Diagnosis Of Vascular Dementia Research Articles

Ultrasound Diagnostic Method in Vascular Dementia: Current Concepts.

Increasing interest in identifying cerebral hemodynamics alterations as a cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions and the diagnosis of vascular dementia (VaD). PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of the available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.

Dementia in People from Ethnic Minority Backgrounds: Disability, Functioning, and Pharmacotherapy at the Time of Diagnosis

ObjectivesIncreasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis. DesignCross-sectional study of patient characteristics at the point of dementia diagnosis. Setting and ParticipantsIn total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015. MethodsData were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record. ResultsCompared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups. Conclusions and ImplicationsAt dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.

Exploratory study on immune phenotypes in Alzheimer’s disease and vascular dementia

The differentiation of Alzheimer's disease (AD) dementia from vascular dementia (VaD) and mixed-type dementia (mixed dementia) requires stepwise analysis and usually occurs late in the disease process. Early diagnosis and therapy monitoring would benefit greatly from the identification of biomarkers of neurodegeneration, especially blood biomarkers. To this end, the aim of the present pilot study was to investigate differences in the distribution of peripheral T-cell populations in patients with AD compared to VaD and mixed dementia. Flow cytometry was performed on blood samples from 11 patients with AD, six with VaD and six with mixed dementia, as well as 17 healthy control subjects (HCs). CD4+ and CD8+ T cells were typed for expression of CD45, CD27, CD28, CD25, FoxP3, CCR4 and CCR6; the other leukocytes were also assessed. Functionally, immune cell uptake of the β-amyloid (Aβ) toxic fragment (Aβ1-42 ) was also evaluated. A higher proportion of CD4+CD28- memory T cells and a reciprocal reduction of CD4+CD28+CD27+ naïve T lymphocytes was detected in all patient groups relative to controls. Significantly fewer CD4+CD25+FoxP3 regulatory T cells were present in patients with VaD, and significantly more CCR6+ and CCR4+ CD4+ T cells in those with AD. Higher CCR6+ T-cell frequencies were also present in patients with mixed dementia, potentially due to the inflammation and immune cell chemoattraction triggered by Aβ. The present study was a comprehensive investigation comparing different kinds of dementia, revealing differentially expressed peripheral markers that are potentially useful for early AD, VaD and mixed dementia diagnoses, and that would assist in proper treatments for these disparate diseases. Validation is now required.

Neuropsychiatric Reflections on Madison v. Alabama.

In Madison v. Alabama (2019),[1][1] the U.S. Supreme Court addressed two questions in the context of Vernon Madison's diagnosis of vascular dementia. The court majority ruled that Mr. Madison's inability to remember his crime secondary to vascular dementia does not prevent him from forming a

Impact of Race-Ethnic and Economic Disparities on Rates of Vascular Dementia in the National Inpatient Sample Database from 2006-2014

Background We have previously reported regional differences in the rates of vascular dementia (VD) in the United States (US), with the West having lower rates of VD diagnosis found in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) Database. We aimed to determine if these regional differences were associated with race-ethnic disparities in economic status or prevalence of the stroke risk factors hypertension, diabetes, and hyperlipidemia. Methods A sampling of the NIS database from 2006-2014 was analyzed using ICD-9 codes (290.40, 290.41, and 290.43) to identify patients admitted with primary or secondary VD diagnoses. Multivariable logistic regression was used to identify significant associations between ethnic groups, stroke risk factors and income. Results The NIS sample included 69,273,455 patients with median age of 53 (interquartile range 27 - 72), 55% female and 34% non-Caucasian. The mean VD primary and secondary diagnosis were 0.03% and 0.21% respectively. Black/African Americans had the highest odds of being admitted with a primary VD code [odds ratio (OR) 1.307, confidence interval (CI) 1.248-1.369] or admitted with VD as a secondary diagnosis code [OR 1.998, CI 1.968-2.03]. Black/African Americans admitted with VD as a primary diagnosis were the only group to have increased odds of having all 3 stroke risk factors, hypertension [OR 1.856, CI 1.705-2.019], diabetes [OR 1.166, CI 1.072-1.268], and hyperlipidemia [OR 1.164, CI 1.062-1.276]. Also, Black/African Americans admitted with VD as a secondary diagnosis had increased odds for the most stroke risk factors of the ethnic groups, including diabetes [OR 1.187, CI 1.155-1.22] and hypertension [OR 1.04, CI 1.012-1.068]. Caucasians were the only group less likely to be admitted with a primary VD diagnosis with increasing income [$25,001-30,000, OR 0.782; $30,001-35,000, OR 0.75; $35,000 or greater, OR 0.77; p-value Conclusion We demonstrate how healthcare disparities in race-ethnicity can influence the frequency of VD diagnosis in the US. This highlights the need for investigating the impact of healthcare disparities across the spectrum of cerebrovascular disease.

Uric Acid and High-Density Lipoprotein Cholesterol Are Differently Associated with Alzheimer's Disease and Vascular Dementia.

Uric acid (UA) is a major contributor to naturally-occurring antioxidant activity and is thought to have protective effects against neurodegenerative processes. However, UA is also implicated as a risk factor in vascular, including cerebrovascular, disease. Its association with, and role in, dementia and its component diseases including Alzheimer's disease (AD) and vascular dementia (VaD) remains unclear and inconsistently studied. Changes in blood lipids, particularly cholesterol measures, have also been implicated in dementias although the relationship or interactions with UA have been little studied.We have measured plasma UA and lipids taken from 187 subjects first attending a general hospital neurology department for symptoms associated with dementia, and from a series of 79 healthy control subjects. Diagnoses of AD and VaD were made following neuroimaging; laboratory measures were compared between dementia and control groups and between AD and VaD subgroups. No overall change in UA was seen in dementia, although a substantial and highly significant reduction was found in the AD patients. Reduced values in total cholesterol, HDL, and LDL were found in dementia, independent of statin treatment. Further investigation found a significant reduction of HDL only in the VaD group, while total cholesterol was significantly reduced in both AD and VaD subjects.These findings indicate that in our Chinese sample, UA deficits are specifically associated with AD, while deficits in HDL cholesterol found in dementia tend to be greater in VaD.

Abstract WP481: Regional Differences in Hospital Setting and Insurance Coverage in Patients Included in the National Inpatient Sample Database 2006-2014 With Vascular Dementia

Introduction: Evaluation of healthcare utilization in patients hospitalized with vascular dementia (VD) in the United States (US) and regionally have not recently been reported. Patients with VD have higher healthcare utilization and costs than other forms of dementia. We previously found regional differences in frequency at which VD patients were hospitalized in the National Inpatient Sample (NIS), with lower frequency being found in the West. Thus, we hypothesized that payor/insurance type and hospital setting may vary regionally. Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database from 2006-2014 was used to query patients with primary or secondary ICD-9 for VD using ICD-9 codes 290.40, 290.41, 290.43. Regional differences in frequency of VD diagnosis were evaluated within the NIS dividing the US into four hospital regions (Northeast, Midwest, South, and West). Comparison of the observed distribution of insurance status and hospital type were performed with Chi-square analysis and patient demographics with Mann Whitney test. Results: There were no significant regional differences in patient demographics. Nationally, 88% of patients were insured with Medicare, 6% private, 4% Medicaid, 1% self-pay, and 1% were not charged. There were no significant differences in the distribution of insurance coverage by region. In contrast, the distribution of patients admitted with VD in the Northeast (p=0.00790) and West (p=0.0018) were significantly different from the national distribution, which included 15% in rural, 42% urban non-teaching, and 43% teaching hospital setting. In the Northeast 7% were admitted to rural hospitals, 36% urban non-teaching, and 57% teaching hospitals. In the West 6% were admitted to rural hospitals, 58% urban non-teaching, and 36% teaching hospitals. Conclusion: While payor and insurance status did not vary regionally, the hospital type did vary regionally. A significant proportion were covered with Medicare. This is likely related to the age at which the patients progress from mild cognitive impairment to vascular dementia. More research is needed to determine if healthcare utilization by hospital type impacts costs and clinical outcome.

Cerebrospinal fluid lipocalin 2 as a novel biomarker for the differential diagnosis of vascular dementia

The clinical diagnosis of vascular dementia (VaD) is based on imaging criteria, and specific biochemical markers are not available. Here, we investigated the potential of cerebrospinal fluid (CSF) lipocalin 2 (LCN2), a secreted glycoprotein that has been suggested as mediating neuronal damage in vascular brain injuries. The study included four independent cohorts with a total n = 472 samples. LCN2 was significantly elevated in VaD compared to controls, Alzheimer’s disease (AD), other neurodegenerative dementias, and cognitively unimpaired patients with cerebrovascular disease. LCN2 discriminated VaD from AD without coexisting VaD with high accuracy. The main findings were consistent over all cohorts. Neuropathology disclosed a high percentage of macrophages linked to subacute infarcts, reactive astrocytes, and damaged blood vessels in multi-infarct dementia when compared to AD. We conclude that CSF LCN2 is a promising candidate biochemical marker in the differential diagnosis of VaD and neurodegenerative dementias.

Psychopathological peculiarities of vascular dementia with different localization of pathological focuses

Relevance. Vascular dementia, caused by various organic lesions, volume and location of organic damage to brain tissue, manifests itself in a wide range of concomitant neuropsychiatric symptoms. However, despite the obvious link between the location of vascular lesions and the patient's psychopathological symptoms, the effects of the physical characteristics of the brain damage that caused the vascular dementia and the corresponding neuropsychiatric symptoms remain poorly understood. The aim of the study was to investigate psychopathological features of cognitive impairment in patients with vascular dementia depending on the location of the lesion. Contingents and methods. 157 people with a diagnosis of vascular dementia were examined, divided into five groups: group 1 — 22 people with localization of the pathological process in the frontal lobe; group 2 — 18 patients with temporal lobe lesions; group 3 — 17 patients with parietal lobe lesions; group 4 — 15 patients with occipital lobe lesions and group 5 — 68 people with total lesions. Results: It was found that the lesion of the frontal lobes is characterized by a high frequency of euphoria and hallucinatory phenomena, as well as minor manifestations of apathy and anxiety; lesion of the temporal lobe — the highest frequency and severity of apathy; parietal lesions — low frequency of anxiety combined with its high intensity; occipital lesions — intense depressive experiences (in cases where they occurred), total brain damage — the lowest prevalence and intensity of delusional feelings, irritability and agitation. Conclusions. A comprehensive study of patients with vascular dementia identified specific to each localization of brain lesions spectra of neuropsychiatric symptoms, which creates the necessary conditions for early application of differentiated therapeutic and rehabilitation measures and, accordingly, to improve the quality of patients life in this category.

Association between air pollution and risk of vascular dementia: A multipollutant analysis in Taiwan

Evidence regarding the association of specific air pollutants with vascular dementia (VaD) risk is limited. In this nested case–control study, we enrolled 831 adults aged >65 years with VaD (International Classification of Diseases, Ninth Revision, Clinical Modification code 290.4x) newly diagnosed during 2005–2013; 3324 controls were age-, sex-, and VaD diagnosis year–matched with the study patients. Both patients with VaD and controls were selected from among a cohort of one million beneficiaries of Taiwan’s National Health Insurance program, all of whom were registered in 2005. Exposure to the mean daily air pollutant concentration, derived from 76 fixed air quality monitoring stations, in 3, 5, and 7 years before VaD diagnosis was assessed using the spatial analysis method (i.e., ordinary kriging) on ArcGIS. A logistic regression model was used to calculate covariate-adjusted odds ratios (ORs) of VaD in relation to specific air pollutants. After potential confounders and other air pollutants were controlled for, high concentrations of coarse particulate matter (10 µm or less in diameter) and carbon monoxide (CO) were sporadically associated with higher OR of VaD. The most prominent association was observed for nitrogen dioxide (NO2) exposure within 5 and 7 years before diagnosis. Compared with the <25th percentile of NO2 exposure, the 25th–50th, 50th–75th, and >75th percentiles of NO2 exposure significantly increased ORs (95% confidence intervals): 1.62 (1.28–2.23), 1.61 (1.11–2.33), and 2.22 (1.35–3.65) within 5 years before diagnosis, respectively, and 1.59 (1.20–2.11), 1.65 (1.15–2.37), and 2.05 (1.28–3.28) within 7 years before diagnosis, respectively. We found that higher NO2 exposure in the past was significantly associated with an elevated risk of VaD. Although less consistent, higher exposure to CO was also associated with a higher risk of VaD. Most NO2 in cities originates from motor vehicle exhaust; other sources of NO2 are petrol and metal refining, electricity generation from coal-fired power stations, other manufacturing industries, and food processing. Future studies should investigate associations of VaD with specific sources of NO2.

The Vascular Behavioral and Cognitive Disorders criteria for vascular cognitive disorders: a validation study.

The Vascular Behavioral and Cognitive Disorders (VASCOG) criteria for vascular cognitive disorders were published in 2014, but their concurrent and predictive validity have not been examined. Participants (N=165, aged 49-86years) were from Sydney Stroke Study, a longitudinal study of post-stroke cognitive impairment and dementia. Diagnoses using the National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN), the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria for vascular dementia (VaD) were made by consensus at multidisciplinary case conferences. Diagnoses for mild vascular cognitive disorder (mVCD) and VaD using VASCOG, DSM-5 and the Vascular Impairment of Cognition Classification Consensus Study (VICCCS) criteria were made by two study authors. Agreement levels between criteria sets were examined using Cohen's kappa (κ). The ability of VaD diagnoses to predict mortality over 10years and of mVCD to predict dementia over 5years was investigated. The VASCOG criteria yielded rates of mVCD slightly lower than for DSM-5 and VICCCS. VaD rates were similar for all criteria, although slightly lower for DSM-IV. Agreement between the VASCOG, VICCCS and DSM-5 criteria was excellent for VaD and mVCD (κ=0.83-1.0), but lower for VaD between VASCOG and the other criteria (κ=0.47-0.63). VaD-based mortality predictions were similar for the VASCOG, VICCCS and DSM-5 criteria, and higher than those for other criteria. The prediction of incident dementia within 5years from mVCD was slightly lower with VASCOG criteria than with DSM-5 and VICCCS criteria. The VASCOG criteria have greater sensitivity, modest concurrent validity and better predictive validity than older criteria for VaD, but are comparable to DSM-5 and VICCCS criteria. Their operationalization and inclusion of a mild VCD category make them useful for clinical and research applications.

Abstract TMP113: Vascular Dementia Amongst Patients Included in the National Inpatient Sample Database 2006-2014 is not on the Decline

Introduction: Vascular dementia is a significant cause of cognitive decline, gait instability, and is associated with stroke risk factors, ischemic and hemorrhagic stroke. The incidence of ischemic stroke has been declining over the past several decades with improved secondary stroke prevention and care systems. Of several stroke risk factors, diabetes and atrial fibrillation have been identified as co-variates associated with rates of vascular dementia in hospitalized patients. We hypothesize that the frequency of secondary diagnosis for vascular dementia will decline over time between 2006 to 2014 and that the rates of vascular dementia diagnosis may vary by region (Northeast, Midwest, South, West). Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database from 2006-2014 was used to query patients with vascular dementia using ICD-9 codes 290.40, 290.41, 290.43. Two-way ANOVA was used to assess for differences in vascular dementia diagnosis frequency over time. Multivariable logistic regression was performed to test the trend of vascular dementia diagnosis code usage in the database over study years and its interaction with region while, controlling for age, gender, race, and diagnosis of diabetes and atrial fibrillation. Results: On average, there were 31,123,558 ± 800,912 total admissions per year between 2006-2014. The mean age was 79, 55% female, 31% non-Caucasian. There were no significant differences in patient demographics between the regions. The mean frequency of vascular dementia diagnosis per year nationwide was 0.33% (SD, 0.03), ranging from 0.28% in 2006 to 0.34% in 2014. The frequency of vascular dementia diagnosis did not decrease during the study period. After controlling for race, age, gender, diagnosis of atrial fibrillation, and diabetes, there was no association between frequency of vascular dementia diagnoses and region. Conclusion: Despite advances in cardiovascular disease risk reduction, the frequency of hospitalizations associated with vascular dementia diagnoses in this database remained unchanged over a nine-year time span. This demonstrates that more research is needed to develop more effective preventative therapies to decrease vascular dementia.

Comorbidity of Alzheimer's disease and gegontophtalmic pathology

To compare the frequency of age-related ophthalmic diseases in patients with Alzheimer's disease and vascular dementia. The study included 60 patients with severe cognitive impairment divided into two equal groups matched for sex and age. The first group included patients diagnosed with Alzheimer's disease. The second group consisted of people with a diagnosis of vascular dementia. All patients underwent clinical and neuropsychological as well as standard (visometry, refraction, measurement of intraocular pressure, biomicroscopy, ophthalmoscopy, computed perimetry) and complex (optic coherent tomography) ophthalmologic examinations. In patients with Alzheimer's disease, concomitant ophthalmologic pathology in the form of glaucoma was observed more often in 46,7% of cases, pseudoexfoliation syndrome in 20% of cases, age-related macular degeneration in 16,7% of cases, while in the vascular dementia group the majority (80%) of patients did not have concomitant ophthalmologic pathology. When analyzing the severity of cognitive impairment in patients with Alzheimer's disease and various concomitant ophthalmic pathology, it was shown that patients with Alzheimer's disease and glaucoma have more significant impairments compared to patients without concomitant ophthalmological pathology.

Screening and diagnostic framework of vascular dementia in Chinese population

For lack of cognitive screening standard system and controversy over the value of imaging for cerebrovascular diseases in China, the research group of Alzheimer's Disease Chinese (ADC) studied the knowledge of neuropsychology, neuroimaging and clinical neurology, systematically reviewed the diagnostic techniques such as memory, language, visuospatial, executive, function, and magnetic resonance imaging (MRI) of cerebrovascular diseases, and their optimal threshold and diagnostic value for vascular dementia. Via a consensus meeting, the diagnostic guidelines and practical screening process are combined to construct a framework in Chinese population, which is based on the objective evidence of medical history and clinical evaluation. The diagnosis of vascular dementia is supported by imaging evidence of cerebrovascular diseases and differentiates from other causes of dementia or comorbidities. This consensus is applicable to medical units in China, and is of great significance for early detection, early diagnosis and early treatment of vascular dementia.

Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway.

IntroductionAlzheimer’s disease patients are reported to have higher survival rate compared to patients with vascular dementia or dementia with Lewy bodies. There is a paucity of studies investigating survival including persons with cognitive decline and dementia of various aetiologies.ObjectivesWe aimed to compare survival for patients with subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease, vascular dementia, mixed Alzheimer’s/vascular dementia, dementia with Lewy bodies/Parkinson’s disease, and other dementias compared to the general Norwegian population, taking into account the role of gender, cognitive function, function in everyday activities, comorbidity and education.MethodsPatients (N = 4682), ≥65 years, in the The Norwegian register of persons assessed for cognitive symptoms (NorCog) during 2009–2017 were followed for mortality in the National Registry until January 2018. Flexible parametric survival models were applied to estimate relative survival, life expectancy and years of life lost for diagnostic groups compared with the general population.ResultsPatients with vascular dementia or dementia with Lewy bodies/Parkinson’s had the shortest survival, followed by mixed dementia, Alzheimer’s disease, unspecified dementia, mild cognitive impairment and subjective cognitive decline. At age 70 years, men with vascular dementia or dementia with Lewy bodies/Parkinson’s had life expectancy of 4.7 years, which corresponded to 10.3 years of life lost compared to the general population. Years of life lost for other diagnoses were 10.0 years for mixed dementia, 9.2 years for Alzheimer’s disease, 9.3 years for other dementias, 5.2 years for mild cognitive impairment and 2.2 years for subjective cognitive decline. Corresponding years of life lost in women were: 12.7 years, 10.5 years, 9.8 years, 10.6 years, 7.8 years, and 2.6 years. Poor relative survival among dementia patients was associated with male gender, comorbidity, low cognitive function, and low function in activities of daily living.ConclusionsCompared with the general population, patients with subjective cognitive decline had no significant loss in life expectancy, while patients with mild cognitive impairment and all dementia subtypes had large losses, especially those with a diagnosis of vascular dementia or dementia with Lewy bodies/Parkinson’s.

ED Visits on the Rise for People With Dementia

Emergency department (ED) visits in the last year of life for people with dementia are common and increasing in the United Kingdom, according to a retrospective cohort study linking clinical and administrative data. The study also found that being a resident in a care home (both residential care homes with personal care only, and care homes with nursing care) was associated with a reduced likelihood of ED attendance, which suggests that care home residence “might ‘protect’ patients against transitions in care setting close to death,” said Katherine E. Sleeman, PhD, of King’s College London, and her associates. The finding that more than three-quarters of patients (78.6%) with dementia had at least one ED visit in their last year of life is similar to data from the United States and Australia, the investigators said, so policy makers should study and consider not only place of death but a broader range of indicators of the quality of end-of-life care. Dying out of the hospital has been a policy focus in the United Kingdom, but “the place of death … doesn’t tell us about the care they received during their last weeks and months,” the investigators reported (Alzheimer’s Dement 2018;14:20–27). The study also found that being a resident in a care home … was associated with a reduced likelihood of ED attendance. Their study linked electronic medical record data from a large mental health care provider covering four boroughs of South London with national mortality and hospital use data, and focused on the last year of life. The closer patients were to death, the more likely they were to visit EDs; approximately one-quarter of all ED visits occurred in the last month of life. Of the 4,867 patients in the cohort, 44.5% had at least one ED visit in the last month of life, and 20.9% had at least one visit in the last week of life. The mean number of ED attendances per patient in the last year of life increased from 1.6 during 2008–2009 to 2.4 during 2012–2013. Almost all ED visits (91%) were by ambulance, and almost half occurred “out of hours,” which suggests that the visits were precipitated by an acute crisis, the authors said. Approximately 75% of the 1,783 care home residents in the cohort had at least one ED visit in the last year of life, compared with 81% of the 3,084 patients who did not live in a care home. Care home residence remained associated with less ED use in a multivariable model of analysis. Factors associated with greater ED use included male gender, higher cognitive function (Mini-Mental State Examination score), diagnosis of vascular dementia, and living in less affluent areas — the latter of which has been shown in prior research to impact access to palliative care/hospice services, the investigators noted. Investigators were limited by the lack of any information regarding patients’ preferences or wishes, the presence or absence of advance directives, or the decision-making process leading to ED attendance. “For people with dementia, high rates of ED attendance near the end-of-life may indicate inadequate availability of community care, a paucity of advance directives, or lack of focus on patients’ quality of life,” the investigators wrote. The most common diagnosis was Alzheimer’s disease (40.4%) followed by vascular dementia (25.4%). Christine Kilgore is a freelance writer in Falls Church, VA.

Erythrocyte Associated Amyloid-β as Potential Biomarker to Diagnose Dementia

Although it is known that Alzheimer's disease (AD) is associated with the progressive accumulation of amyloid β-peptide (Aβ) in the human brain, its pathogenic role has to be completely clarified. Aβ moves from the bloodbrain barrier to the plasma and an increased Aβ production in brain could be associated with higher Aβ concentrations in blood. A recent study has evaluated Aβ40 and Aβ42 levels in human red blood cells (RBCs) with evidence of agedependent higher Aβ concentration in RBCs. The aim of the study was to investigate if erythrocyte associated Aβ (iAβ) levels could be different in subjects affected by dementia in comparison with controls and according to the patient's cognitive impairment or different dementia subtypes. To answer these questions we assessed iAβ40 and iAβ42 levels in 116 patients: 32 healthy controls, 39 with diagnosis of vascular dementia (VaD), 14 mild cognitive impairment (MCI) and 31 AD. In this population we found significant differences in iAβ42 between controls and cognitive impaired patients. Moreover, iAβ42 significantly differed between dementia vs MCI. AD also showed different iAβ42 levels as compared to VaD. Conversely, no differences were found for iAβ40. All the analyses were adjusted for potential confounders like age, gender and Hb concentration. A direct correlation between increasing iAβ42 concentration and the progression of the cognitive decline using the MMSE score as continuous variable was also found. Our findings support the evidence that iAβ42 could be an instrument to early recognize dementia and predict cognitive impairment.

Evaluation of cerebrospinal fluid phosphorylated tau231 as a biomarker in the differential diagnosis of Alzheimer's disease and vascular dementia.

The diagnosis of either Alzheimer's disease (AD) or vascular dementia (VaD) is still largely based on clinical guidelines and exclusion of other diseases that may lead to dementia. In this study, we assessed whether the use of sensitive and specific biomarkers such as phosphorylated tau proteins could contribute to an earlier and more accurate diagnosis of AD and VaD, as well as to their differentiation. A total of 198 patients, of which 152 had AD, 28 VaD, and 18 were healthy controls (HC), were included in the analyses. We analyzed cerebrospinal fluid (CSF) levels of total tau protein (t-tau), tau protein phosphorylated at threonine 231 (p-tau231), and factor score (FS) determined by combination of p-tau231 and Mini-Mental State Examination (MMSE) in patients with AD and VaD, as well as in HC. We tested the diagnostic accuracy of these biomarkers in the CSF and FS (p-tau231, MMSE) in differentiating AD from VaD and HC. Total tau levels were significantly elevated in subjects with AD compared to HC, as well as in VaD subjects compared to HC. p-tau231 levels were significantly higher in patients with ADvsHC as well in patients with VaD vsHC. p-tau231 levels did not distinguish AD from VaD patients. Importantly, FS(p-tau231 and MMSE) showed statistically significant differences in the distribution of subjects with AD and VaD. These results indicate that FS (p-tau231 and MMSE) has a strong potential to provide an early distinction between AD and VaD.

Characteristics of electroencephalograph in cerebral infarction patients with subsequent vascular dementia

Clinical data of 65 patients with acute cerebral infarction (frontal or temporal or both lobes) treated in our hospital during 2015—2016 were retrospectively reviewed.The patients were followed up for 6 months, 34 cases were diagnosed as vascular dementia (VD) according to ICD-10 (VD group) and 31 cases were diagnosed as simple cerebral infarction (control group). The abnormal rate of electroencephalograph (EEG) at baseline in VD group was significantly higher than that in control group (χ2=5.44, P=0.02). Compared to control group, the powers of slow wave (θ wave and δ wave) at baseline, third month and sixth month in VD group were significantly increased (Fbetween groups=17.39, Finner groups=163.50, Finteraction=38.71; all P=0.00) and (Fbetween groups=5.10, Finner groups=119.04, Finteraction=6.54; P<0.05). Compared to baseline, the α wave and β wave were significantly decreased at third month and sixth month in VD (Finner groups=116.40, P=0.00) and (Finner groups=55.90, P<0.05). Compared to control group, the powers of θ wave (except in the frontal lobe at baseline and third month) and δ wave were significantly increased at all time points (P<0.05). Except the θ wave in occipital lobe, there were significant differences in slow wave at all time points between VD group and control group (P<0.05). The featured EEG with increased slow wave in many regions of cerebral infarction can be used for early diagnosis of VD in patients with cerebral infarction. Key words: Vascular dementia; Cerebral infarction; Electroencephalograph

A panel of clinical and neuropathological features of cerebrovascular disease through the novel neuroimaging methods.

ABSTRACT.The last decade has witnessed substantial progress in acquiring diagnostic biomarkers for the diagnostic workup of cerebrovascular disease (CVD). Advanced neuroimaging methods not only provide a strategic contribution for the differential diagnosis of vascular dementia (VaD) and vascular cognitive impairment (VCI), but also help elucidate the pathophysiological mechanisms ultimately leading to small vessel disease (SVD) throughout its course.Objective:In this review, the novel imaging methods, both structural and metabolic, were summarized and their impact on the diagnostic workup of age-related CVD was analysed. Methods: An electronic search between January 2010 and 2017 was carried out on PubMed/MEDLINE, Institute for Scientific Information Web of Knowledge and EMBASE.Results:The use of full functional multimodality in simultaneous Magnetic Resonance (MR)/Positron emission tomography (PET) may potentially improve the clinical characterization of VCI-VaD; for structural imaging, MRI at 3.0 T enables higher-resolution scanning with greater imaging matrices, thinner slices and more detail on the anatomical structure of vascular lesions.Conclusion:Although the importance of most of these techniques in the clinical setting has yet to be recognized, there is great expectancy in achieving earlier and more refined therapeutic interventions for the effective management of VCI-VaD.