The Spectrum of Cerebrovascular Disease and Associated Cognitive Decline

2019 ◽  
pp. 574-599
Author(s):  
Victoria J. Williams ◽  
Steven E. Arnold ◽  
David H. Salat
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Structure And Function ◽  
Vascular Risk Factors ◽  
Vascular Health ◽  
Vascular Risk ◽  
And Function

Throughout the lifespan, common variations in systemic health and illness contribute to alterations in vasculature structure and function throughout the body, significantly increasing risk for cardiovascular and cerebrovascular disease (CVD). CVD is a prevalent cause of mortality in late life; it also promotes brain alterations, contributing to cognitive decline and, when severe, vascular dementia. Even prior to diseased states, individual variation in CVD risk is associated with structural and functional brain alterations. Yet, how cumulative asymptomatic alterations in vessel structure and function contribute to more subtle changes in brain tissue integrity and function that emerge in late life is unclear. Finally, vascular risk factors are associated with the clinical progression of neurodegenerative diseases such as Alzheimer’s disease (AD); however, recent theory posits that vascular degeneration may serve a contributory role in these conditions. This chapter reviews how lifespan changes in vascular health contribute to degenerative changes in neural tissue and the subsequent development of cognitive impairment and/or vascular dementia. It first discusses associations between vascular risk factors and cognition and also how declining vascular health may lead to cognitive impairment and dementia. Next, it identifies basic aspects of cerebrovascular anatomy and physiology sustaining tissue health and discusses how vulnerabilities of this system contribute to neurodegenerative changes. Finally, it reviews evidence of vascular contributions to AD and presents ideas for future research to better understand the full spectrum of cerebrovascular contributions to brain aging, cognitive decline, and dementia.

scholarly journals VASCULAR RISK FACTORS AND COGNITIVE FUNCTIONS IN THE PATIENTS WITH CEREBROVASCULAR DISEASE

2020 ◽  
Vol 73 (10) ◽  
pp. 2250-2254
Author(s):  
Oksana O. Kopchak ◽  
Natalia Yu. Bachinskaya ◽  
Oleksandr R. Pulyk
Keyword(s):  
Risk Factors ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Mmse Score ◽  
Significant Negative Correlation ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test

The aim: To assess the severity of cognitive impairment (CI) in patients with cerebrovascular disease (CVD) depending on the number of vascular risk factors (VRF). Materials and methods: The study consisted of five hundred and eighty patients with CVD (247 females and 333 males) aged from 45 to 89 years (mean age: 64,1±8,9 years). The patients were divided into 6 groups (I, II, III, IV, V, VI) depending on the number of VRF. The examination consisted of a standard clinical evaluation, neurological examination, the application of neuropsychological tests (the MMSE; the PALT/The Paired Associates Learning Test; clock drawing test), laboratory tests, MRI of brain. Results: According to ANOVA, the greater the number of VRF the patients had, the lower was their total MMSE score corresponding to more pronounced cognitive decline (F=2,97, p=0,012). A significant negative correlation between patients’ age and their MMSE score was detected regardless of their VRF count. The patients of the V and VI groups had substantially lower parameters of immediate, delayed memory and clock drawing test score comparing to the patients of the I group. Conclusions: The presence of 4 and more VRF was related to more pronounced CI in the patients with CVD. Decline of different aspects of memory, attention, spatial orientation, abstract thinking, planning, concentration, executive and visuospatial skills in groups of patients with 4,5 and 6 vascular risk factors was established. Age was substantially associated with cognitive decline in all the group of patients.

P3-252: Vascular risk factors are associated with cognitive decline in mild cognitive impairment

2011 ◽  
Vol 7 ◽  
pp. S597-S597
Author(s):  
Natacha Lorius ◽  
Joseph Locascio ◽  
Dorene Rentz ◽  
Keith Johnson ◽  
Reisa Sperling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Vascular Risk Factors ◽  
Vascular Risk

3.5 ASSOCIATION OF VASCULAR RISK FACTORS WITH BRAIN STRUCTURE AND FUNCTION

2015 ◽  
Vol 12 (C) ◽  
pp. 43
Author(s):  
Chloe Park* ◽  
Therese Tillin ◽  
Robert Stewart ◽  
Nish Chaturvedi ◽  
Alun Hughes
Keyword(s):  
Risk Factors ◽  
Brain Structure ◽  
Structure And Function ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Brain Structure And Function ◽  
And Function

scholarly journals Documentation of vascular risk factors in vascular dementia

1998 ◽  
Vol 22 (2) ◽  
pp. 97-99
Author(s):  
Rahul Rao
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Cerebrovascular Disease ◽  
Vascular Dementia ◽  
Case Note ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Noticeable Improvement ◽  
The Impact ◽  
Disease Specific

The diagnosis of vascular dementia may often be made on the basis of structural neuroimaging, this may not always be reliable. In view of this, a retrospective study of 30 case notes with diagnosis of vascular dementia was undertaken to examine the documentation of vascular risk factors and presence of cerebrovascular disease. Specific recommendations were then made for the future case note documentation. Nine months later, 10 case notes were examined to assess the impact of the recommendations. A noticeable improvement in the documentation of most risk factors was observed. The wider implications of these findings are discussed.

scholarly journals Therapeutic Issues in Vascular Dementia: Studies, Designs and Approaches

2007 ◽  
Vol 34 (S1) ◽  
pp. S125-S130 ◽  
Author(s):  
Sandra E. Black
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Vascular Dementia ◽  
Executive Dysfunction ◽  
Vascular Cognitive Impairment ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Trial Duration ◽  
Disease Heterogeneity ◽  
Cognitive Behavioural

Vascular dementia (VaD) is a heterogeneous disorder resulting from various cerebrovascular diseases (CVD) causing cognitive impairment that reflects severity and location of damage. Epidemiological studies suggest VaD is the second commonest cause of dementia, but autopsy series report that pure VaD is infrequent, while combined CVD and Alzheimer's Disease(AD) is likely the commonest pathological-dementia correlate. Both diseases share vascular risk factors and benefit from their treatment. The most widely used diagnostic criteria for VaD are highly specific but not sensitive. Vascular Cognitive Impairment (VCI) is a dynamic, evolving concept that embraces VaD, Vascular Cognitive Impairment No Dementia (VCIND) and mixed AD and CVD. Clinical trials to date have focused on probable and possible VaD with beneficial effects evident for different drug classes, including cholinergic agents and NMDA agonists. Limitations have included use of cognitive tools suitable for AD that are insensitive to executive dysfunction. Disease heterogeneity has not been adequately controlled and subtypes require further study. Diagnostic VaD criteria now 13 years old need updating. More homogeneous subgroups need to be defined and therapeutically targeted to improve cognitive-behavioural outcomes including optimal control of vascular risk factors. More sensitive testing of executive function outlined in recent VCI Harmonization criteria and longer trial duration are needed to discern meaningful effects. Imaging criteria must be well-defined, with centralized review and standardized protocols. Serial scanning with quantification of tissue atrophy and lesion burden is becoming feasible, and cognitive interventions, including rehabilitation pharmacotherapy, with drugs strategically coupled to cognitive -behavioural treatments, hold promise and need further development.

scholarly journals Predictors of the Progression of Dementia Severity in Brazilian Patients with Alzheimer's Disease and Vascular Dementia

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Márcia L. Chaves ◽  
Ana L. Camozzato ◽  
Cristiano Köhler ◽  
Jeffrey Kaye
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Cox Regression ◽  
Strong Predictor ◽  
Disease Diagnosis ◽  
Vascular Risk Factors ◽  
Vascular Risk

Introduction. This study evaluates the progression of dementia and identifies prognostic risk factors for dementia.Methods. A group of 80 Brazilian community residents with dementia (34 with Alzheimer's disease and 46 with vascular dementia) was assessed over the course of 2 years. Data were analyzed with Cox regression survival analysis.Results. The data showed that education predicted cognitive decline (HR=1.2;P<.05) when analyzed without controlling for vascular risk factors. After the inclusion of vascular risk factors, education (HR=1.32;P<.05) and hypertension were predictive for cognitive decline (HR=38;P<.05), and Alzheimer's disease diagnosis was borderline predictive (P=.055).Conclusion.Vascular risk factors interacted with the diagnosis of vascular dementia. Education was a strong predictor of decline.

Vascular Risk Factors, Vascular Diseases, and Imaging Findings in a Hospital-based Cohort of Mild Cognitive Impairment Types

2018 ◽  
Vol 15 (7) ◽  
pp. 679-690 ◽  
Author(s):  
Cecilia Camarda ◽  
Carmela Pipia ◽  
Delia Azzarello ◽  
Iacopo Battaglini ◽  
Giovanni Romeo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Brain Atrophy ◽  
Vascular Diseases ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Amnestic Mci ◽  
Multiple Domain

Background: Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia. Objective: The aim of this study is to investigate the role of vascular risk factors, vascular diseases, cerebrovascular disease and brain atrophy in a large hospital-based cohort of MCI types including 471 amnestic MCI (a-MCI), 693 amnestic MCI multiple domain (a-MCImd), 322 single non-memory MCI (snm-MCI), and 202 non amnestic MCI multiple domain (na-MCImd). For comparison, 1,005 neurologically and cognitively healthy subjects were also evaluated. Method: Several vascular risk factors and vascular diseases were assessed. All participants underwent neurological, neuropsychological and behavioural assessments as well as carotid ultrasonography and standard brain MRI. Multinomial logistic regression models on the MCI cohort with the NCH group and a-MCI type as reference categories were used to assess the effects of the variables evaluated on the estimated probability of one of the four MCI types. Results: This study demonstrates that cerebrovascular disease contributes substantially to the risk of non-memory MCI types and a-MCImd type, and that brain atrophy is present in all MCI types and is greater in multiple domain types particularly in the na-MCI type. Conclusion: Improving detection and control of cerebrovascular disease in aging individuals should be mandatory. Since the incidence of MCI and dementia will be expected to rise because of the progressive life expectancy, a better management of cerebrovascular disease could indeed prevent or delay the onset of MCI, or could delay progression of MCI to dementia.

scholarly journals Vascular risk factors and cognitive impairment in a stroke-free cohort

Neurology ◽  
2011 ◽  
Vol 77 (19) ◽  
pp. 1729-1736 ◽  
Author(s):  
F. W. Unverzagt ◽  
L. A. McClure ◽  
V. G. Wadley ◽  
N. S. Jenny ◽  
R. C. Go ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Vascular Risk Factors ◽  
Vascular Risk

Abstract WP244: Applicability of the Compass Trial Criteria Among Stable Outpatients With Established Atherothrombotic Disease or Major Risk Factors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Carlos Cantu-Brito ◽  
Erwin Chiquete ◽  
Jose L Ruiz-Sandoval ◽  
Fernando Flores-Silva
Keyword(s):  
Risk Factors ◽  
Cerebrovascular Disease ◽  
Selection Criteria ◽  
Vascular Risk Factors ◽  
Cox Proportional Hazards Model ◽  
Vascular Risk ◽  
Similar Frequency ◽  
History Of ◽  
Atherothrombotic Disease

Background and Purpose: The objective of this study were to describe the proportion of patients eligible for the COMPASS trial among stable outpatients with either established atherothrombotic disease or major vascular risk factors, and to analyze 6-month incident stroke risk according vascular risk factors at baseline. Methods: We prospectively recruited 5,101 stable outpatients in 172 sites, within the Mexican INDAGA cohort study. Inclusion criteria were age >18 years and established atherothrombotic disease [history of either acute coronary syndromes (ACS), acute ischemic stroke (AIS)/transient ischemic attack (TIA) or peripheral artery disease (PAD)] or major vascular risk factors (age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors). Among these patients, we applied the selection criteria of the COMPASS trial for analysis, dividing the population in no COMPASS criteria met and COMPASS criteria met, and this last group subdivided among patients with previous AIS/TIA and without this antecedent, in order to stratify the risk for stroke during 6-month follow-up (incident AIS/TIA). Results: Among 5,101 stable outpatients with either established atherothrombotic disease (n=2,827) or major vascular risk factors (n=2,274), a total of 1,927 (37.8%) met COMPASS trial criteria: 1,054 (54.7%) with established cerebrovascular disease (past history of AIS/TIA) and 873 (45.3%) without. During 6-month follow-up, there were 89 incident AIS/TIA (39 AIS and 54 TIA): 1.7% among the whole population and 2.2% among the COMPASS subgroup. AIS/TIA occurred in a similar frequency among the COMPASS subgroup with established cerebrovascular disease (1.6%) and COMPASS without cerebrovascular disease (0.9%) (P=0.18). After a Cox-proportional hazards model, independent predictors of incident AIS/TIA were age ≥65 years (HR: 1.99, 95% CI: 1.29-3.07) and established cerebrovascular disease at baseline (HR: 1.61, 95% CI: 1.02-2.53). Conclusions: The majority of stable outpatients at vascular risk met COMPASS selection criteria and could be good candidates for low-dose rivaroxaban in addition to aspirin. Short-term predictors of AIS/TIA were old age and history of cerebrovascular disease

Sign in / Sign up

Export Citation Format

Share Document