Vascular Mild Cognitive Impairment Research Articles

Alterations of White Matter Microstructure in Subcortical Vascular Mild Cognitive Impairment with and without Depressive Symptoms.

Depressive symptoms were thought to increase the risk of vascular dementia. Previous studies reported widespread white matter damages in the subcortical vascular mild cognitive impairment (svMCI), but little is known about the mechanism of depressive symptoms in svMCI. In the current study, we aim to explore the white matter microstructural alterations in svMCI with depressive symptoms, and their associations with clinical measurements. Fifty-eight subjects including 18 svMCI with depression (svMCI+D), 17 svMCI without depression (svMCI-D), and 23 normal controls (NC) were included in the study. Voxel-based analyses were performed on fractional anisotropy (FA) and mean diffusivity (MD). Compared to NC, both svMCI groups showed decreased FA in the bilateral insula and the left precentral gyrus, and increased MD in the cerebellum. Compared to svMCI-D, svMCI+D showed increased FA in left precentral gyrus. Moreover, svMCI+D showed significant correlation between the increased MD in the cerebellum and the Hamilton Depression Rating Scale (HAMD) scores. Our findings of white matter alterations might be associated with executive function and memory performance in the svMCI patients. Moreover, the structural alterations in the cerebellum might underlie the mechanism of depressive symptoms in svMCI patients.

Prevalence, Influence Factors and Cognitive Characteristics of Vascular Mild Cognitive Impairment and Vascular Dementia In Hypertension

Background: Hypertension is considered as an independent risk factor for vascular mild cognitive impairment (vMCI) and vascular dementia (VaD). This study was performed to investigate the prevalence, influencing factors, and cognitive characteristics of vMCI and VaD in elderly patients with hypertension in China. Methods: In the cross-sectional study, we performed a cluster random sampling of 3246 people age 60 years and older across the country. All participants were interviewed and screened for hypertension. Among the 1495 hypertensive patients, 57 were diagnosed with vMCI and 48 with VaD according to the criteria of Petersen and DSM-IV, respectively. Logistic regression analyses were performed to evaluate risk and protective factors for vMCI and VaD with Hypertension. And we also assessed their cognitive function by a series of neuropsychological tests. Results: We finally found that: 1) the prevalence of vMCI and VaD in hypertension was 3.8% and 3.2%, respectively, which was much higher than that of normal controls (p<0.05). 2)Multivariate logistic regression analyses showed that advanced age (p<0.001, OR=1.066, 95%CI: 1.030~1.104), sleep too little (p=0.011, OR=2.279, 95%CI: 1.210~4.291) and physical discomfort (p<0.001, OR=6.380, 95%CI: 2.956~13.774) were the risk factors for the development of vMCI in patients with hypertension; advanced age (p=0.002, OR=1.061, 95%CI: 1.021~1.011), physical discomfort (p=0.005, OR=3.922, 95%CI: 1.506~10.214) and depressive symptoms (p<0.001, OR=8.363, 95%CI: 3.023~23.138) were also the risk factor for VaD, while education (p=0.040, OR=0.941, 95%CI: 0.888~0.997), tea drinker (p=0.017, OR=0.483, 95%CI: 0.266~0.878) as well as take exercise (p=0.003, OR=0.416, 95%CI: 0.234~0.737) were protective factors of VaD;3) both overall and specific areas of cognitive function decrease in hypertension patients with vMCI and VaD, and show a gradual trend of aggravation. Conclusions: In summary, the prevalence of vMCI and VaD in patients with hypertension is much higher than that in the normal control group. Preventive strategies for vMCI and VD are needed to enhance lifestyle factors that promote brain health. Funding Statement: This work was supported by grants from Clinical research center project of Shanghai Mental Health Center (CRC2017ZD02), the Cultivation of Multidisciplinary Interdisciplinary Project in Shanghai Jiaotong University (YG2019QNA10), curriculum reform of Medical College of Shanghai Jiaotong University, the Feixiang Program of Shanghai Mental Health Center(2020-FX-03). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was conducted by the principles of Declaration of Helsinki. The Research Ethical Committee of the affiliated mental health center of Shanghai Jiaotong University School of Medicine approved this study and written informed consent was obtained from all participants before the study was initiated.

Cortical Alterations Are Associated with Depression in Subcortical Vascular Mild Cognitive Impairment Revealed by Surface-Based Morphometry.

Late-life depression often coexists with vascular cognitive impairment and affects the quality of life for elders. However, little is known about cortical morphometric interactions between subcortical vascular mild cognitive impairment (svMCI) and concomitant mild depressive symptoms at the early stage. We aimed to investigate cortical alterations of svMCI with and without depressive symptoms and determine whether these parameters are associated with depression symptoms and/or cognitive impairments. Surface based morphometry was performed on 18 svMCI patients with depressive symptoms (svMCI + D), 16 svMCI patients without depressive symptoms (svMCI-D), and 23 normal controls (NC). Compared to NC, both svMCI + D and svMCI-D patients exhibited significantly decreased surface area (SA) in many cortical areas. Interestingly, svMCI + D patients showed significantly increased rather than decreased SA in right lateral occipital gyrus (LOG.R), and a consistent trend of increased SA in these areas compared to svMCI-D. In addition, the svMCI + D showed increased gray matter volume of left pericalcarine (periCAL.L) than svMCI-D, whereas svMCI-D showed decreased gray matter volume of periCAL.L than NC. Further correlation analyses revealed that the SA of left superior temporal gyrus (STG.L) and right lateral orbital part of frontal gyrus (lorbFG.R) were significantly correlated with Hamilton depression rating scale of svMCI + D. In conclusion, these results extend our insight into svMCI and add weight to reevaluation of concomitant early stage depressive symptoms. Moreover, we suggest that LOG.R∖periCAL.L∖STG.L∖lorbFG.R might serve as sensitive and trait-dependent biomarkers to detect concomitant depressive symptoms in svMCI patients.

White Matter Hyperintensities Relate to Basal Ganglia Functional Connectivity and Memory Performance in aMCI and SVMCI.

Cerebral small vessel diseases play a crucial role in both vascular and non-vascular dementias. The location of white matter hyperintensities (WMHs), a neuroimaging marker of cerebral small vessel disease, has been found to vary between different types of dementias, and those in the basal ganglia (BG) have been particularly associated with vascular cognitive impairment (VCI). However, anatomical variation of WMHs across BG nuclei and its effect on brain network dysconnectivity has not been clearly elucidated. The study sample consisted of 40 patients with amnestic mild cognitive impairment (aMCI), 40 with subcortical vascular MCI (SVMCI), and 40 healthy control subjects. We examined the volume of WMH using T2-weighted magnetic resonance imaging. We also assessed the disturbances in BG-cortical communication by measuring resting-state functional connectivity (rsFC) from the functional magnetic resonance imaging signal. WMHs were more pronounced in the SVMCI group particularly in the caudate regions. In SVMCI patients, while higher WMHs in the dorsal caudate correlated with weaker FC with executive control regions and worse immediate recall performance, WMHs in the ventral caudate were associated with weaker FC with anterior default mode regions and worse delayed recall performance. In contrast, in aMCI patients, BG WMHs were not correlated with their changes in functional connectivity changes, which showed weaker connectivity with almost all BG structures, rather than restricting to specific BG subdivisions as observed in the SVMCI group. Our findings demonstrate that heterogeneously distributed BG WMHs are associated with changes in functional network interactions and verbal episodic memory performance only in SVMCI patients, which establishes a link between cerebrovascular-related structural abnormality, functional integrity of BG circuits, and episodic memory impairments in SVMCI, and may reflect a differential role of the cerebrovascular pathology in disrupting network-level communications and cognition between Alzheimer’s and subcortical vascular dementia.

THE ROLE OF S100B IN AEROBIC TRAINING EFFICACY IN OLDER ADULTS WITH MILD VASCULAR COGNITIVE IMPAIRMENT

Aerobic training improves cognitive and brain outcomes across different populations and neurocognitive disorders of aging, including mild subcortical ischemic vascular cognitive impairment (SIVCI). However, little is known of the underlying mechanisms through which aerobic training exerts its beneficial effects on the brain. Recently, S100 calcium-binding protein B (S100B) has been proposed as a possible mediator of aerobic training. At low levels, S100B is neurotrophic but at higher levels it is neurotoxic. Elevated levels of S100B have been associated with decreased performance on measures of global cognitive function. Thus, we conducted a secondary analysis of data collected from the proof-of-concept single-blind randomized controlled trial (NCT01027858) in older adults with mild SIVCI to determine whether the beneficial effects of 6-months, thrice weekly, moderate intensity aerobic training on cognitive performance is related to changes in S100B levels. In a subsample of 45 participants, blood samples were collected both before and after trial completion. Global cognitive function was assessed using Mini Mental State Examination (MMSE). At trial completion, aerobic training decreased circulating levels of S100B compared with usual care plus education (F(1,41) = 6.673, p = 0.013, ηp2 = 0.140; Figure 1). Furthermore, reduced S100B levels were associated with improved global cognitive function in those who received the aerobic exercise intervention (partial r = -0.519, p = 0.023). Together these findings suggest that S100B is a promising target mediating the beneficial effects of moderate-intensity aerobic training on brain health in older adults with mild SIVCI.

AEROBIC TRAINING, THE DEFAULT MODE NETWORK, AND COGNITION IN OLDER ADULTS WITH MILD VASCULAR COGNITIVE IMPAIRMENT

Aerobic training has been shown to be effective at improving cognitive and brain outcomes in older adults with mild subcortical ischemic vascular cognitive impairment (SIVCI). However, uncertainty remains regarding the underlying neurobiological mechanisms by which exercise elicits these improvements in cognition. Increased aberrant functional connectivity of the default mode network has been highlighted as a factor contributing to cognitive decline in older adults with cognitive impairment. Greater connectivity of the DMN at rest is associated with poorer performance on attention-demanding tasks, indicative of a lack of ability to deactivate the network on task. Our previous work on a randomized controlled trial of participants with mild SIVCI, demonstrated that 6-months of thrice weekly aerobic training led to improved global cognitive function, as measured by Alzheimer’s disease Assessment Scale-Cognitive subscale (ADAS-Cog), compared with a health education program. Thus, we conducted secondary analyses to investigate whether these changes in global cognitive function were associated with changes in resting state DMN connectivity. A subsample of 21 participants underwent a resting state functional magnetic resonance imaging (fMRI) scan before and after trial completion. Change in resting state DMN connectivity was found to significantly predict change in ADAS-Cog score (β = -.442, p=.038) after controlling for age, intervention group, and baseline functional capacity (R2=.467, F(4,16)= 3.507, p=.031). These findings suggest that functional connectivity of the DMN may underlie changes in global cognitive function. Furthermore, aerobic exercise is a promising intervention by which to elicit these changes in older adults with mild SIVCI.

Cognition in Vascular Aging and Mild Cognitive Impairment

Cardiovascular health declines with age, due to vascular risk factors, and this leads to an increasing risk of cognitive decline. Mild cognitive impairment (MCI) is defined as the negative cognitive changes beyond what is expected in normal aging. The purpose of the study was to compare older adults with vascular risk factors (VRF), MCI patients, and healthy controls (HC) in main dimensions of cognitive control. The sample comprised a total of 109 adults, aged 50 to 85 (M = 66.09, S.D. = 9.02). They were divided into three groups: 1) older adults with VRF, 2) MCI patients, and 3) healthy controls (HC). VRF and MCI did not differ significantly in age, educational level, or gender as was the case with HC. The tests used mainly examine inhibition, cognitive flexibility, and working memory processing. Results showed that the VRF group had more Set Loss Errors in drawing designs indicating deficits in establishing cognitive set and in cognitive shifting. MCI patients displayed lower performance in processing. Hence, different types of specific impairments emerge in vascular aging and MCI, and this may imply that discrete underlying pathologies may play a role in the development of somewhat different profiles of cognitive decline.

Structural and Functional Disruptions in Subcortical Vascular Mild Cognitive Impairment With and Without Depressive Symptoms.

Many previous studies have revealed structural and functional abnormalities in patients with the subcortical vascular mild cognitive impairment (svMCI). Although depression symptoms were suggested to serve as a potential marker of conversion to dementia in patients with svMCI, whether these disruptions or other new findings will be identified in the svMCI comorbid with depression symptoms has not been established. In the current study, we combined voxel-based morphometry (VBM) and the resting-state functional magnetic resonance imaging (fMRI) to investigate the structural and functional disruptions in the svMCI with and without depression symptoms using a cohort of 18 svMCI with depression symptoms (svMCI+D), 17 svMCI without depression symptoms (svMCI−D), and 23 normal controls (NC). As a result, we identified significantly decreased gray matter density in the left parahippocampus (ParaHIPP.L), the right hippocampus (HIPP.R), and the right middle cingulate cortex (MCC.R) in both svMCI+D and svMCI−D compared to NC. Most importantly, we also identified increased gray matter density in the MCC.R accompanied by increased resting-state functional connectivity (RSFC) with right parahippocampus (ParaHIPP.R) in the svMCI+D compared to svMCI−D. Moreover, the gray matter density of MCC.R and ParaHIPP.L was correlated with cognitive impairments and depression symptoms in the svMCI, respectively. In conclusion, these results extended previous studies and added weight to considerations of depression symptoms in the svMCI. Moreover, we suggested that a processing loop associated with HIPP, ParaHIPP, and MCC might underlie the mechanism of depression symptoms in the svMCI.

Amyloid and cerebrovascular burden divergently influence brain functional network changes over time.

To examine the effects of baseline Alzheimer disease and cerebrovascular disease markers on longitudinal default mode network (DMN) and executive control network (ECN) functional connectivity (FC) changes in mild cognitive impairment (MCI). We studied 30 patients with amnestic MCI (aMCI) and 55 patients with subcortical vascular MCI (svMCI) with baseline Pittsburgh Compound B (PiB)-PET scans and longitudinal MRI scans. Participants were followed up clinically with annual MRI for up to 4 years (aMCI: 26 with 2 timepoints, 4 with 3 timepoints; svMCI: 13 with 2 timepoints, 16 with 3 timepoints, 26 with 4 timepoints). β-Amyloid (Aβ) burden was associated with longitudinal DMN FC declines, while cerebrovascular burden was associated with longitudinal ECN FC changes. When patients were divided into PiB+ and PiB- groups, PiB+ patients showed longitudinal DMN FC declines, while patients with svMCI showed longitudinal ECN FC increases. Direct comparisons between the 2 groups without mixed pathology (aMCI PiB+ and svMCI PiB-) recapitulated this divergent pattern: aMCI PiB+ patients showed steeper longitudinal DMN FC declines, while svMCI PiB- patients showed steeper longitudinal ECN FC increases. Finally, using baseline PiB uptake and lacune numbers as continuous variables, baseline PiB uptake showed inverse U-shape associations with longitudinal DMN FC changes in both MCI subtypes, while baseline lacune numbers showed mainly inverse U-shape relationships with longitudinal ECN FC changes in patients with svMCI. Our findings underscore the divergent effects of Aβ and cerebrovascular burden on longitudinal FC changes in the DMN and ECN in the predementia stage, which reflect the underlying pathology and may be used to track early changes in Alzheimer disease and cerebrovascular disease.

Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects.

Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or “hidden” in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.

Effect of Pushen capsule for treating vascular mild cognitive impairment: a pilot observational study.

ObjectiveTraditional Chinese medicine (TCM) may be beneficial for vascular dementia (VaD). We evaluated the efficacy of Pushen capsule, a compound containing several TCM components, for treating vascular mild cognitive impairment (VaMCI).MethodsSeventy outpatients with VaMCI were randomized to Pushen capsule or control treatment with Ginkgo biloba. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Subjective Memory Loss Rating Scale scores; and lipid, lipoprotein, and haemorheological parameters were collected at baseline, week 4, and week 12 of treatment.ResultsMMSE score at week 12 was significantly higher in the treatment group compared with baseline (t = −2.352) but was not significantly different from week 12 in the control group. The MoCA score at week 12 was higher than that at baseline for both the treatment and control groups (t = −2.619 and −2.582, respectively), as was the “delayed recall” item score. Subjective memory loss score and the cognitive function “forgetting acquaintance's name” were significantly higher in the treatment group at week 12 than at baseline (t = −2.621 and χ2 = 4.419, respectively). Lipid, lipoprotein, and haemorheological parameters were significantly different after treatment in both groups.ConclusionThe benefits of Pushen capsule on cognitive function in VaMCI were comparable with that of Ginkgo biloba.

Low-Frequency Fluctuations Amplitude Signals Exhibit Abnormalities of Intrinsic Brain Activities and Reflect Cognitive Impairment in Leukoaraiosis Patients.

BackgroundThis study aimed to explore the amplitude of low-frequency fluctuations (ALFF) for whole-brain in leukoaraiosis (LA) patients suffering from cognitive decline or impairment.Material/MethodsPatients were selected by employing magnetic resonance imaging (MRI) technique. According to results of the clinical dementia rating and Montreal cognitive assessment (MoCA), patients were divided into 3 groups: LA patients diagnosed as vascular mild-cognitive impairment (LA-VaMCI, n=28), LA patients diagnosed as vascular-dementia (LA-VaD, n=18), and normal individuals (NC, n=28). Executive functions were evaluated by using the Stroop test and Trail Making Test (TMT). The higher scores in TMT test mean greater impairments. Changes for the ALFF were measured by using resting-state functional MRI (rs-fMRI) technique. Correlations between ALFF and cognition scores were analyzed.ResultsIt was found that widespread differences in ALFF were present predominantly in the posterior cingulate cortex/precuneus (PCC/PCu) and in the right inferior temporal gyrus (ITG). Compared with the NC group, ALFF values in PCC/PCu were significantly decreased (F=3.273, P=0.022) and ALFF values were significantly increased (F=2.864, P=0.033) in temporal regions of the LA-VaD patients. ALFF values in LA-VaMCI patients were significantly increased in ITG compared to that in the NC group (F=1.064, P=0.042) and the LA-VaD group (F=2.725, P=0.037). Impairment in executive functions were positively correlated with average ALFF of the left PCu.ConclusionsThis research showed that LA patients exhibited abnormal intrinsic-brain activities. Furthermore, altered ALFF was positively correlated with executive function scores.

P1‐316: THE CLINICAL CHARACTERISTICS OF COGNITIVE IMPAIRMENT IN PATIENTS WITH VASCULAR MILD COGNITIVE IMPAIRMENT

To investigate the characteristics of the cognitive impairment in patients with vascular mild cognitive impairment (VaMCI). Seventy-five patients with VaMCI and 38 age, gender-matched healthy subjects were recruited from the department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between Jan 2016 and June 2016. All the participant underwent the neuropsychological tests. The Fazekas scale was used to assess the severity of white matter lesions, and the medial temporal lobe atrophy (MTA) to evaluate the atrophic severity of medial temporal lobe. The results of our study showed that patients with VaMCI were associated with comprehensive cognitive function deficits, including MMSE [25.7±2.3 vs 28.4±2.0] MoCA [22.8±3.9 vs 26.3±3.7], AVLD-I [5.1±1.0 vs 8.9±1.9], AVLT-D [3.7±1.0 vs 9.8±1.5] and AVLT-R [7.6±1.9 vs 12±1.5] (P＜0.05) . Correlation analysis showed that the scale of medial temporal lobe atrophy had a negative relationship with the performance of MoCA (r=−0.434, P=0.002). Our findings demonstrate patients with VaMCI were closely correlated to cognitive impairment, especially with memory decline, which may be attributed to white matter lesions and the atrophy of medial temporal lobe.

Classification of Subcortical Vascular Cognitive Impairment Using Single MRI Sequence and Deep Learning Convolutional Neural Networks.

Deep learning has great potential for imaging classification by extracting low to high-level features. Our aim was to train a convolutional neural network (CNN) with single T2-weighted FLAIR sequence to classify different cognitive performances in patients with subcortical ischemic vascular disease (SIVD). In total, 217 patients with SIVD [including 52 with vascular dementia (VaD), 82 with vascular mild cognitive impairment (VaMCI), and 83 with non-cognitive impairment (NCI)] and 46 matched healthy controls (HCs) underwent MRI scans and neuropsychological assessments. 2D and 3D CNNs were trained to classify VaD, VaMCI, NCI, and HCs based on FLAIR data. For 3D-based model, the loss curves of the training set approached 0.017 after about 20 epochs, while the curves of the testing set maintained at about 0.114. The accuracy of training set and testing set reached 99.7 and 96.9% after about 30 and 35 epochs, respectively. However, the accuracy of the 2D-based model was only around 70%, which performed significantly worse than 3D-based model. This experiment suggests that deep learning is a powerful and convenient method to classify different cognitive performances in SIVD by extracting the shift and scale invariant features of neuroimaging data with single FLAIR sequence. 3D-CNN is superior to 2D-CNN which involves clinical evaluation with MRI multiplanar reformation or volume scanning.

P79-S Tolerability of repetitive transcranial magnetic stimulation: Analysis of 727 sessions with standardized questionnaires

Background Repetitive transcranial magnetic stimulation (rTMS) is used in both clinical practice and basic research. The aim of our study was to investigate rTMS tolerability using standardized questionnaires. Materials and methods 69 patients (vascular mild cognitive impairment – 36, recurrent depression – 13, post-stroke pain – 8, trigeminal neuralgia – 8, multiple sclerosis – 4) and 12 healthy volunteers were included. Participants received high-frequency rTMS (10 or 20 Hz) over dorsolateral prefrontal cortex (DLPFC, n = 42), primary motor cortex (n = 20), supplementary motor area (n = 6) and vertex (n = 21). Standardized questionnaires were obtained to assess adverse effects (AEs) during the procedure and within 24 h after. Results 727 sessions were analyzed. The rate of AEs was 56.0% during rTMS and 24.7% within 24 h after procedure. Treatment cessation due to AEs was registered in 3.6% of cases (1 syncope and 2 cases of severe headache). The most common AEs during rTMS included drowsiness (29.9%), headache (22.3%) and contractions of face muscles (13.5%); within 24 h - headache (15.8%), mood changes (8.9%) and concentration difficulties (7.7%). Headache during rTMS was predominantly low intensive (62.9%) and pulsatile (35.2%); after stimulation - moderate intensive (55.3%), pressing (54.4%), developed within 30 min (40.8%) and continued more than 4 h (47.6%). Headache occurred significantly more often during rTMS over DLPFC than other areas (p Conclusions Mild AEs are common during rTMS and within 24 h, while severe AEs occur rarely. We have also shown distinctive characteristics of headache during and after rTMS, suggesting different underlying mechanisms.

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review.

Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face-to-face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post-stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5years. Most studies compared more than one instrument. Five papers examined clock-drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC>0.90) and MMSE (AUC: 0.86-0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83-.88). The MoCA (AUC: 0.87-0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta-analysis. Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.

The Role of S100B in Aerobic Training Efficacy in Older Adults with Mild Vascular Cognitive Impairment: Secondary Analysis of a Randomized Controlled Trial

Aerobic training improves cognitive and brain outcomes across different populations and neurocognitive disorders of aging, including mild subcortical ischemic vascular cognitive impairment (SIVCI). However, little is known of the underlying mechanisms through which aerobic training exerts its beneficial effects on the brain. Recently, S100 calcium-binding protein B (S100B) has been proposed as a possible mediator of aerobic training. Thus we conducted a secondary analysis of data collected from the proof-of-concept single-blind randomized controlled trial (NCT01027858) in older adults with mild SIVCI to determine whether the beneficial effects of 6-months, thrice weekly, moderate-intensity aerobic training on cognitive performance is related to changes in S100B levels. At trial completion, aerobic training decreased circulating levels of S100B compared with usual care plus education. Furthermore, reduced S100B levels were associated with improved global cognitive function in those who received the aerobic exercise intervention. Together these findings suggest that S100B is a promising target mediating the beneficial effects of moderate-intensity aerobic training on brain health in older adults with mild SIVCI.

COWAT Performance of Persons with Alzheimer Dementia, Vascular Dementia, and Parkinson Disease Dementia According to Stage of Cognitive Impairment.

The Controlled Oral Word Association Test (COWAT) evaluates frontal lobe and executive function. Therefore, it can be helpful in differentiating cognitive deficits. However, there are no studies comparing the COWAT performance according to the type and stage of cognitive impairment. To compare performance among persons with Alzheimer dementia (AD), vascular dementia (VaD), and Parkinson disease dementia (PDD) on the COWAT according to stage of cognitive impairment. Retrospective chart review. University hospital rehabilitation psychology center. We reviewed the medical records of 246 persons diagnosed with mild cognitive impairment (MCI) or dementia using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Korean-Instrumental Activities of Daily Living (K-IADL). Patients were divided into a control group, Alzheimer groups (amnestic mild cognitive impairment [aMCI] + AD), Vascular groups (vascular mild cognitive impairment [VaMCI] + VaD), and Parkinson groups (Parkinson disease-mild cognitive impairment [PD-MCI] + PDD). Total scores (ie, total number of words produced in 60 seconds on the semantic and phonemic fluency tests of the COWAT) were analyzed. Secondary analysis included calculating percentage scores of words produced during each of the four, 15-second segments from the total number of words produced in each trial. All MCI groups scored significantly lower than the control group on both semantic and phonemic fluency tests. Among the dementia groups, the VaD (mean ± SD, 5.6 ± 5.1) and PDD (5.5 ± 5.5) groups' scores were significantly lower and worse than that of the AD (11.0 ± 8.8) group on the phonemic test (P < .001). The difference in percentage scores was most marked between the PD-MCI (17.0 ± 2.2) and PDD (1.2 ± 3.1) groups, followed by the VaMCI (13.3 ± 1.9) and VaD (5.6 ± 1.8) groups on the latter phonemic test (P = .007). The COWAT is a sensitive test of frontal-lobe and executive function impairment in persons with MCI. Decreased verbal output in the last 15 seconds of phonemic fluency test is significantly decreased and impaired in persons with VaMCI and PD-MCI compared to persons with aMCI as they progress to dementia. III.

Characterizing the Penumbras of White Matter Hyperintensities and Their Associations With Cognitive Function in Patients With Subcortical Vascular Mild Cognitive Impairment.

Normal-appearing white matter (NAWM) surrounding white matter hyperintensities (WMHs), frequently known as the WMH penumbra, is associated with subtle white matter injury and has a high risk for future conversion to WMHs. The goal of this study was to define WMH penumbras and to further explore whether the diffusion and perfusion parameters of these penumbras could better reflect cognitive function alterations than WMHs in subjects with subcortical vascular mild cognitive impairment (svMCI). Seventy-three svMCI subjects underwent neuropsychological assessments and 3T MRI scans, including diffusion tensor imaging (DTI) and arterial spin labeling (ASL). To determine the extent of cerebral blood flow (CBF) and DTI penumbras. A NAWM layer mask was generated for periventricular WMHs (PVWMHs) and deep WMHs (DWMHs) separately. Mean values of CBF, fractional anisotropy (FA), mean diffusivity (MD) within the WMHs and their corresponding NAWM layer masks were computed and compared using paired t-tests. Pearson's partial correlations were used to assess the relations of the mean CBF, FA, and MD values within the corresponding penumbras with composite z-scores of global cognition and four cognitive domains controlling for age, sex, and education. For both PVWMHs and DWMHs, the CBF penumbras were wider than the DTI penumbras. Only the mean FA value of the PVWMH-FA penumbra was correlated with the composite z-scores of global cognition before correction (r = 0.268, p = 0.024), but that correlation did not survive after correcting the p-value for multiple comparisons. Our findings showed extensive white matter perfusion disturbances including white matter tissue, both with and without microstructural alterations. The imaging parameters investigated, however, did not correlate to cognition.

Impact of Educational Inequality on the Incidence of Post-stroke Vascular Mild Cognitive Impairment - Application of the Previous Study on Stratified Education-adjusted MoCA Assessment (P1.1-023)

Impact of Educational Inequality on the Incidence of Post-stroke Vascular Mild Cognitive Impairment - Application of the Previous Study on Stratified Education-adjusted MoCA Assessment (P1.1-023)