scholarly journals Vascular cognitive impairment (VCI): Progress towards knowledge and treatment

2010 ◽  
Vol 4 (1) ◽  
pp. 4-13 ◽  
Author(s):  
Silvia Di Legge ◽  
Vladimir Hachinski
Keyword(s):  
Cognitive Impairment ◽  
Clinical Manifestations ◽  
Vascular Cognitive Impairment ◽  
Cognitive Outcome ◽  
Cognitive Domains ◽  
Mitochondrial Dna Damage ◽  
Complex Interactions ◽  
Dementia Syndrome ◽  
Data Elements ◽  
The Impact

Abstract Until recently, the study of cognitive impairment as a manifestation of cerebrovascular disease (CVD) has been hampered by the lack of common standards for assessment. The term vascular cognitive impairment (VCI) encompasses all levels of cognitive decline associated with CVD from mild deficits in one or more cognitive domains to crude dementia syndrome. VCI incorporates the complex interactions among classic vascular risk factors (i.e. arterial hypertension, high cholesterol, and diabetes), CVD subtypes, and Alzheimer's Disease (AD) pathology. VCI may be the earliest, commonest, and subtlest manifestation of CVD and can be regarded as a highly prevalent and preventable syndrome. However, cognition is not a standardized outcome measure in clinical trials assessing functional ability after stroke. Furthermore, with the exception of anti-hypertensive medications, the impact of either preventive or acute stroke treatments on cognitive outcome is not known. Although clinical, epidemiological, neuroimaging, and experimental data support the VCI concept, there is a lack of integrated knowledge on the role played by the most relevant pathophysiological mechanisms involved in several neurological conditions including stroke and cognitive impairment such as excitotoxicity, apoptosis, mitochondrial DNA damage, oxidative stress, disturbed neurotransmitter release, and inflammation. For this reason, in 2006 the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) defined a set of data elements to be collected in future studies aimed at defining VCI etiology, clinical manifestations, predictive factors, and treatment. These recommendations represent the first step toward developing diagnostic criteria for VCI based on sound knowledge rather than on hypotheses. The second step will be to integrate all studies using the agreed methodologies. This is likely to accelerate the search for answers.

scholarly journals Are we adequately reviewing confusion inducing drugs in patients referred to the memory assessment service?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S193-S193
Author(s):  
Siddhant Hegde ◽  
Rashi Negi ◽  
Hari Shanmugaratnam
Keyword(s):  
Quality Improvement ◽  
Cognitive Impairment ◽  
Royal College ◽  
Support Worker ◽  
Short Term ◽  
Data Set ◽  
Memory Assessment ◽  
Dementia Syndrome ◽  
Diagnosis Of Dementia ◽  
The Impact

AimsThe aim of this quality improvement evaluation project is to establish the standard of current practice in relation to reviewing confusion inducing drugs (CIDs) at the time of referral, as it has been hypothesised that these medications contribute to short term cognitive impairment. This is essential in order to establish the validity of the diagnostic processes of dementia syndrome in the memory assessment services.BackgroundIt has long been established that anti-cholinergic medications (ACMs) have contributed to short-term cognitive impairment in patients taking them. This is compounded with the fact that these medications may be continued without review, for longer than was originally intended. The impact of polypharmacy, subsequent anti-cholinergic burden, and the overlapping presence of delirium, may call into question the validity of a diagnosis of dementia in patients who have not been correctly vetted during the course of their assessment. This quality improvement evaluation aims to assess whether patients’ medications are being reviewed before diagnosing a memory disorder. This is in accordance with guidance set out by the NG97 NICE guidelines, The Royal College of Psychiatrists Memory Service National Accreditation Programme (MSNAP), and the National Institute on Ageing and Alzheimer's Association (NIA-AA).MethodAll new referrals to the memory assessment service during July and August 2019 were systematically reviewed and data extracted from the memory referral document and entries on RIO from first point of contact. The following data were recorded: patient ID, GPCOG/6CIT score, final diagnosis, CID prescriptions and CID review.ResultThe results were collated using a data-set of 216 patients (136 females and 80 males,) of which the mean age was 79 years. It was noted that 36% of patients had not had any sort of cognitive assessment before referral, which identifies an area for improvement. However the most substantial finding was that only 10 patients (5%) had a CID prescription review documented in the RIO notes.ConclusionOur data suggest that in our memory assessment service, only a small proportion of patients are having a documented review of their CIDs prior to diagnosis of dementia. In order to improve this and thus improve compliance with guidelines from the Royal College of Psychiatrists MSNAP and the NIA-AA, measures will be taken to issue each dementia support worker and nurse with a CID prescription review card, which will list those medications to consider and flag for review.

scholarly journals Cognitive Impact of Deep Brain Stimulation on Parkinson’s Disease Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Raja Mehanna ◽  
Jawad A. Bajwa ◽  
Hubert Fernandez ◽  
Aparna Ashutosh Wagle Shukla
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Negative Impact ◽  
Cognitive Outcome ◽  
Cognitive Domains ◽  
The Impact ◽  
Deep Brain

Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson’s disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS.

scholarly journals Corpus callosal atrophy and associations with cognitive impairment in Parkinson disease

Neurology ◽  
2017 ◽  
Vol 88 (13) ◽  
pp. 1265-1272 ◽  
Author(s):  
Jennifer G. Goldman ◽  
Ian O. Bledsoe ◽  
Doug Merkitch ◽  
Vy Dinh ◽  
Bryan Bernard ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Corpus Callosum ◽  
Parkinson Disease ◽  
Clinical Manifestations ◽  
Cognitive Domain ◽  
Intracranial Volume ◽  
Volume Loss ◽  
Cognitive Domains

Objective:To investigate atrophy of the corpus callosum on MRI in Parkinson disease (PD) and its relationship to cognitive impairment.Methods:One hundred patients with PD and 24 healthy control participants underwent clinical and neuropsychological evaluations and structural MRI brain scans. Participants with PD were classified as cognitively normal (PD-NC; n = 28), having mild cognitive impairment (PD-MCI; n = 47), or having dementia (PDD; n = 25) by Movement Disorder Society criteria. Cognitive domain (attention/working memory, executive function, memory, language, visuospatial function) z scores were calculated. With the use of FreeSurfer image processing, volumes for total corpus callosum and its subsections (anterior, midanterior, central, midposterior, posterior) were computed and normalized by total intracranial volume. Callosal volumes were compared between participants with PD and controls and among PD cognitive groups, covarying for age, sex, and PD duration and with multiple comparison corrections. Regression analyses were performed to evaluate relationships between callosal volumes and performance in cognitive domains.Results:Participants with PD had reduced corpus callosum volumes in midanterior and central regions compared to healthy controls. Participants with PDD demonstrated decreased callosal volumes involving multiple subsections spanning anterior to posterior compared to participants with PD-MCI and PD-NC. Regional callosal atrophy predicted cognitive domain performance such that central volumes were associated with the attention/working memory domain; midposterior volumes with executive function, language, and memory domains; and posterior volumes with memory and visuospatial domains.Conclusions:Notable volume loss occurs in the corpus callosum in PD, with specific neuroanatomic distributions in PDD and relationships of regional atrophy to different cognitive domains. Callosal volume loss may contribute to clinical manifestations of PD cognitive impairment.

scholarly journals Cognitive impairment, dizziness, and unsteadiness in hypertensive patients

2020 ◽  
Vol 12 (5) ◽  
pp. 92-97
Author(s):  
L. M. Antonenko ◽  
N. V. Vakhnina ◽  
D. O. Gromova
Keyword(s):  
Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Brain Damage ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Vascular Cognitive Impairment ◽  
Cerebrovascular Diseases ◽  
Treatment And Prevention ◽  
Cerebral Microangiopathy ◽  
Selection Of

Hypertension is a widespread disease related to modifiable vascular risk factors for stroke and chronic cerebrovascular diseases. The pathogenetic basis of brain damage in hypertension is cerebral microangiopathy that leads to vascular cognitive impairment (CI), instability, and falls. Microcirculatory changes in the presence of hypertension at the initial stages of cerebrovascular disease occur without visible clinical manifestations of brain damage. Pathogenetically justified treatment used at an early stage of the disease makes it possible to achieve good results in the prevention of vascular brain damage. An important aspect of selecting effective therapy is the competent diagnosis of the causes of dizziness and instability, which can be caused not only by brain damage, but also by peripheral vestibular system diseases. Early diagnosis of vascular CI, selection of adequate therapy, and prevention of their further progression are of great importance. The studies performed have shown the high efficacy of vinpocetine (Cavinton®) that has a multifactorial mechanism of action in the treatment and prevention of CI, dizziness, and instability caused by cerebrovascular disease.

scholarly journals The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Stina Aam ◽  
Mari Nordbø Gynnild ◽  
Ragnhild Munthe-Kaas ◽  
Ingvild Saltvedt ◽  
Stian Lydersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Cognitive Impairment ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Z Score ◽  
Cognitive Domains ◽  
Post Stroke ◽  
The Impact

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

scholarly journals The etiology, manifestations, and therapy of chronic cerebrovascular diseases

2020 ◽  
Vol 12 (5) ◽  
pp. 84-91
Author(s):  
A. G. Gogoleva ◽  
V. V. Zakharov
Keyword(s):  
Cognitive Impairment ◽  
Pathological Condition ◽  
Clinical Manifestations ◽  
Vascular Cognitive Impairment ◽  
Cerebrovascular Diseases ◽  
International Standards ◽  
Amyloid Angiopathy ◽  
Neuroradiological Diagnosis ◽  
Genetically Determined

The paper presents the current etiopathogenetic classification of chronic cerebrovascular diseases (CVD) and discusses the role of hypertension, cerebral amyloid angiopathy, and genetically determined syndromes in the development of this pathological condition. It gives recommendations for the neuroradiological diagnosis of chronic CVD in accordance with the international standards. The paper discusses the clinical manifestations of chronic CVD, primarily vascular cognitive impairment. It discusses international guidelines for the examination and treatment of patients with chronic CVD, as well as the rules for stroke prevention in this patient cohort. The possibilities of pathogenetically based therapy in decreasing the severity of vascular cognitive impairment in the presence of chronic CVD are also highlighted.

scholarly journals Neuroimaging Research on Dementia in Brazil in the Last Decade: Scientometric Analysis, Challenges, and Peculiarities

2021 ◽  
Vol 12 ◽  
Author(s):  
Liara Rizzi ◽  
Ítalo Karmann Aventurato ◽  
Marcio L. F. Balthazar
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Functional Neuroimaging ◽  
Citation Impact ◽  
Scientometric Analysis ◽  
Gender Inequalities ◽  
Dementia Syndrome ◽  
The World ◽  
Dementia Research ◽  
The Impact

The last years have evinced a remarkable growth in neuroimaging studies around the world. All these studies have contributed to a better understanding of the cerebral outcomes of dementia, even in the earliest phases. In low- and middle-income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of diagnosing mild cognitive impairment and dementia, the purpose of this paper is to offer an overview of neuroimaging dementia research in Brazil. The review includes a brief scientometric analysis of quantitative information about the development of this field over the past 10 years. Besides, discusses some peculiarities and challenges that have limited neuroimaging dementia research in this big and heterogeneous country of Latin America. We systematically reviewed existing neuroimaging literature with Brazilian authors that presented outcomes related to a dementia syndrome, published from 2010 to 2020. Briefly, the main neuroimaging methods used were morphometrics, followed by fMRI, and DTI. The major diseases analyzed were Alzheimer's disease, mild cognitive impairment, and vascular dementia, respectively. Moreover, research activity in Brazil has been restricted almost entirely to a few centers in the Southeast region, and funding could be the main driver for publications. There was relative stability concerning the number of publications per year, the citation impact has historically been below the world average, and the author's gender inequalities are not relevant in this specific field. Neuroimaging research in Brazil is far from being developed and widespread across the country. Fortunately, increasingly collaborations with foreign partnerships contribute to the impact of Brazil's domestic research. Although the challenges, neuroimaging researches performed in the native population regarding regional peculiarities and adversities are of pivotal importance.

P5659Atrial fibrillation causes cognitive impairment-which cognitive domains are affected?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Pal ◽  
M German-Sallo ◽  
Z Preg ◽  
D Szentendrey ◽  
R G Tripon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cognitive Impairment ◽  
Sinus Rhythm ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Hungarian Academy ◽  
Hypertensive Patients ◽  
Cognitive Domains ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains. Purpose We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains. Methods In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program. Results Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains. Conclusions The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction. Acknowledgement/Funding Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.

scholarly journals Vascular dementia: a pragmatic review

2012 ◽  
Vol 18 (5) ◽  
pp. 372-380 ◽  
Author(s):  
Hugh Series ◽  
Margaret Esiri
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Vascular Dementia ◽  
Cerebrovascular Circulation ◽  
Dementia Syndrome ◽  
Wide Range ◽  
Managing Risk ◽  
The Impact

SummaryVascular dementia is associated with a group of diverse pathologies affecting the cerebrovascular circulation and with other dementia pathologies, particularly Alzheimer's disease. It is rather rare on its own. There is a spectrum of severity of cerebrovascular disease ranging from pathology but no cognitive impairment, to mild cognitive impairment to a dementia syndrome (vascular dementia). Where present, cerebrovascular disease can magnify the impact of other pathologies such as Alzheimer's disease. Current criteria for diagnosing vascular dementia are inadequate. Neuroimaging can be very helpful in defining the extent of pathology. Assessment needs to take into account a wide range of issues. Specific evidence-based treatments are limited, but attention should be given to managing risk factors and associated psychiatric problems such as depression.

scholarly journals Magnetic Resonance Image Feature Analysis under Deep Learning in Diagnosis of Neurological Rehabilitation in Patients with Cerebrovascular Diseases

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xue Li ◽  
Wenjun Ji ◽  
Hufei Chang ◽  
Chunyan Yang ◽  
Zhao Rong ◽  
...  
Keyword(s):  
Deep Learning ◽  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Cerebrovascular Disease ◽  
Vascular Cognitive Impairment ◽  
Cerebrovascular Diseases ◽  
Image Feature ◽  
Neurological Rehabilitation ◽  
Neurological Evaluation ◽  
The Impact

To explore the impact of magnetic resonance imaging (MRI) image features based on deep learning algorithms on the neurological rehabilitation of patients with cerebrovascular diseases, eighty patients with acute cerebrovascular disease were selected as the research objects. According to whether the patients were with vascular cognitive impairment (VCI), they were divided into VCI group (34 cases) and non-VCI group (46 cases). In addition, based on the convolutional neural network (CNN), a new multimodal CNN image segmentation algorithm was proposed. The algorithm was applied to the segmentation of MRI images of patients with vascular cognitive impairment (VCI) and compared with the segmentation results of CNN and fully CNN (FCN). As a result, the segmentation results of the three different algorithms showed that the Dice coefficient, accuracy, and recall of the multimodal CNN algorithm were 0.78 ± 0.24, 0.81 ± 0.28, and 0.88 ± 0.32, respectively, which were significantly increased compared to those of other two algorithms ( P  < 0.05). The neurological evaluation results showed that the MMSE and MoCA scores of VCI patients were 15.4 and 14.6 ± 5.31, respectively, which were significantly lower than those of the non-VCI group ( P  < 0.05). The TMT-a and TMT-b scores of VCI patients were 221.7 and 385.9, respectively, which were significantly higher than those of the non-VCI group ( P  < 0.05). The FA and MD values of nerve function-related fibers shown in the MRI images of the VCI group were significantly different from those of the non-VCI group ( P  < 0.05). Therefore, the neurological recovery process of VCI patients was affected by multiple neurocognitive-related fiber structures. To sum up, the multimodal CNN algorithm can sensitively and accurately reflect the degree of neurological impairment in patients with cerebrovascular disease and can be applied to disease diagnosis and neurological evaluation of VCI patients.

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