Pathogenesis, Diagnosis, and Treatment of Vascular and Mixed Dementias

2013 ◽  
pp. 900-903
Author(s):  
Helena Chang Chui
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Cognitive Impairment ◽  
Mr Imaging ◽  
Early Identification ◽  
Late Life ◽  
Vascular Cognitive Impairment ◽  
Prevention And Treatment ◽  
The Brain ◽  
Alzheimer Pathology

This chapter addresses five common questions surrounding vascular cognitive impairment (VCI): pathogenesis, diagnostic accuracy, incidence and prevalence, relationship between VBI and Alzheimer disease (AD), and prevention/treatment. Although vascular cognitive impairment is considered to be the second most common form of cognitive impairment and dementia in late life, it can be argued that public health emphasis should be placed more on the prevention and treatment of vascular brain injury (VBI), which for example may be detectable by MR imaging. We review the historical syndromes and current diagnostic criteria, which have focused on defining various subtypes of VCI and have influenced estimates of incidence and prevalence. Recent neuropathological studies have highlighted the frequent concurrence of Alzheimer pathology and VBI in late life. Converging evidence suggests that AD and VBI impose differential but additive deleterious effects on cognitive function. The field is moving increasingly to earlier detection of the brain at risk using MR imaging, as well as to the early identification and treatment of vascular risk factors.

scholarly journals A comparison of the prevalence of and modifiable risk factors for cognitive impairment among community-dwelling Canadian seniors over two decades, 1991–2009

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242911
Author(s):  
Batholomew Chireh ◽  
Carl D’Arcy
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Cognitive Impairment ◽  
Healthy Aging ◽  
Canadian Community Health Survey ◽  
Community Dwelling ◽  
Health Concern ◽  
Population Census ◽  
Modifiable Risk Factors ◽  
Canadian Population

Background The prevalence of cognitive impairment or dementia is of public health concern globally. Accurate estimates of this debilitating condition are needed for future public health policy planning. In this study, we estimate prevalence and modifiable risk factors for cognitive impairment by sex over approximately 16 years. Methods Canadian Study of Health and Aging (CSHA) baseline data conducted between 1991–1992 were used to measure the prevalence of cognitive impairment and dementia among adults aged 65+ years. The standard Modified Mini-Mental State Examination (3MS) was used for the screening test for cognitive impairment. We compared the CSHA data with Canadian Community Health Survey–Healthy Aging (CCHS-HA) conducted between 2008–2009. The CCHS-HA used a four-dimension cognitive module to screen for cognitive impairment. Only survey community-dwelling respondents were included in the final sample. After applying exclusion criteria, final samples of (N = 8504) respondents in the CSHA sample and (N = 7764) respondents for CCHS–HA sample were analyzed. To account for changes in the age structure of the Canadian population, prevalence estimates were calculated using age-sex standardization to the 2001 population census of Canada. Logistic regression analyses were used to examine predictors of cognitive impairment. A sex stratified analysis was used to examine risk factors for cognitive impairment in the survey samples. Results We found that prevalence of cognitive impairment among respondents in CSHA sample was 15.5% in 1991 while a prevalence of 10.8% was reported in the CCHS–HA sample in 2009, a 4.7% reduction [15.5% (CI = 14.8–16.3), CSHA vs 10.8% (CI = 10.1–11.5), CCHS–HA]. Men reported higher prevalence of cognitive impairment in CSHA study (16.0%) while women reported higher prevalence of cognitive impairment in CCHS–HA (11.6%). In the multivariable analyses, risk factors such as age, poor self-rated health, stroke, Parkinson’s disease, and hearing problems were common to both cohorts. Sex differences in risk factors were also noted. Conclusions This study provides suggestive evidence of a potential reduction in the occurrence of cognitive impairment among community-dwelling Canadian seniors despite the aging of the Canadian population. The moderating roles of improved prevention and treatment of vascular morbidity and improvements in the levels of education of the Canadian population are possible explanations for this decrease in the cognitive impairment.

scholarly journals Disturbance of Intracerebral Fluid Clearance and Blood–Brain Barrier in Vascular Cognitive Impairment

2019 ◽  
Vol 20 (10) ◽  
pp. 2600 ◽  
Author(s):  
Masaki Ueno ◽  
Yoichi Chiba ◽  
Ryuta Murakami ◽  
Koichi Matsumoto ◽  
Ryuji Fujihara ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Blood Brain Barrier ◽  
Brain Function ◽  
Vascular Cognitive Impairment ◽  
Brain Dysfunction ◽  
Brain Parenchyma ◽  
The Other ◽  
Brain Barrier ◽  
Blood Brain ◽  
The Brain

The entry of blood-borne macromolecular substances into the brain parenchyma from cerebral vessels is blocked by the blood–brain barrier (BBB) function. Accordingly, increased permeability of the vessels induced by insult noted in patients suffering from vascular dementia likely contributes to the cognitive impairment. On the other hand, blood-borne substances can enter extracellular spaces of the brain via endothelial cells at specific sites without the BBB, and can move to brain parenchyma, such as the hippocampus and periventricular areas, adjacent to specific sites, indicating the contribution of increased permeability of vessels in the specific sites to brain function. It is necessary to consider influx and efflux of interstitial fluid (ISF) and cerebrospinal fluid (CSF) in considering effects of brain transfer of intravascular substances on brain function. Two pathways of ISF and CSF are recently being established. One is the intramural peri-arterial drainage (IPAD) pathway of ISF. The other is the glymphatic system of CSF. Dysfunction of the two pathways could also contribute to brain dysfunction. We review the effects of several kinds of insult on vascular permeability and the failure of fluid clearance on the brain function.

Depression and mild cognitive impairment – Comorbidity and/or continuum?

2016 ◽  
Vol 33 (S1) ◽  
pp. S190-S191
Author(s):  
G. Sobreira ◽  
M.A. Aleixo ◽  
C. Moreia ◽  
J. Oliveira
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Late Life ◽  
The Elderly ◽  
Late Life Depression ◽  
Pubmed Database ◽  
Competing Interest ◽  
The Relationship

IntroductionDepression and mild cognitive impairment are common among the elderly. Half the patients with late-life depression also present some degree of cognitive decline, making the distinction between these conditions difficult.ObjectivesTo conduct a database review in order to understand the relationship between these entities, and treatment approaches.AimsTo create and implement clinical guidelines at our institution, to evaluate and treat elderly patients presenting with depression and mild cognitive impairment.MethodsA PubMed database search using as keywords “late life depression”, “depression”; “cognitive impairment”; “mild cognitive impairment” and “dementia” between the year 2008 and 2015.ResultsLate-life depression and cognitive impairment are frequent among the elderly (10–20%). Depression is also common in the early stages of dementia decreasing as the cognitive decline progresses. The causal relationship between these entities is not well understood and some authors advocate a multifactorial model (genetic risk factors; neuroendocrine changes; vascular risk factors) and the cognitive impairment of said changes is dependent on the individual's cognitive reserve. Regarding treatment of depression in patients with cognitive impairment, most authors advocate a stepped approach with watchful waiting and then, if symptoms persist, the introduction of pharmacotherapy and psychosocial intervention.ConclusionsThe relationship between cognitive impairment and depression is still not clear and probably multifactorial. The diagnosis of depressive symptoms in patients with severe cognitive impairment can be difficult and most forms of pharmacological treatment in this population are not beneficial, making it important to carefully evaluate the benefits of introducing new medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Lipid Metabolism in the Development and Progression of Vascular Cognitive Impairment: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Qi Qin ◽  
Yunsi Yin ◽  
Yi Xing ◽  
Xuan Wang ◽  
Yan Wang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Lipid Metabolism ◽  
Public Health Problem ◽  
Vascular Cognitive Impairment ◽  
Lipid Biomarkers ◽  
Systemic Review ◽  
Major Public Health Problem ◽  
Clinical Biomarkers ◽  
The Brain ◽  
Potential Biomarkers

Background: Vascular cognitive impairment (VCI) is a major public health problem. The current diagnosis of VCI is made based on the assessment of clinical symptoms and neuropsychological measurements, and is supported by neuroimaging. These methods are both time-consuming and expensive, which leads to needs for alternative biomarkers for VCI. Metabolomics is an emerging and powerful tool to discover of new biomarkers of disease, which can investigate variations in different metabolic processes such as lipid, since the brain is highly enriched in lipids and that lipid changes may lead to pathology in the brain. Vascular cognitive impairment is vulnerable to the disturbance of lipid metabolism. Furthermore, blood samples, which could be identified as reliable clinical biomarkers are relatively convenient to obtain and provide a non-invasive assessment. Therefore, our study aims to understand whether peripheral lipid biomarkers can be used as diagnostic biomarkers and monitor the progression of VCI.Methods: We systematically searched the PubMed, Embase, CNKI, and VIP databases to find VCI and lipid metabolism in reports from inception through February 2021. Studies meeting the following criteria were eligible: (1) original studies in humans; (2) lipid metabolites in blood; (3) reports of VCI.Results: Through our review, nine original articles were eligible. Blood-based metabolites that might be potential biomarkers were identified. Most of them including PC, PE, Cers, and ChEs were significantly lower, while elevation of FAs and DGs were associated with VCI. Most importantly, these blood-based metabolites might be proposed as potential biomarkers for VCI, which provides direction for further validation.Discussion and Conclusion: To the best of our knowledge, this is the first systemic review concerning the relationship of lipid metabolism and VCI. It identifies potential biomarkers and provides insights into the disease pathobiology. However, more advanced studies and researches on a lipidomic platform must be done to understand the exact pathology behind and identify potential lipid biomarkers, which might help achieve the goal of discovering novel therapeutics.

scholarly journals Role of age-related alterations of the cerebral venous circulation in the pathogenesis of vascular cognitive impairment

2019 ◽  
Vol 316 (5) ◽  
pp. H1124-H1140 ◽  
Author(s):  
Gabor A. Fulop ◽  
Stefano Tarantini ◽  
Andriy Yabluchanskiy ◽  
Andrea Molnar ◽  
Calin I. Prodan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cerebral Arteries ◽  
Vascular Cognitive Impairment ◽  
Cerebral Veins ◽  
Older Individuals ◽  
Low Velocity ◽  
Venous Circulation ◽  
Age Related ◽  
The Brain

There has been an increasing appreciation of the role of vascular contributions to cognitive impairment and dementia (VCID) associated with old age. Strong preclinical and translational evidence links age-related dysfunction and structural alterations of the cerebral arteries, arterioles, and capillaries to the pathogenesis of many types of dementia in the elderly, including Alzheimer’s disease. The low-pressure, low-velocity, and large-volume venous circulation of the brain also plays critical roles in the maintenance of homeostasis in the central nervous system. Despite its physiological importance, the role of age-related alterations of the brain venous circulation in the pathogenesis of vascular cognitive impairment and dementia is much less understood. This overview discusses the role of cerebral veins in the pathogenesis of VCID. Pathophysiological consequences of age-related dysregulation of the cerebral venous circulation are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages of venous origin, altered production of cerebrospinal fluid, impaired function of the glymphatics system, dysregulation of cerebral blood flow, and ischemic neuronal dysfunction and damage. Understanding the age-related functional and phenotypic alterations of the cerebral venous circulation is critical for developing new preventive, diagnostic, and therapeutic approaches to preserve brain health in older individuals.

Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes

2019 ◽  
Vol 257 ◽  
pp. 166-172 ◽  
Author(s):  
Martino Belvederi Murri ◽  
Matteo Respino ◽  
Luca Proietti ◽  
Michele Bugliani ◽  
Beatriz Pereira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Clinical Outcomes ◽  
Late Life ◽  
Disorder Risk
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