Mild Vascular Dementia Research Articles

The clinical efficacy of nicergoline combined with donepezil hydrochloride in the treatment of mild vascular de-mentia and its influence on cognitive function

Objective To investigate the clinical efficacy of nicergoline combined with donepezil hydrochloride in the treatment of mild vascular dementia and its influence on cognitive function. Methods 66 patients with mild vascular dementia from neurology were divided into two groups by random numbers,33 cases in each group.On the based of the routine symptomatic treatment,the control group were given nicergoline,the observation group were treated with nicergoline combined with aricept.Four weeks was a course,both groups were continuously treated for 3 courses. Results The MMSE scores of the observation group after treatment was(36.7±5.7)points,which was significantly increased compared with before treatment(t=10.137,P<0.05)and the control group(t=11.236,P<0.05);The ADL score was(35.8±16.2)points,which was significantly lower compared with before treatment(t=10.825,P<0. 05)and the control group(t=11.415,P<0.05);The total effective rate of the observation group was 78.9%,which was higher than 54.5%of the control group(χ2=9.24,P<0.05). Conclusion Nicergoline combined with donepezil hydrochloride in the treatment of mild vascular dementia can significantly improve cognitive function scores,and it is a significant effect,safe and reliable method. Key words: Nicergoline; Donepezil Hydrochloride; Dementia,Vascular; Cognitive

Abstract T P410: Angiopoietin-1 Mimetic Peptide Treatment Promotes White Matter Remodeling And Improves Cognitive Function In Rats With Vascular Dementia

Background and Purpose: Vascular Dementia (VaD) affects cognitive and memory function. Clinically, a series of minor or silent strokes induce subcortical lesions and may lead to VaD. In this study, we developed a multiple microinfarct-based mild VaD model in retired breeder rats and tested the therapeutic effects of an Angiopoietin-1 mimetic peptide, Vasculotide (VT) on cognitive decline and white matter (WM) damage. Methods: Male retired breeder rats were subjected to a multiple microinfarct model (500 70-100 μm cholesterol crystals injected into the internal carotid artery) and treated with 1) PBS 2) VT (3 μg/Kg, i.p. injection) starting at 1 day for 14 days (n=6/group). Neurological and cognitive deficits were evaluated 2 and 6 weeks later. Rats were sacrificed on 7th week. Results: The multiple microinfarct model induced cognitive decline in retired breeder rats starting at 2 weeks which persisted to 6 weeks after surgery. Significant (p&lt;0.05) loss in short term memory was observed using the Novel Object Recognition Task and memory loss was evident from the Odor Test. Anxiety-like behavior was observed during Open Field evaluation. Compared to non surgery rats, VaD significantly decreased neurite branching and spine density measured by Golgi staining; induced significant WM damage identified by decreased axon and myelin density, decreased oligodendrocyte progenitor cells and oligodendrocyte number; and decreased synaptic protein expression in the corpus callosum and striatum. VaD also significantly increased RAGE (Receptor for Advanced Glycation Endproducts) expression in the brain. Treatment of VaD with VT significantly (p&lt;0.05) improved cognitive function and memory, decreased anxiety, significantly attenuated WM damage, increased neurite branching and spine density and synaptic protein expression as well as decreased RAGE expression compared to VaD control rats (p&lt;0.05). Conclusion: Multiple microinfarcts can induce significant WM damage and cause decline in cognition and memory. VT treatment promotes WM remodeling, synaptic plasticity and anti-inflammation which in concert may contribute to the improvement in cognition and memory.

Neuropsychiatric symptoms in patients with vascular dementia in mainland China.

BackgroundNeuropsychiatric deficits can induce marked disability in patients with dementia and increase caregiver distress. Several studies have found that neuropsychiatric symptoms are common both in patients with Alzheimer’s disease (AD) and patients with vascular dementia (VaD). However, there are few studies of the neuropsychiatric disturbances in large clinical samples of patients with mixed (cortical - subcortical) VaD from mainland China. This study aimed to investigate the neuropsychiatric symptoms in VaD patients in mainland China.MethodsEighty patients with mixed VaD for over 6 months duration, and their caregivers (VaD group), were recruited for interview in Zhongnan Hospital of Wuhan University, from June 2010 to June 2012. Eighty age- and sex-matched normal volunteers (control group) were interviewed at the same time. The Mini Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered to the VaD patients, their caregivers, and normal volunteers. Group differences were analyzed using the unpaired t-test.ResultsThe total mean scores of the NPI in the VaD group were higher than in the control group (P < 0.01). The subscale scores of NPI, including delusions, hallucinations, depression, apathy, irritability, agitation, aberrant motor behavior, and change in appetite were significantly higher in the VaD group than in the control group (P < 0.05–0.01). Compared with the mild VaD subgroup, the NPI subscale scores of apathy, irritability and total scores were significantly higher in the moderate VaD subgroup (P < 0.05–0.01); the NPI subscale scores of anxiety, apathy, irritability, and total scores were significantly higher in the severe VaD subgroup (P < 0.01). Compared with the moderate VaD subgroup, the NPI subscale scores of anxiety and apathy were significantly higher in the severe VaD subgroup (P < 0.05–0.01).ConclusionsNeuropsychiatric symptoms, such as hallucination, anxiety, apathy, irritability and aberrant action behavior, are common in patients with mixed VaD from mainland China; anxiety and apathy were more pronounced in the subgroup of severe VaD patients.

경도 알츠하이머병과 혈관치매 환자의 쓰기능력 비교

경도 알츠하이머병과 혈관치매 환자의 쓰기능력 비교

Art and Music Programs Prove Their Worth

Art and Music Programs Prove Their Worth

Differentiating Vascular Dementia from Alzhemer’s Disease with Brief Cognitive Tests

Abstract Introduction. Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common causes of dementia in the elderly. The aim of this study was to investigate the diagnostic value of brief cognitive tests investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia from Alzheimer’s disease. Methods. Fifteen patients with mild VaD, 15 patients with probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drqawing and copy), category of letter fluency, delayed recall test of figures and the EXIT 25 battery. Results. VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, Receiver Operating Characteristic (ROC) curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. Conclusions. Altough the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited.

Neuropsychological Profile and Performance Variability in Vascular Cognitive Impairment

Background: Cognitive impairment from cerebrovascular disease varies in scope. Methods: We studied healthy elderly individuals and those with mild cognitive impairment (MCI) or mild dementia attributed to vascular pathology, in order to assess the diagnostic utility of intra-individual variability across neuropsychological domains and the cognitive profile of vascular cognitive disorders. A large battery of tests was used to create z-scores for seven neuropsychological domains by principle components analysis. Results: We did not find group differences in the average intra-individual variance across neuropsychological domains. We did find group differences in the within-domain variability for Language, reflecting increased performance variability in those participants with vascular pathology. There was a lower inter-correlation of domain scores in the MCI group than in the mild vascular dementia (VD) group. The MCI group had the largest deficits in Executive Function, Fluency and Memory relative to the healthy control (HC) group. The VD group evidenced a broad range of further cognitive decline relative to the MCI group, with the largest difference on Visuoconstruction. Conclusions: While intra-individual performance variability may increase early in the course of cognitive decline from vascular pathology, this is not because of greater across-domain variability or because impairments occur in only one particular cognitive domain or small cluster of inter-related domains. Early cognitive change includes decreased executive function that cannot be attributed to slow information processing or response time.

GW24-e3585 Differentiating vascular dementia from Alzheimer's disease with the Memory and Executive Screening test (MES)

ObjectivesAlzheimer’ disease (AD) and vascular dementia (VaD) are the most common causes of dementia in the elderly. The Memory and Executive Screening test (MES) is a brief and sensitive screening...

アルツハイマー病と血管性認知症高齢者の食行動の比較に関する調査報告：第一報―食行動変化について―

In elderly patients with dementia, it is known that a loss of independence in eating can cause malnutrition, dehydration, a decrease in food consumption and the immune function and further worsening of the cognitive function, with an increased risk of pneumonia and a shortened life expectancy. The purpose of this study was to investigate the occurrence of a disturbed eating behavior in elderly patients with Alzheimer's disease (AD) and vascular dementia (VaD), who together comprise the majority of elderly patients with dementia. A total of 233 patients (150 AD patients and 83 VaD patients) who were residents of institutions or group homes were enrolled. The patients underwent an assessment of eating behavior, a cognitive assessment, a neurological examination and measurement of the vital signs. Additionally, statistical analyses were performed to compare eating behavior between the patients with AD and those with VaD at varying severity of dementia. A disturbed eating behavior was observed significantly more frequently as the severity of dementia increased. The prevalence of difficulty in rinsing/gargling and dysphagia increased with the severity of dementia. There were differences in the frequency of disturbed eating behavior between the AD and VaD patients. Among the patients with mild dementia, the VaD patients exhibited a higher incidence of a disturbed eating behavior than the AD patients. On the other hand, some behaviors prominent in the patients with severe dementia were related to various types of cognitive impairment in the AD patients, namely difficulty in beginning a meal, difficulty in maintaining attention while eating and difficulty in performing the specific motor skills necessary to open food packages. Marked individual differences were observed in the mild VaD patients, with a high frequency of disturbed eating behavior and dysphagia related to symptoms of neurological deficits. No correlations were found with the severity of dementia. Both AD and VaD are types of dementia; however, the frequency of a disturbed eating behavior differs greatly between these populations. It is necessary to focus on differences in these parameters and also the causes of dementia in order to develop effective care techniques for patients with dementia.

Motor intentional disorders in vascular mild cognitive impairment and vascular dementia of subcortical type

Subcortical vascular mild cognitive impairment (svMCI), a prodromal stage of subcortical vascular dementia (SVaD), is primarily associated with frontal injuries, whereas amnestic MCI (aMCI) is associated with temporoparietal injuries. Twenty-seven patients with svMCI, 20 with aMCI, 14 with SVaD, and 10 normal controls underwent motor intentional tasks (force initiation, development, maintenance, and termination) using a force dynamometer. Of the four motor intentional tasks, the maintenance task proved sensitive in differentiating svMCI from aMCI. In most motor intentional tasks, performances of svMCI patients were intermediate between those of controls and SVaD patients (initiation and termination: NC=aMCI=svMCI>SVaD; development: NC>aMCI=svMCI>SVaD; maintenance: NC=aMCI>svMCI=SVaD).

P2‐170: Scope (quantitative) and performance (qualitative) of instrumental ADLs in older adults with mild cognitive impairment: Difference between very mild Alzheimer's disease and very mild subcortical vascular dementia—The Kurihara Project

P2‐170: Scope (quantitative) and performance (qualitative) of instrumental ADLs in older adults with mild cognitive impairment: Difference between very mild Alzheimer's disease and very mild subcortical vascular dementia—The Kurihara Project

Neurobehavioral Dysfunction in Patients with Subcortical Vascular Mild Cognitive Impairment and Subcortical Vascular Dementia

Amnestic mild cognitive impairment (MCI) is considered to be a prodromal stage of Alzheimer's disease. Likewise, subcortical vascular MCI (svMCI) is considered as a prodromal stage of subcortical vascular dementia (SVaD). The objective of this study was to investigate neuropsychiatric features in patients with svMCI compared to healthy controls and patients with SVaD. We evaluated 31 patients with svMCI, 42 with SVaD, and 28 healthy controls who underwent neuropsychiatric assessments using the Neuropsychiatric Inventory (NPI) and the Frontal Behavioral Inventory (FBI). On both the NPI and FBI, SVaD patients had the most severe neuropsychiatric symptoms, followed by svMCI patients and then healthy controls, suggesting that svMCI might be a prodromal stage of SVaD in terms of neuropsychiatric abnormalities. When we compared the differences of mean scores between negative and positive symptoms in FBI, negative symptoms tended to be more predominant than positive symptoms in both svMCI and SVaD patients, but the tendency was stronger in SVaD patients than in svMCI patients. These results suggest that vascular cognitive impairment with small vessel disease would start with both negative and positive neuropsychiatric symptoms and progress to present more severe negative symptoms. These behavioral ratings may be useful for early detection of vascular cognitive impairment associated with small vessel disease.

Depressive Symptom Endorsement among Alzheimer’s Disease, Vascular Dementia and Mild Cognitive Impairment

Background: The Geriatric Depression Scale (GDS) is widely used to assess depressive symptoms in clinical and research settings. This study utilized a 4 factor solution for the 30-item GDS to explore differences in the presentation of depressive symptoms in various types of cognitive impairment. Method: Retrospective chart review was conducted on 254 consecutive cases of community dwelling elderly newly diagnosed with mild Alzheimer’s Dementia (AD) n = 122, mild Vascular Dementia (VaD) n = 71 or Amnestic Mild Cognitive Impairment (aMCI) n = 32 and Non-Amnestic MCI (nMCI) n = 29. Results: Analysis revealed no significant differences (p 05). No statistically significant differences were found between VaD and nMCI or between the MCI groups. Conclusions: Support is provided for the use of GDS subscales in a wide range of cognitively impaired elderly. This study suggests in mild dementia the number and type of depressive symptoms vary significantly between AD and VaD. There are indications that aMCI patients are similar in their symptom endorsement to AD and nMCI are similar to VaD which is consistent with some of the notions regarding likely trajectories of the respective MCI groups.

Potential Beneficial Effects of Low Molecular Weight Heparin on Cognitive Impairment in Elderly Patients on Haemodialysis

Vascular cognitive impairment or mixed vascular cognitive impairment and Alzheimer's disease (AD) appear to be much more common in elderly patients than AD alone. Furthermore, vascular dementia (VaD) and AD are more prevalent in elderly patients receiving haemodialysis (HD), leading to a loss of independence and a poor quality of life. Hypotensive episodes in patients receiving HD contribute to vascular changes in the brain, with consequent progression of VaD and AD. The use of the lowest individually optimized bolus dose of low molecular weight heparin (LMWH) during HD, with fewer hypotensive episodes during and between HD procedures, may exert a sparing effect on changes in microvascular circulation and decrease the incidence of VaD and AD. We believe that long-term use of LMWH, with its direct effect on amyloid β protein (Aβ) in the blood and on Aβ accumulation in the brain and indirect effects on prevention of complement activation, may delay the progression of cognitive impairment in patients receiving HD. There is a need for a robustly designed, prospective trial to evaluate the effects of long-term treatment with LMWH on mild cognitive impairment, VaD and AD in elderly patients receiving maintenance HD.

The Chinese (Cantonese) Montreal Cognitive Assessment in Patients with Subcortical Ischemic Vascular Dementia

Background: Subcortical ischemic vascular dementia (SIVD) has been proposed as the most frequent subtype of vascular cognitive impairment. The aim of this study was to evaluate the psychometric properties of the Chinese (Cantonese) Montreal Cognitive Assessment (CC- MoCA) in patients with SIVD in the Guangdong Province of China. Methods: 71 SIVD patients and 60 matched controls were recruited for the CC-MoCA, Mini Mental State Examination and executive clock drawing tasks. Receiver-operating characteristic curve analyses were performed to determine optimal sensitivity and specificity of the CC-MoCA total score in differentiating mild vascular dementia (VaD) patients from moderate VaD patients and controls. Results: The mean CC-MoCA scores of the controls, and mild and moderate VaD patients were 25.2 ± 3.8, 16.4 ± 3.7, and 10.0 ± 5.1, respectively. In our study, the optimal cutoff value for the CC-MoCA to be able to differentiate patients with mild VaD from controls is 21/22, and 13/14 to differentiate mild VaD from moderate VaD. Conclusion: The CC-MoCA is a useful cognitive screening instrument in SIVD patients.

Simvastatin-induced myopathy, the role of interaction with diltiazem and genetic predisposition

Diltiazem shows a pharmacokinetic interaction with statins that are CYP3A substrates but this may not result in myopathy unless additional genetic or clinical factors are present. Subsequent changes in treatment or underlying disease may result in a delayed onset of this adverse affect. Our objective is to report on two cases of statin-induced myopathy associated with concomitant use of diltiazem and other contributing factors, and to briefly review the related literature. A 63-year-old Chinese woman with hypertension and familial hypercholesterolaemia (FH) taking diltiazem 90 mg twice daily had elevation of creatine kinase (CK) to 4016 U/L and alanine aminotransferase (ALT) to 165 IU/L 4 weeks after increasing the dose of simvastatin from 40 to 80 mg daily. Another 80-year-old Chinese woman with FH, mild vascular dementia and hypertension was hospitalized with bilateral lower limb weakness associated with raised CK (8869 IU/L), lactate dehydrogenase (1384 IU/L) and ALT (288 IU/L) after taking diltiazem 60 mg twice daily with simvastatin 40 mg for 11 months. Statin-associated myopathy was suspected and simvastatin was stopped in both cases, and symptoms resolved and all laboratory parameters returned to normal in 2 weeks. The myopathy in both cases is likely to have resulted from an interaction of higher doses of simvastatin with diltiazem through inhibition of CYP3A enzymes and drug transporters. The strength of simvastatin-diltiazem interactions in the two cases estimated by the Drug Interaction Probability Scale (DIPS) indicated a possible association. The two cases reported here and the brief literature review emphasize the potential interaction between two drugs frequently coadministered, simvastatin and diltiazem and we suggest that diltiazem should not be used with higher doses of those statins metabolized by CYP3A such as simvastatin or atorvastatin and even with lower doses caution should be exercised in patients who may have cause for impaired metabolism.

Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests

To investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia (VaD) from Alzheimer's disease (AD). Fifteen patients with mild VaD, 15 patients with mild probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drawing and copy), category and letter fluency, delayed recall test of figures and the EXIT 25 battery. VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, ROC curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. Although the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited.

Excessive compensatory recruitment as a compulsory neurophysiological mechanism in Very Early Alzheimer's Disease as compared to Mild Vascular Dementia and to age-matched normal controls

This paper supports the theoretical position of the existence of neurophysiological mechanisms of excessive compensatory recruitment of neuronal pools in Very Early Alzheimer's Disease (VEAD) as compared to patients with Mild Vascular Dementia (MVD) and age-matched normal controls. In addition, considering that the very early recognition of Alzheimer's disease is of paramount importance for diagnosis, treatment and clinical follow-up, in the present investigation, we have used Topographic Mapping of ERPs to our Memory Workload Paradigm to delineate excessive compensatory recruitment as a sensitive neurophysiological marker for the accurate detection of VEAD as compared to MVD and to age-matched normal controls.The present findings with the Topographic Mapping of ERPs indicate that VEAD patients displayed significantly larger amplitudes with memory loads as compared to MVD patients (p=0.0001) and to age-matched normal controls (p=0.0001). VEAD patients displayed abnormally high P450 amplitudes (p=0.0001) and shorter P450 latencies (p=0.0001) over parietal and occipital sites as opposed to age-matched normal controls. In addition, contrary to normal controls, VEAD patients exhibited longer latencies over pre-frontal and frontal regions (p=0.0001). On the other hand, P450 latencies for VEAD and MVD patients were not significantly different over anterior and posterior regions (p>0.05).These findings suggest that the delayed P450 latencies found over pre-frontal and frontal regions in both patient populations, reflect the partial disconnection of their neuronal pathways from limbic structures. Specifically, in VEAD patients, this aspect, along with the abnormally high amplitudes found over parietal and occipital regions, support the conclusion that VEAD patients allocate much more cerebral physiological resources and effort to accomplish the memory workload tasks as opposed to age-matched normal controls and to MVD patients. As such, in VEAD, the excessive recruitment of compensatory neuronal pools becomes a compulsory neurophysiological mechanism to meet the demanding tasks of our Memory Workload Paradigm.

Neurophysiological mechanisms of excessive compensatory recruitment of neuronal pools in Early Alzheimer's Disease as compared to mild vascular dementia and normal aging

Psychosocial and contextual factors, such as patient–physician relationship, prior treatment experience, and treatment expectation, can either improve or compromise treatment efficacy. These phenomena are commonly specified as placebo and nocebo effects. As placebo and nocebo effects can influence symptom development, adverse event rate, and treatment efficacy, it is crucial to be aware of these effects and to develop strategies for prevention to optimize treatment outcomes. While experimental studies have made substantial progress in elucidating the psychosocial and neurobiological mechanisms underlying placebo effects, the detailed mechanisms of nocebo effects remain largely unexplored. A better understanding of these mechanisms promises to facilitate the development of easy-to-use strategies in clinical care to improve overall treatment outcomes and patient satisfaction.

Hippocampal size and dementia in stroke patients: The Sydney stroke study

Background Hippocampal atrophy is an early feature of Alzheimer's disease (AD) but it has also been reported in vascular dementia (VaD). It is uncertain whether hippocampal size can help differentiate the two disorders. Methods We assessed 90 stroke/TIA patients 3–6 months after the event, and 75 control subjects, with neuropsychological tests, medical and psychiatric examination and brain MRI scans. A diagnosis of VaD, vascular mild cognitive impairment (VaMCI) or no cognitive impairment (NCI) was reached by consensus on agreed criteria. T1-weighted MRI was used to obtain total intracranial volume (TICV), gray and white matter volume, CSF volume, hippocampus and amygdala volumes, and T2-weighted scans for white matter hyperintensity (WMH) ratings. Results Stroke/TIA patients had more white matter hyperintensities (WMHs), larger ventricle-to-brain ratios and smaller amygdalae than controls, but hippocampus size and gray and white matter volumes were not different. WMHs and amygdala but not hippocampal volume distinguished stroke/TIA patients with VaD and VaMCI and without NCI and amygdala volumes. Right hippocampus volume significantly correlated with new visual learning. Conclusions Stroke/TIA patients and patients with post-stroke VaMCI or mild VaD do not have hippocampal atrophy. The amygdala is smaller in stroke/TIA patients, especially in those with cognitive impairment, and this may be accounted for by white matter lesions. The hippocampus volume relates to episodic memory, especially right hippocampus and new visual learning. A longitudinal study of these subjects will determine whether hippocampal atrophy is a late development in VaD.