tiel C, Sudo FK, Calmon AB. Neuropsychiatric symptoms and executive function impairments in Alzheimer's disease and vascular dementia: The role of subcortical circuits. Dement Neuropsychol 2019; 13:293-298. [PMID: 31555401 PMCID: PMC6753905 DOI: 10.1590/1980-57642018dn13-030005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) in dementia are prevalent, under-recognized and little studied regarding their pathophysiological aspects. The pathophysiological mechanism, as well as the possible role of vascular lesions in the genesis of these symptoms, are still matters of debate. OBJECTIVE to describe and compare the prevalence and severity of NPS in subjects with Alzheimer's disease (AD) and vascular dementia (VaD). METHODS a cross-sectional study involving 82 outpatients, divided into two groups (AD × VaD), was conducted. Patients were submitted to the Cambridge Cognitive Test (CAMCOG), the Clock Drawing Test (CLOX 1 and 2), the Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating (CDR) scale. Neuroimaging was scored using the de Leon and Fazekas scales. RESULTS 90.8% of the patients had at least one neuropsychiatric symptom. There were statistical differences on the CLOX test and in the apathy symptoms between AD and VaD groups. Apathy and disinhibition proved more prevalent in patients with higher vascular load. CONCLUSION apathy and impaired executive function may reflect vascular damage in subcortical circuits in dementia patients.
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Affiliation(s)
- Chan Tiel
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
| | - Felipe Kenji Sudo
- Instituto D’Or de Ensino e PesquisaMemory ClinicRio de JaneiroRJBrazilMemory Clinic, Instituto D’Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil.
| | - Ana Beatriz Calmon
- Universidade de VassourasMedical SchoolVassourasRJBrazilUniversidade de Vassouras (UV), Medical School, Vassouras, Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de JaneiroDepartment of NeurologyRio de JaneiroRJBrazilDepartment of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
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Meguro K, Dodge HH. Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects. J Alzheimers Dis 2019; 70:S293-S302. [PMID: 30909215 PMCID: PMC6699913 DOI: 10.3233/jad-180899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/15/2023]
Abstract
Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or "hidden" in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.
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Affiliation(s)
- Kenichi Meguro
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center (NICHe), Tohoku University, Sendai, Japan
- The Osaki-Tajiri SKIP Center, Osaki, Japan
| | - Hiroko H. Dodge
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health and Science University, Portland, OR, USA
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Pantsiou K, Sfakianaki O, Papaliagkas V, Savvoulidou D, Costa V, Papantoniou G, Moraitou D. Inhibitory Control, Task/Rule Switching, and Cognitive Planning in Vascular Dementia: Are There Any Differences From Vascular Aging? Front Aging Neurosci 2018; 10:330. [PMID: 30410439 PMCID: PMC6211074 DOI: 10.3389/fnagi.2018.00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 09/28/2018] [Indexed: 01/06/2023] Open
Abstract
Recent studies have shown that patients diagnosed with Vascular Dementia (VaD) exhibit deficits in executive functions. According to “vascular hypothesis of cognitive aging,” community-dwelling older adults having risk factors for vascular disease development (RVD) may suffer from cognitive decline of the same type. The aim of the study was to assess the level of specific executive functions (EF) that have been revealed as most affected by vascular abnormalities, in older adults with incipient VaD and RVD. Subsequently specific ways of EF measuring could be suggested for more accurate diagnosis of early stage VaD. The study compared three adult groups (N = 60): (a) patients diagnosed with incipient VaD, according to DSM-5 criteria (n = 20); (b) community-dwelling older adults presenting cardiovascular risk factors (RVD; n = 20); (c) healthy young adult controls (n = 20). Three types of executive functions were examined: inhibitory control, cognitive flexibility as rule/task switching, and planning. The following D-KEFS subtests were administered for their evaluation: The ‘Color-Word Interference Test,’ the ‘Verbal Fluency Test,’ and the ‘Tower Test.’ Mixed-measures ANOVA, MANOVA, and one-way ANOVA as well as Scheffe post hoc test were applied to the data of the scores in each condition of each test. The results showed that VaD patients had significantly lower performance in test conditions requiring switching and planning, compared to RVD group and young controls. The specific deficits of VaD patients, compared to older adults presenting RVD according to multiple-group path analyses were: more uncorrected errors in inhibition, the use of semantic knowledge primarily instead of switching ability to switch between semantic categories, as well as a lower level of movement precision in planning.
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Affiliation(s)
- Krystallia Pantsiou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ourania Sfakianaki
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Savvoulidou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Costa
- 1st Neurology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Papantoniou
- Department of Early Childhood Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Despina Moraitou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Freitas MID, Porto CS, Oliveira MO, Brucki SMD, Mansur LL, Nitrini R, Radanovic M. Linguistic abilities in major vascular cognitive impairment: a comparative study with Alzheimer's disease. Acta Neurol Belg 2018; 118:465-473. [PMID: 30027378 DOI: 10.1007/s13760-018-0977-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Abstract
We assessed the linguistic abilities of multi-infarct (cortical) dementia and subcortical ischemic vascular dementia (VaD) patients and compared the linguistic performance of VaD and Alzheimer's Disease (AD) patients. A total of 23 VaD patients, 20 mild AD patients, and 31 controls participated in the study. All were evaluated using the Arizona Battery for Communication Disorders of Dementia (ABCD). Neuropsychological testing was performed to ascertain that VaD and AD patients had comparable cognitive performance. Both dementia groups performed more poorly than controls in the ABCD measures, except for the comparative question subtest. Comparison between VaD and AD patients showed statistically significant differences only in the confrontation naming subtest (p < 0.05), where paraphasias and visual errors were the most prevalent. AD patients showed a trend towards more circumlocution errors than VaD patients (p = 0.0483). When compared to controls, linguistic abilities of VaD patients were impaired in all measures of linguistic expression and linguistic comprehension, except for the comparative question subtest. Linguistic differences between VaD and AD patients were observed only in the confrontation naming subtest.
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Affiliation(s)
- Maria Isabel D'Avila Freitas
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil.
- Department of Speech, Language and Hearing Sciences, Federal University of Santa Catarina (UFSC), Trindade Campus, Florianopolis, SC, 88040-970, Brazil.
| | - Claudia S Porto
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Maira O Oliveira
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Sonia M D Brucki
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Leticia L Mansur
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Marcia Radanovic
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
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10
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Holz MR, Kochhann R, Ferreira P, Tarrasconi M, Chaves MLF, Fonseca RP. Cognitive performance in patients with Mild Cognitive Impairment and Alzheimer's disease with white matter hyperintensities: An exploratory analysis. Dement Neuropsychol 2017; 11:426-433. [PMID: 29354224 PMCID: PMC5770002 DOI: 10.1590/1980-57642016dn11-040013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND White matter hyperintensities (WMH) are commonly associated with vascular dementia and poor executive functioning. Notwithstanding, recent findings have associated WMH with Alzheimer's disease as well as other cognitive functions, but there is no consensus. OBJECTIVE This study aimed to verify the relationship between WMH and cognitive performance in Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) patients. The study also sought to identify cognitive and demographic/cultural factors that might explain variability of WMH. METHODS The sample was composed of 40 participants (18 MCI and 22 AD patients) aged ≥ 65 years. Spearman's correlation was performed among cognitive performance (memory, language, visuospatial ability, and executive function) and WMH evaluated by the Fazekas and ARWMC scales. Two stepwise linear regressions were carried out, one with cognitive and the other with demographic/cultural variables as predictors. RESULTS Only naming showed significant correlation with ARWMC. Fazekas score exhibited significant correlation with all cognitive domains evaluated. Fazekas score was better predicted by episodic visual memory and age. CONCLUSION This study found that the most relevant cognitive profile in MCI and AD patients with WMH was related to episodic memory. And, without taking clinical aspects into consideration, age was the best predictor of WMH.
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Affiliation(s)
- Maila Rossato Holz
- Mestranda do Programa de Pós-Graduação em Psicologia – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), RS, Brazil
| | - Renata Kochhann
- Aluna de Pós-doutorado do Programa de Pós-Graduação em Psicologia – PUCRS, RS, Brazil
| | - Patrícia Ferreira
- Aluna de Graduação em Psicologia – Universidade do Vale do Rio dos Sinos, RS, Brazil
| | | | - Márcia Lorena Fagundes Chaves
- Professora Titular do Departamento de Medicina Interna – Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Rochele Paz Fonseca
- Professora Adjunta do Programa de Pós-Graduação em Psicologia – PUCRS, RS, Brazil
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Sudo FK, Amado P, Alves GS, Laks J, Engelhardt E. A continuum of executive function deficits in early subcortical vascular cognitive impairment: A systematic review and meta-analysis. Dement Neuropsychol 2017; 11:371-380. [PMID: 29354217 PMCID: PMC5769995 DOI: 10.1590/1980-57642016dn11-040006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Subcortical Vascular Cognitive Impairment (SVCI) is a clinical continuum of vascular-related cognitive impairment, including Vascular Mild Cognitive Impairment (VaMCI) and Vascular Dementia. Deficits in Executive Function (EF) are hallmarks of the disorder, but the best methods to assess this function have yet to be determined. The insidious and almost predictable course of SVCI and the multidimensional concept of EF suggest that a temporal dissociation of impairments in EF domains exists early in the disorder. OBJECTIVE This study aims to review and analyze data from the literature about performance of VaMCI patients on the most used EF tests through a meta-analytic approach. METHODS Medline, Web of Knowledge and PsycINFO were searched, using the terms: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular mild neurocognitive disorder" AND "dysexecutive" OR "executive function". Meta-analyses were conducted for each of the selected tests, using random-effect models. RESULTS Systematic review showed major discrepancies among the results of the studies included. Meta-analyses evidenced poorer performance on the Trail-Making Test part B and the Stroop color test by VaMCI patients compared to controls. CONCLUSION A continuum of EF impairments has been proposed in SVCI. Early deficits appear to occur in cognitive flexibility and inhibitory control.
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Affiliation(s)
- Felipe Kenji Sudo
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
- Instituto D'Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil
| | - Patricia Amado
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Gilberto Sousa Alves
- Departamento de Medicina Interna, Universidade Federal do Ceará, CE, Brazil
- Goethe Universitat Frankfurt Am Main, Germany
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional (BIOTRANS), Unigranrio, Duque de Caxias, RJ, Brazil
| | - Eliasz Engelhardt
- Setor de Neurologia Cognitiva e do Comportamento, INDC/CDA/ IPUB, Universidade Federal do Rio de Janeiro, RJ, Brazil
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Sudo FK, Alves GS, Moreira DM, Laks J, Engelhardt E. Subcortical Vascular Cognitive Impairment staged through cdr's functional subsum (cdr-func): Preliminary results from an outpatient sample. eNeurologicalSci 2016; 5:7-10. [PMID: 29430551 PMCID: PMC5803105 DOI: 10.1016/j.ensci.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/04/2016] [Accepted: 06/08/2016] [Indexed: 10/31/2022] Open
Abstract
Background Methods Results Discussion The CDR's Functional Subsum is proposed for staging vascular cognitive impairment. CDR-FUNC correlated with scores in executive tasks, whereas CDR total score did not. CDR-FUNC might be a better tool for staging vascular cognitive impairment than CDR.
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