Vascular Mild Cognitive Impairment Research Articles

Constructing a Composite Score for the Seoul Neuropsychological Screening Battery-Core

Background and Purpose The brief version of the Seoul Neuropsychological Screening Battery (SNSB), the SNSB-Core (SNSB-C), has been developed. Although each subtest score of the SNSB-C provides information on different features of broad cognitive functioning or im pairment, a composite score is needed to identify the severity of global cognitive impairment. We aimed to develop and validate a composite score of the SNSB-C that would provide a normative-based summary score of global cognitive functioning, especially for differentiating pa tients with cognitive impairment from normal elderly. Methods A normative sample of 1067 elderly was used to develop a composite score of SNSB-C. The composite score was corrected for the effects of age, years of education, and sex by the regression method. Patients with Alzheimer’s disease ( n=41), vascular dementia (n=40), amnestic mild cognitive impairment (MCI) (n=73), vascular MCI (n=41), and Parkinson’s disease with MCI (n=41) were differentiated from a normal sample (n=70) by the uncorrected and corrected composite scores using receiver operating characteristic (ROC) curve analysis. Results Confirmatory factor analysis showed that the composite score equal weight to each standardized cognitive domain of SNSB-C is appropriate for indexing overall cognitive functioning. The corrected and uncorrected composite scores yielded a satisfactory size of the area under the ROC curve comparable to the Mini Mental State Examination (MMSE). Conclusions The composite scores of SNSB-C, especially the corrected score, provide an index of overall cognitive functioning, and they can be used as an alternative to MMSE for screening patients with cognitive impairment.

Brain metabolism assessed via proton magnetic resonance spectroscopy in patients with amnestic or vascular mild cognitive impairment

Background and objectivesTo address the possible role of brain regional metabolic differences between different types of mild cognitive impairment (MCI). Patients and methodsBrain regional metabolites in patients with amnestic mild cognitive impairment (A-MCI) and vascular mild cognitive impairment (V-MCI) were measured via proton magnetic resonance spectroscopy (1H MRS) technique. Twenty-eight patients with A-MCI, 24 patients with V-MCI and 34 normal controls (NC) were tested by a battery of neuropsychological screens. All the subjects underwent the single voxel 1H MRS with the regions of interest (ROIs) located in the left frontal lobe, left basal ganglia and left hippocampus. ResultsThe A-MCI showed lower NAA/Cr ratio in the left hippocampus. There was a significant correlation between recent memory score and the NAA/Cr ratio. In V-MCI, NAA/Cr ratio in the left frontal lobe was positively correlated with the cognitive score evaluated with Cambridge Cognitive Examination-Chinese version (CAMCOG-C) and its subscores of orientation, praxi, language and language comprehension. ConclusionsThis study indicated that there are differences in metabolism related to brain regions between A-MCI and V-MCI, thus it may be concluded that 1H MRS may be a useful tool to differentiate A-MCI and V-MCI.

MCI of different etiologies differ on the Cognitive Assessment Battery.

The study aims to investigate whether patients with mild cognitive impairment (MCI) who have significant vascular disease (MCI-vas) differ from those with no significant vascular disease (MCI-nov) in terms of cognitive profile when assessed with the cognitive assessment battery (CAB). Seventy patients clinically diagnosed with MCI were included in the study, 32 were classified as MCI-vas, and 38 as MCI-nov, together with 40 healthy controls. CAB consists of six short tests measuring speed and attention, memory, visuospatial functions, language, and executive functions. The healthy controls performed better than both MCI groups on CAB. MCI-vas patients were significantly older and had fewer years of education than MCI-nov patients. When adjusted for age and education, MCI-vas performed significantly worse than MCI-nov on memory, language, and executive tests. The results suggest that CAB can differentiate between MCI patients with and without vascular disease and that their cognitive profiles differ. Furthermore, CAB classified the patients as vascular and non-vascular MCI with good sensitivity and specificity.

Post-stroke memory impairment among patients with vascular mild cognitive impairment.

BackgroundThe American Stroke Association/American Heart Association recommended the criteria for diagnosis of vascular cognitive impairment and memory impairment (MI) is a feature in the classification of vascular mild cognitive impairment (VaMCI). VaMCI patients with MI may differ in terms of infarct location or demographic features, so we evaluated the clinical characteristics associated with MI in patients with VaMCI.MethodsA prospective multicenter study enrolled 353 acute ischemic stroke patients who underwent evaluation using the Korean Vascular Cognitive Impairment Harmonization Standard Neuropsychological Protocol at three months after onset. The association between MI and demographic features, stroke risk factors, and infarct location was assessed.ResultsVaMCI was diagnosed in 141 patients, and 58 (41.1%) exhibited MI. Proportions of men and of left side infarcts were higher in VaMCI with MI than those without (75.9 vs. 57.8%, P = 0.03, 66.7 vs. 47%, P = 0.02). Multiple logistic analyses revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [95% CI] 1.12-8.42), left-side infarcts (OR 3.14, 95% CI 1.37-7.20), and basal ganglia/internal capsule infarcts (OR 4.53, 95% CI 1.55-13.22) were associated with MI after adjusting other demographic variables, vascular risk factors, and subtypes of stroke.ConclusionsMI is associated with sex and infarct location in VaMCI patients.

Vascular Cognitive Disorders and Depression After First-Ever Stroke: The Fogarty-Mexico Stroke Cohort

Background and Purpose: Stroke is the major cause of vascular behavior and cognitive disorders worldwide. In developing countries, there is a dearth of information regarding the public health magnitude of stroke. The aim of the Fogarty-Mexico cohort was to assess the prevalence of vascular behavioral and cognitive disorders, ranging from mild vascular cognitive impairment (VCI) to vascular dementia (VaD), in a cohort of acute first-ever symptomatic stroke patients in Mexico. Methods: A total of 165 consecutive, first-ever stroke patients admitted to the National Institute of Neurology and Neurosurgery in Mexico City, were included in the cohort. Patients were eligible if they had an ischemic stroke, primary intracerebral hemorrhage, or cerebral venous thrombosis (CVT). Stroke diagnosis required the presence of an acute focal deficit lasting more than 24 h, confirmed by a corresponding lesion on CT/MRI. Stroke severity was established with the NIH Stroke Scale. The pre-stroke functional status was determined by the IQCODE. Three months after the occurrence of stroke, 110 survivor patients returned for follow-up and were able to undergo functional outcome (modified Rankin scale, Barthel index), along with neurological, psychiatric, neuropsychological, laboratory, and imaging assessments. We compared depression, demographic, and clinical and imaging features between patients with and without dementia, and between patients with VCI and those with intact cognition. Results: Of the 110 patients (62% men, mean age 56 ± 17.8, education 7.7 ± 5.2 years) 93 (84%) had ischemic strokes, 14 (13%) intracerebral hemorrhage, and 3 (3%) CVT. The main risk factors were hypertension (50%), smoking (40%), hypercholesterolemia (29%), hyperhomocysteinemia (24%), and diabetes (22%). Clinical and neuropsychological evaluations demonstrated post-stroke depression in 56%, VCI in 41%, and VaD in 12%; 17% of the latter had pre-stroke functional impairment (IQCODE >3.5). Cognitive deficits included executive function in 69%, verbal memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054), older age (mean age 65.6 years vs. 49.3, p < 0.001), diabetes (p ≤ 0.004), illiteracy and lower education (p ≤ 0.001), and PSD (p = 0.03) were significantly higher in VCI-VaD compared with cognitively intact post-stroke subjects. We could not demonstrate an association with lesion site and distribution of the cognitive deficits. Conclusions: The Fogarty-Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable.

Remote thalamic microstructural abnormalities related to cognitive function in ischemic stroke patients.

Ischemic stroke can lead to a continuum of cognitive sequelae, ranging from mild vascular cognitive impairment to vascular dementia. These cognitive deficits can be influenced by the disruption of cortico-subcortical circuits. We sought to explore remote thalamic microstructural abnormalities and their association with cognitive function after ischemic stroke. Seventeen patients with right hemispheric ischemic stroke and 17 controls matched for age, sex, and years of education were included. All participants underwent neurological, neuropsychological, and diffusion tensor image examination. Patients were assessed 3 months poststroke. Voxel-wise analysis was used to study thalamic diffusion differences between groups. Mean fractional anisotropy (FA) and mean diffusivity (MD) values in significant thalamic areas were calculated for each subject and correlated with cognitive performance. Stroke patients showed lower FA values and higher MD values in specific areas of both the left and right thalamus compared with controls. In patients, decreased FA values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.45, β = 0.74) and the left thalamus (R(2) = 0.57, β = 0.77) after adjusting for diabetes mellitus. Moreover, increased MD values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.27, β = -0.54) after adjusting for diabetes mellitus. In controls, thalamic FA and MD values were not related to any cognitive function. Our findings support the hypothesis that ischemic stroke lesions are associated with remote thalamic diffusion abnormalities, and that these abnormalities can contribute to cognitive dysfunction 3 months after a cerebrovascular event.

Prediction for vascular mild cognitive impairment using the p300 event-related potentials technique

Prediction for vascular mild cognitive impairment using the p300 event-related potentials technique

Age and Gender Differences in Force Control Capabilities by Force Control Phase

The present study is intended to analyze effects of age (6 levels; 20s ~ 70s), gender (2 levels; male, female), and hand (2 levels; left hand, right hand) on force control capabilities by force control phase (initiation, development, maintenance, and termination). The force control capabilities by phase was quantified as initiation time (IT), development time (DT), maintenance error (ME), and termination time (TT) using a finger dynamometer. Thirty healthy people by combination category (e.g., 30s, male) of age group and gender participated in the experiment ( n = 360). IT (20s:70s = 1:1.24) and TT (1.33) increased linearly, DT (1.29) and ME (2.07) increased quadratically with age. ME of female was significantly 36% (20s &amp; 30s: 16%, 40s &amp; 50s: 28%, 60s: 42%, 70s: 67%) larger than that of male. Hand effects on DT and TT were significant; however the mean difference between both hands was very slight (&lt; 2%). A normative force control data by force control phase with 4 age groups (20s &amp; 30s, 40s &amp; 50s, 60s, and 70s) and gender (male, female) was established, and would be applicable to evaluation criteria for early detection of a variety of patients with brain injury types (e.g., subcortical vascular mild cognitive impairment, svMCI).

Effects of carotid endarterectomy on cognitive function in patients with carotid stenosis

To investigate the theraputic effects of carotid endarterectomy (CEA) on cognitive function in patients with carotid stenosis (CAS) and congnitive impairment. CEA was performed on 38 patients with CAS from December 2011 to July 2013. There were 26 male and 12 female patients, with an average age of (70 ± 7) years. Patients was underwent neuropsychological examinations (NPEs) including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 1 week before and 6 weeks after treatment. Cerebral perfusion was assessed with MR perfusion-weighted imaging and diffusion-weighted inmaging at 1 week before and 6 weeks after treatment. All of the 38 patients completed NPEs and MRI at baseline and 6 weeks after CEA. After therapy, the parameters and the extents of abnormal perfusion was improved, including the decrease of time to peak (29 ± 9 vs. 23 ± 4), relative mean transit time (22 ± 8 vs. 14 ± 6), arrive time (21 ± 8 vs. 15 ± 4) and relative cerebral blood volume (11.6 ± 3.5 vs. 7.5 ± 3.2) (t = 1.31 to 5.24, all P < 0.05). Significant improvement in MoCA (20.4 ± 1.5 vs. 22.0 ± 1.6, t = -4.25, P = 0.000) but MMSE (26.16 ± 1.35 vs. 26.47 ± 1.52, t = -0.96, P = 0.341) was observed. CEA significantly improved the assessment of visuospacial/constructive abilities (2.4 ± 0.9 vs. 2.8 ± 0.7), naming (2.0 ± 0.7 vs. 2.3 ± 0.6), abstraction (1.2 ± 0.7 vs. 1.6 ± 0.6) and attention (2.3 ± 0.6 vs. 2.6 ± 0.5) (t = 0.015 to 0.029, P = 0.015). CEA can improve the cognitive function of patients with carotid stenosis as well as the cerebral perfusion of patients and has therapeutic effects on vascular mild cognitive impairment.

A relationship study on ambulatory pulse pressure, pulse pressure index and cognitive function in vascular cognitive impairment patients

Objective To assess the relationship between ambulatory pulse pressure (PP), pulse pressure indices (PPI) and the severity of cognitive function. Methods Sixty patients with severe, moderate, mild vascular cognitive impairment(VCI) as the research object, and forty healthy people as control group.All of the patients of ambulatory blood pressure were monitored. Results Severe VCI group of PP and PPI was significantly higher than moderate, mild VCI group and the control group(PP(mmHg): (59.10±11.82, 54.94±10.86, 50.28±8.33, 45.54±9.22, P<0.05), PPI: (0.61±0.08, 0.53±0.06, 0.44±0.05, 0.37±0.03, P<0.05), and the MMSE score was significantly lower than moderate, mild, and the control group(15.56±2.64, 19.32±3.32, 22.62±3.11, 26.45±2.94, P<0.05). Moderate VCI group of PP and PPI was significantly higher than the control group(P<0.05). MMSE score was significantly lower than mild VCI and the control group(P<0.05). Linear correlation analysis showed that PP and PPI was significantly negative related to MMSE score. Conclusion The increase of dynamic pulse pressure, pulse pressure index is associated with the damage of cognitive function. Key words: Ambulatory pulse pressure; Pulse pressure index; Cognitive function

NEUROPSYCHIATRIC SYMPTOMS IN AMNESTIC AND SUBCORTICAL VASCULAR MILD COGNITIVE IMPAIRMENT

Mild cognitive impairment (MCI) has emerged as an identifiable condition and in many cases is a transitional state preceding diagnosable Alzheimer disease (AD) and Subcortical Vascular dementia (SVaD). The aim of this study was to define the neuropsychiatric features of the amnestic MCI and compare with subcortical vascular MCI (svMCI). Patients with subcortical vascular cognitive impairment can be isolated using criteria modified from those of Erkinjunti et al. for SVaD. We used new criteria of MCI (MCI-R) subclassifying amnestic MCI.The Neuropsychiatric Inventory (NPI) was used to assess individual mean score of NPI symptoms. 155 subjects was analyzed: 115 were classified as a MCI and 40 svMCI. Subjects with subcortical vascular MCI were more compromised than those with amnestic MCI on global cognitive function. About 70% of MCI patients had some neuropsychiatric symptoms evaluated with the NPI. A significantly higher mean score of depression and anxiety has been observed in the amnestic MCI group compared with the subcortical vascular MCI group. Neuropsychiatirc symptoms occur in the majority of persons with MCI and may be the earliest manifestation of different disease. A significantly higher mean score of depression and anxiety has been observed in the amnestic MCI group compared with the subcortical vascular MCI group. These results are derived from a limited clinical sample and require confirmation in longtudinal community-based investigation.

Characteristics of cognitive impairment in adults with cerebral ischemia

To explore the characteristics of cognitive impairment of cerebral ischemia in adults to provide rationales for proper diagnosis and targeted treatment. A battery of standardized neuropsychological tests including mini-mental state examination (MMSE) and memory and executive screening (MES) was administered in a cohort of consecutive patients with cerebral ischemia. According to the screening results, they were divided into 3 subgroups of vascular dementia (VaD), vascular mild cognitive impairment (VaMCI) and non-vascular cognitive impairment (VCI). The general profiles of 3 subgroups were compared and the characteristics of VaMCI subgroup examined. Then the relationship between the composition of cognitive impairment and the type of ischemia (stroke and transient ischemic attack) was analyzed. Fifty-six patients and 48 healthy subjects (normal control group) matched with regards to age, gender and education were recruited. Compared to normal control group, there was a decline in the scores of MMSE [(25.0 ± 5.6) vs (28.0 ± 1.4); t = 2.695, P = 0.007] and MES [(67 ± 21) vs (84 ± 7); z = 3.860, P = 0.000] in case group. There were 33 cases (58.9%) of VCI in case group, including 11 (19.6%) in VaD subgroup, 22 (39.3%) in VaMCI subgroup and 23 (41.1%) in non-VCI subgroup. And the rate of VaD/VaMCI was 1/2. The percentage of males (36.4% vs 78.3%; χ(2) = 5.720, P = 0.017) and education [(8 ± 3) vs (12 ± 4); P = 0.010] of VaD subgroup were significantly lower than that of non-VCI subgroup; the education of VaMCI subgroup was significantly lower than that of non-VCI subgroup [(7 ± 3) vs (12 ± 4); P = 0.001]; a positive correlation existed between scores of MMSE/MES and cognitive impairment. The neuropsychological tests were both sensitive and specific.In VaMCI subgroup, 22 cases (100%) presented with a deficit of at least 1 certain executive function/attention index, 21(95.5%) with at least 1 certain memory index, 17(77.3%) with at least 1 certain language index and 16(72.7%) with at least 1 certain visuospatial function index; all VaMCI cases presented with comprehensive cognitive impairment: 11 (50%) in 4 domains, 10 (45%) in 3 domains and 1 (5%) in 2 domains.No significant difference existed among 3 subgroups with regard to type of ischemia (χ(2) = 1.111, P = 0.574). In the case group, 30 patients suffered stroke and 17 (56.7%) had an onset of VCI with a rate of VaMCI/VCI at 58.8%; transient ischemic attack occurred in 26 patients and 16 (61.5%) suffered VCI with a rate of VaMCI/VCI at 75.0%. Our study not only profiles the prevalence and peculiarity of cognitive impairment in patients with cerebral ischemia, but also provides concrete rationales for further diagnosis and classification of VCI.

Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment.

Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). A cross-sectional study was conducted using a hospital-based sample at a tertiary referral center. We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. On evaluation, 22 of the svMCI group (33%) and 28 of the aMCI group (62%) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.

Blood Viscosity in Subcortical Vascular Mild Cognitive Impairment with versus without Cerebral Amyloid Burden

Subcortical vascular dementia (SVaD) is a common form of dementia, attributed to ischemic small-vessel disease. Blood viscosity (BV) may contribute to the pathophysiology of SVaD. However, SVaD patients with coexisting amyloid deposition may not show differences in BV because their small-vessel disease may result from amyloid angiopathy independently of BV. We, therefore, hypothesized that BV might show different changes compared with control subjects in subcortical vascular mild cognitive impairment (svMCI) that refers to the prodromal stage of SVaD according to cerebral amyloid burden detected by the [(11)C] Pittsburgh compound B (PiB) PET (positron emission tomography), and apolipoprotein 4 (ApoE4) genotype (a known risk factor for vascular and parenchymal amyloid). Our subjects consisted of 33 healthy normal controls (NC), 28 patients with PiB(-) svMCI, and 12 with PiB(+) svMCI. They underwent scanning capillary tube viscometer measuring BV during systolic and diastolic phases. Compared with the NC group, the PiB(-) svMCI group showed increased diastolic blood viscosity (DBV) but no difference in systolic blood viscosity (SBV). By contrast, there was no significant difference in SBV and DBV between the NC and PiB(+) svMCI groups. Within the PiB(+) svMCI group, ApoE4(-) subgroup showed increased DBV compared with the ApoE4(+) subgroup. Increased DBV is an important contributor to the development of "pure" svMCI (ie, without cerebral amyloid deposition). The relationship between BV and PiB(+) svMCI differed according to ApoE genotype, suggesting that the pathogenesis of PiB(+) svMCI might also be heterogeneous.

Neuroprotective properties of citicoline: facts, doubts and unresolved issues.

Citicoline is the generic name of the pharmaceutical substance that chemically is cytidine-5′-diphosphocholine (CDP-choline), which is identical to the natural intracellular precursor of phospholipid phosphatidylcholine. Following injection or ingestion, citicoline is believed to undergo quick hydrolysis and dephosphorylation to yield cytidine and choline, which then enter the brain separately and are used to resynthesize CDP-choline inside brain cells. Neuroprotective activity of citicoline has been repeatedly shown in preclinical models of brain ischaemia and trauma, but two recent, large, pivotal clinical trials have revealed no benefits in ischaemic stroke and traumatic brain injury. However, the substance seems to be beneficial in some slowly advancing neurodegenerative disorders such as glaucoma and mild vascular cognitive impairment. This paper critically discusses issues related to the clinical pharmacology of citicoline, including its pharmacokinetics/biotransformation and pharmacodynamics/mode of action. It is concluded that at present, there is no adequate description of the mechanism(s) of the pharmacological actions of this substance. The possibility should be considered and tested that, in spite of apparently fast catabolism, the intact citicoline molecule or the phosphorylated intermediate products of its hydrolysis, cytidine monophosphate and phosphocholine, are pharmacologically active.

Cortical thickness and hippocampal shape in pure vascular mild cognitive impairment and dementia of subcortical type

The progression pattern of brain structural changes in patients with isolated cerebrovascular disease (CVD) remains unclear. To investigate the role of isolated CVD in cognitive impairment patients, patterns of cortical thinning and hippocampal atrophy in pure subcortical vascular mild cognitive impairment (svMCI) and pure subcortical vascular dementia (SVaD) patients were characterized. Forty-five patients with svMCI and 46 patients with SVaD who were negative on Pittsburgh compound B (PiB) positron emission tomography imaging and 75 individuals with normal cognition (NC) were recruited. Compared with NC, patients with PiB(-) svMCI exhibited frontal, language and retrieval type memory dysfunctions, which in patients with PiB(-) SVaD were further impaired and accompanied by visuospatial and recognition memory dysfunctions. Compared with NC, patients with PiB(-) svMCI exhibited cortical thinning in the frontal, perisylvian, basal temporal and posterior cingulate regions. This atrophy was more prominent and extended further toward the lateral parietal and medial temporal regions in patients with PiB(-) SVaD. Compared with NC subjects, patients with PiB(-) svMCI exhibited hippocampal shape deformities in the lateral body, whilst patients with PiB(-) SVaD exhibited additional deformities within the lateral head and inferior body. Our findings suggest that patients with CVD in the absence of Alzheimer's disease pathology can be demented, showing cognitive impairment in multiple domains, which is consistent with the topography of cortical thinning and hippocampal shape deformity.

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack

The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke. Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability. One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83-0.91) vs. 0.84 (95% CI 0.80-0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87-0.93), p <0.001; MoCA+SDMT 0.91 (95% CI 0.88-0.94), p < 0.02). The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.

A Comparison of the Performances on the MMSE, HDS-R, and MoCA According to the CDR Sum of Boxes in Amnestic Mild Cognitive Impairment and Vascular Mild Cognitive Impairment

Background: O’Bryant et al. (2008) argued that the CDR Sum of Boxes (CDR-SB) can be used to distinguish MCI from very early dementia in patients with CDR-GS of 0.5. They reported that the optimal CDRSB cut-off score was 2.5. The present study was conducted to examine whether the subgroups classified with CDR-SB scores showed the corresponding group differences on the cognitive tests. Methods: The subjects were 45 amnestic multi-domain MCI (amMCI) and 53 vascular MCI (VaMCI) with CDR-GS of 0.5. Each patient group was classified into “mild (0.5-2.0)” and “severe (2.5-4.0)” subgroups based on the CDR-SB. As the result, 4 groups were formed such as mild amMCI (n= 23), severe amMCI (n= 22), mild VaMCI (n= 29), and severe VaMCI (n= 24). The subjects were given the MMSE, HDS-R, and MoCA. The MANCOVA was conducted separately for each test with a Bonferroni correction for multiple comparisons. Results: Severe groups of both amMCI and VaMCI showed significantly lower performances than two mild groups in MMSE, HDS-R, and MoCA. It was found that “serial 100-7” was a good item to discriminate between the mild and severe groups in both amMCI and VaMCI. Items measuring “orientation” or “naming” showed significant subgroup differences in the amMCI, whereas items related to “memory,” “visuospatial construction,” or “frontal/executive function” showed significant subgroup differences in the VaMCI. Conclusions: These results showed that there were significant differences in cognitive functions between the two subgroups with CDR-GS of 0.5. The results about the items discriminating between subgroups in amMCI and VaMCI were consistent with the previous findings about the progression of cognitive impairments in AD and VaD. Therefore, these results support the use of CDR-SB as a guideline for distinguishing MCI from early dementia. Received: November 20, 2014 Revision received: December 23, 2014 Accepted: December 23, 2014

The Contribution of EEG to the Diagnosis of Dementia

Changes induced by cerebrovascular damage (CVD) and amigdalo-hippocampal atrophy (AHC) on brain rhythmicity as revealed by scalp electroencephalography (EEG) were evaluated in a cohort of subjects with mild cognitive impairment (MCI) in order to detect different EEG patterns due to the vascular or degenerative impairment. All subjects underwent EEG recording and magnetic resonance imaging (MRI). EEGs were recorded at rest. Relative power was separately computed for delta, theta, alpha1, alpha2, and alpha 3 frequency bands. Increased delta power and decreased alpha2 power were associated with the load of cerebrovascular damage (CVD). Moreover, the theta/alpha 1 ratio could be a reliable index for the estimation of the individual extent of CV damage. No association of vascular damage was observed with alpha3 power. On the other side, moderate hippocampal atrophy was related to an increase of alpha2 and alpha3 frequency power ratio. Our results show that different EEG markers are associated to vascular dementia and Alzheimer’s disease (AD). EEG markers could be expression of different global network pathological changes, helping in differentiation of prodromal AD from vascular demented patients. MCI stated that EEG markers could have a prospective value in differential diagnosis between vascular and degenerative MCI.

Vascular risk factors and mild cognitive impairment in the elderly population in Southwest China.

Increasing evidence has demonstrated that vascular risk factors (VRFs) contribute to cognitive impairment in the elderly population. Prevention and administration of VRFs can be a vital strategy for delaying cognitive impairment. This study aimed to determine the impact of VRFs on cognitive function of the aged people from Chongqing, Southwest China. A total of 597 participants (≥60 years) from hospital and community population were enrolled in the cross-sectional study. Participants were screened for hypertension, coronary heart disease (CHD), and cerebrovascular disease (CVD). Blood pressure (BP) and blood lipid were also measured. Cognitive function was assessed with Mini-Mental State Examination and Clinical Dementia Rating. Logistic regression analysis was used to look for VRFs impacting mild cognitive impairment (MCI). Then we investigated the relationship between different types of vascular diseases and MCI. A total of 457 participants showed normal cognitive function and 140 participants showed MCI. After adjusting for age, gender, and education, logistic regression analysis demonstrated that hypertension, CHD, systolic BP, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were independently associated with MCI; however, CVD, diastolic BP, triglyceride, and high-density lipoprotein cholesterol were not associated with MCI. Moreover, vascular diseases significantly contributed to MCI compared with no vascular disease; however, no significant difference in incident MCI was found among different combinations of vascular diseases. Hypertension, CHD, TC, and LDL-C are independent risk factors for MCI. Moreover, patients with vascular diseases have a higher risk of MCI; however, the amount of vascular diseases does not increase the risk of MCI.