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The determinants and longitudinal course of post-stroke mild cognitive impairment

Published online by Cambridge University Press:  01 November 2009

PERMINDER S. SACHDEV ,
XIAOHUA CHEN ,
HENRY BRODATY ,
CLAIRE THOMPSON ,
ANNETTE ALTENDORF  and
WEI WEN
PERMINDER S. SACHDEV*
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales
XIAOHUA CHEN
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales
HENRY BRODATY
Affiliation:
The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
CLAIRE THOMPSON
Affiliation:
The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
ANNETTE ALTENDORF
Affiliation:
Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
WEI WEN
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales
*
*Correspondence and reprint requests to: Perminder S. Sachdev, NPI, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia. E-mail: [email protected].
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Abstract

While post-stroke dementia has been extensively investigated, the large number of patients with mild cognitive impairment (MCI) following stroke has received less attention, and reports on the longitudinal course of such impairment are inconsistent in their findings. We examined patients with MCI (n = 45) or no cognitive impairment (NCI) (n = 59), based on consensus criteria following detailed neuropsychological assessments and magnetic resonance imaging (MRI) scans, and compared them with healthy control subjects (n = 84), all of whom were assessed at two time points, 3 years apart. The MCI at baseline in this group was judged to be vascular in etiology (vaMCI). Incident dementia was diagnosed in 24.4% of vaMCI and 8.5% of NCI subjects and no control subjects over 3 years, giving a rate of conversion of approximately 8% per year in post-stroke vaMCI. The vaMCI group showed greater decline in logical memory than the NCI group. Within the vaMCI group, those who developed dementia had great decline in language and executive function. Compared with NCI patients, those with vaMCI had more vascular risk factors and more white matter hyperintensities on MRI at baseline, but did not differ in their brain or hippocampal volumes. Neither MRI volumetric measures nor interval cerebrovascular events predicted decline in function. The major determinant of decline and categorical transition was impaired performance at baseline, suggesting that those with mild impairment post-stroke are more vulnerable to subsequent decline. (JINS, 2009, 15, 915–923.)

Keywords

Vascular cognitive impairmentMild cognitive impairmentDementiaStrokeProgressionMRI brain scanWhite matter hyperintensities
Type
MCI Series
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 6 , November 2009 , pp. 915 - 923
Copyright
Copyright © The International Neuropsychological Society 2009

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References

REFERENCES

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Ballard, C., Rowan, E., Stephens, S., Kalaria, R., & Kenny, R.A. (2003). Prospective follow-up study between 3 and 15 months after stroke: Improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke, 34, 2440–2444.CrossRefGoogle ScholarPubMed
Benson, D.F., & Cummings, J.L. (1982). Angular gyrus syndrome simulating Alzheimer’s disease. Archives of Neurology, 39, 616–620.CrossRefGoogle ScholarPubMed
Benton, A., Hamsher, K.D., Varney, N., & Spree, O. (1983). Contributions to Neuropsychological Assessment. New York: Oxford University Press.Google Scholar
Bombois, S., Debette, S., Bruandet, A., Delbeuck, X., Delmaire, C., Leys, D., et al. (2008). Vascular subcortical hyperintensities predict conversion to vascular and mixed dementia in MCI patients. Stroke, 39, 2046–2051.CrossRefGoogle ScholarPubMed
Bowler, J.V., Munoz, D.G., Merskey, H., & Hachinski, V. (1998). Fallacies in the pathological confirmation of the diagnosis of Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 64, 18–24.CrossRefGoogle ScholarPubMed
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
del Ser, T., Barba, R., Morin, M.M., Domingo, J., Cemillan, C., Pondal, M., et al. (2005). Evolution of cognitive impairment after stroke and risk factors for delayed progression. Stroke, 36, 2670–2675.CrossRefGoogle ScholarPubMed
First, M., Spitzer, R., Gibbon, M., & Williams, B.W. (1997). User’s Guide for the Structured Clinical Interview for DSM-IV Axis 1 Disorders-Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Goldberg, D.P., & Hillier, V.F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145.CrossRefGoogle ScholarPubMed
Hachinski, V.C., Lassen, N.A., & Marshall, J. (1974). Multi-infarct dementia. A cause of mental deterioration in the elderly. Lancet, 2, 207–210.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hantson, L., De Weerdt, W., De Keyser, J., Diener, H.C., Franke, C., Palm, R., et al. (1994). The European Stroke Scale. Stroke, 25, 2215–2219.CrossRefGoogle ScholarPubMed
Helzner, E.P., Luchsinger, J.A., Scarmeas, N., Cosentino, S., Brickman, A.M., Glymour, M.M., et al. (2009). Contribution of vascular risk factors to the progression in Alzheimer disease. Archives of Neurology, 66, 343–348.CrossRefGoogle Scholar
Hsiung, G.Y., Donald, A., Grand, J., Black, S.E., Bouchard, R.W., Gauthier, S.G., et al. (2006). Outcomes of cognitively impaired not demented at 2 years in the Canadian Cohort Study of Cognitive Impairment and Related Dementias. Dementia and Geriatric Cognitive Disorders, 22, 413–420.CrossRefGoogle Scholar
Ingles, J.L., Wentzel, C., Fisk, J.D., & Rockwood, K. (2002). Neuropsychological predictors of incident dementia in patients with vascular cognitive impairment, without dementia. Stroke, 33, 1999–2002.CrossRefGoogle ScholarPubMed
Jellinger, K.A. (2008). Morphologic diagnosis of “vascular dementia” - a critical update. Journal of the Neurological Sciences, 270, 1–12.CrossRefGoogle ScholarPubMed
Jorm, A.F., & Jacomb, P.A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015–1022.CrossRefGoogle ScholarPubMed
Jorm, A.F., & Jolley, D. (1998). The incidence of dementia. Neurology, 51, 728–733.CrossRefGoogle ScholarPubMed
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919.CrossRefGoogle Scholar
Kertesz, A. (1983). Western Aphasia Battery. San Antonio: The Psychological Corporation.Google Scholar
Kokmen, E., Whisnant, J.P., O’Fallon, W.M., Chu, C.P., & Beard, C.M. (1996). Dementia after ischemic stroke: A population-based study in Rochester, Minnesota (1960-1984). Neurology, 46, 154–159.CrossRefGoogle ScholarPubMed
Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Looi, J.C., & Sachdev, P.S. (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology, 53, 670–678.CrossRefGoogle ScholarPubMed
Mack, W.J., Freed, D.M., Williams, B.W., & Henderson, V.W. (1992). Boston Naming Test: Shortened versions for use in Alzheimer’s disease. Journal of Gerontology, 47, P154–P158.CrossRefGoogle ScholarPubMed
Morris, J.C., Heyman, A., Mohs, R.C., Hughes, J.P., van Belle, G., Fillenbaum, G., Mellits, E.D., et al. (1989). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology, 39, 1159–1165.Google Scholar
Nelson, H., & Willison, J. (1982). National Adult Reading Test (NART): Test manual. (2nd ed.). Windsor, UK: NFER Nelson.Google Scholar
Neuropathology Group. Medical Research Council Cognitive Function and Aging Group (MRC CFAS). (2001). Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet, 357, 169–175.CrossRefGoogle Scholar
Nordlund, A., Rolstad, S., Klang, O., Lind, K., Hansen, S., & Wallin, A. (2007). Cognitive profiles of mild cognitive impairment with and without vascular disease. Neuropsychology, 21, 706–712.CrossRefGoogle ScholarPubMed
O’Brien, J.T., Erkinjuntti, T., Reisberg, B., Roman, G., Sawada, T., Pantoni, L., et al. (2003). Vascular cognitive impairment. Lancet Neurology, 2, 89–98.CrossRefGoogle ScholarPubMed
Petersen, R.C. (2003). Conceptual overview. In Petersen, R.C. (Ed.), Mild Cognitive Impairment: Aging to Alzheimer’s Disease (pp. 1–14). New York: Oxford University Press.CrossRefGoogle Scholar
Qui, C., Skoog, I., & Fratiglioni, L. (2000). Occurrence and determinants of vascular cognitive impairment. In Erkinjuntti, T. & Gauthier, S. (Eds.), Vascular Cognitive Impairment. London: Martn Dunitz.Google Scholar
Reitan, R., & Wolfson, D. (1985). The Hatstead-Reitan Neuropsychological Test Battery. Tucson: Neuropsychology Press.Google Scholar
Rockwood, K., King Moorhouse, P., Song, X., MacKnight, C., Gauthier, S., Kertesz, A., et al. (2007). Disease progression in vascular cognitive impairment: Cognitive, functional and behavioural outcomes in the Consortium to Investigate Vascular Impairment of Cognition (CIVIC) cohort study. Journal of the Neurological Sciences, 252, 106–112.CrossRefGoogle Scholar
Sachdev, P.S., Brodaty, H., Valenzuela, M.J., Lorentz, L.M., & Koschera, A. (2004). Progression of cognitive impairment in stroke patients. Neurology, 63, 1618–1623.CrossRefGoogle ScholarPubMed
Sachdev, P.S., Brodaty, H., Valenzuela, M.J., Lorentz, L., Looi, J.C., Berman, K., et al. (2006). Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke: The Sydney Stroke Study. Dementia and Geriatric Cognitive Disorders, 21, 275–283.CrossRefGoogle ScholarPubMed
Serrano, S., Domingo, J., Rodriguez-Garcia, E., Castro, M.-D., & del Ser, T. (2007). Frequency of cognitive impairment without dementia in patients with stroke: A two-year follow-up study. Stroke, 38, 105–110.CrossRefGoogle ScholarPubMed
Sheikh, J., & Yesavage, J. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. In Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165–173). New York: The Haworth Press.Google Scholar
Smith, A. (1991). Symbol Digit Modalities Test. Los Angeles: Western Psychological Services.Google Scholar
Srikanth, V.K., Quinn, S.J., Donnan, G.A., Saling, M.M., & Thrift, A.G. (2006). Long-term cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort. Stroke, 37, 2479–2483.CrossRefGoogle Scholar
Strub, R., & Black, F. (1985). Mental Status Examination in Neurology (2nd ed.). Philadelphia: Davis.Google Scholar
Tham, W., Auchus, A.P., Thong, M., Goh, M.L., Chang, H.M., Wong, M.C., et al. (2002). Progression of cognitive impairment after stroke: One year results from a longitudinal study of Singaporean stroke patients. Journal of the Neurological Sciences, 203–204, 49–52.CrossRefGoogle Scholar
Viswanathan, A., Rocca, W.A., & Tzourio, C. (2009). Vascular risk factors and dementia: How to move forward? Neurology, 72, 368–374.CrossRefGoogle ScholarPubMed
Wechsler, D. (1981). Wechsler Adult Intelligence Scale - Revised. New York: The Psychological Corporation.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale-Revised. San Antonio: The Psychological Corporation.Google Scholar
Wentzel, C., Rockwood, K., MacKnight, C., Hachinski, V., Hogan, D.B., Feldman, H., et al. (2001). Progression of impairment in patients with vascular cognitive impairment without dementia. Neurology, 57, 714–716.CrossRefGoogle ScholarPubMed
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.O., et al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar
Wolf, H., Ecke, G.M., Bettin, S., Dietrich, J., & Gertz, H.J. (2000). Do white matter changes contribute to the subsequent development of dementia in patients with mild cognitive impairment? A longitudinal study. International Journal of Geriatric Psychiatry, 15, 803–812.3.0.CO;2-W>CrossRefGoogle Scholar
Xu, W.L., von Strauss, E., Qiu, C.X., Winblad, B., & Fratiglioni, L. (2009). Uncontrolled diabetes increases the risk of Alzheimer’s disease: A population-based cohort study. Diabetologia, 52, 1031–1039.CrossRefGoogle ScholarPubMed