Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up.

Nilton Custodio,Yadira Bardales,Lucia Valeriano-Lorenzo,Rosa Montesinos,David Lira,Eder Herrera-Perez

doi:10.1590/1980-57642016dn11-040007

Abstract

ABSTRACT.There is limited evidence about the progression of cognitive performance during the post-stroke stage.Objective:To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD).Methods:A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS).Results:152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening.Conclusion:According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

Highlights

Cerebrovascular diseases (CVD) cause cerebral vascular injury (CVI) that can lead to vascular cognitive impairment (VCI), a syndrome in which cognitive impairment can be attributed to vascular disorders.[1]
This study showed that, based on the majority of applied short tests, cognitive performance worsened as time progressed in stroke patients with VCI, but this was observed in some stroke patients without VCI
The clinical and cognitive profile of VCI differs from other causes of cognitive impairment and dementia.[3]

Summary

Introduction

Cerebrovascular diseases (CVD) (such as infarction, hemorrhage, large artery disease, cardiac embolism, small-vessel disease, among others) cause cerebral vascular injury (CVI) that can lead to vascular cognitive impairment (VCI), a syndrome in which cognitive impairment can be attributed to vascular disorders.[1] there are two main clinical forms of VCI, including VCI caused by recent and symptomatic stroke (post-stroke VCI) and VCI caused by “covert” CVI (VCI without recent stroke), such as silent brain infarction, hemorrhage, and white matter lesions, detectable only on neuroimaging or at autopsy.[2]. VCI may be subdivided into either mild cognitive impairment (MCI) or dementia.[3,4] MCI is defined based on the presence of acquired cognitive problems, representing a decline from a previous level of functioning, accompanied by objective evidence of impairment on cognitive testing but with essentially preserved activities of daily living. Dementia caused by vascular disease as well as AD, i.e. mixed dementia, is the most common cause of later life dementia.[7]

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