Behavioral and psychological symptoms and hippocampal atrophy in subcortical ischaemic vascular disease.

Chan Tiel,Felipe Kenji Sudo,Eliasz Engelhardt,Jerson Laks,Gilberto Sousa Alves,Carlos Eduardo Oliveira Alves,Letice Ericeira-Valente,Denise Madeira Moreira

doi:10.1590/s1980-57642012dn06030011

Chan Tiel, Felipe Kenji Sudo + Show 6 more

Open Access

https://doi.org/10.1590/s1980-57642012dn06030011

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Abstract

BackgroundNeuropsychiatric symptoms are common in patients with cognitive impairments, mediated by both neurodegenerative processes and cerebrovascular disease. Previous studies have reported that Behavioral and Psychological Symptoms of Dementia (BPSD) might correlate with severity of cognitive decline. Thus far, the impact of the association between white-matter hyperintensities (WHM) and hippocampal atrophy (HA) on the incidence of these symptoms has been less studied.ObjectiveThis cross-sectional study aimed to describe the clinical profile of a sample with large extensions of WMH, examining the association between different degrees of HA and cognitive, functional, and behavioral status.MethodsFifty outpatients (mean age: 76.86±8.70 years; 58% female; mean schooling: 7.44±4.69 years) with large extensions of WMH (modified-Fazekas scale=3) on MRI and different degrees of hippocampal atrophy (according to de Leon Score) underwent cognitive, functional, and behavioral assessments.ResultsPatients with mild-moderate to severe HA had worse performance on the Mini-Mental State Examination, Cambridge Cognitive Examination, Clinical Dementia Rating and Pfeffer's Functional Activities Questionnaire, compared to the group with none or questionable HA. Appetite/Eating Behavior was the only cluster of neuropsychiatric symptoms associated with presence of HA in Vascular Cognitive Impairment patients.DiscussionAlthough HA may exhibit distinct impact on cognitive performance and functional status, it appears to have little effect on behavioral symptoms in patients with high severity WMH.

Highlights

Vascular cognitive impairment (VCI) can be defined as cognitive alterations due to cerebrovascular lesions
Concomitant with cognitive impairment, behavioral and psychological symptoms of dementia (BPSD) have been reported as frequent features in both vascular and degenerative dementias,[1,2,3] with an incidence ranging from 80-90% during the course of the disease.[4]
In VCI/Vascular Dementia (VaD), impaired cognition has been associated with impaired behavior and rates of behavioral changes have been correlated with rates of cognitive changes.[1,5]

Summary

Introduction

Vascular cognitive impairment (VCI) can be defined as cognitive alterations due to cerebrovascular lesions. Some authors have reported that VaD, which is more likely to affect subcortical areas, is believed to be involved in mood disorders, especially depression.[27,28] In contrast, AD, which damages temporal lobe areas, is often associated with psychosis, developing with a higher prevalence of hallucinations and delusions.[1,3,28] Previous studies[1,3,5,7,8,9] have shown that the severity of BPSD was accompanied by clinical worsening of dementia.

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