Latent Cognitive Profiles Differ Between Incipient Alzheimer’s Disease and Dementia with Subcortical Vascular Lesions in a Memory Clinic Population
Mattias GöthlinMarie EckerströmMagnus LindwallSindre RolstadCarl EckerströmMichael JonssonPetronella KettunenJohan SvenssonAnders Wallin
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Abstract:
It is unclear if latent cognitive profiles can distinguish between dementia with subcortical vascular lesions and Alzheimer's disease (AD) at the incipient stage, and if they differ in performance from the Petersen subtypes. To identify latent cognitive profiles in a naturalistic population of patients from a memory clinic sample, and investigate the derived classes not only in terms of conversion to AD, but also in terms of conversion to dementia with subcortical vascular lesions. Another objective was to compare the derived classes to the Petersen subtypes. We performed a latent profile analysis (LPA) on standardized neuropsychological test scores from 476 memory clinic patients (age 64±8) without dementia, and analyzed progression to dementia after 2 years. The LPA resulted in two classes with impaired cognition (Amnestic and Slow/Dysexecutive) and two classes with normal cognition (Normal-Low and Normal-High cognition). Belonging to the Amnestic class predicted progression to all-cause dementia and to AD; belonging to the Slow/Dysexecutive class predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions. Of the Petersen MCI subtypes, only amnestic multi-domain MCI predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions. Latent cognitive profiles separated between AD and dementia with subcortical vascular lesions, while the Petersen subtypes did not. However, similar to the Petersen subtypes, LPA classes work better for ruling out progression to dementia than for case finding.Keywords:
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To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type.Retrospective analysis of a database of diagnostic codes.All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989.All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia).The study involved 3447 patients aged 81.0 +/- 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 +/- 2.10 in the Alzheimer dementia group, 4.73 +/- 2.38 in the vascular dementia group, and 3.96 +/- 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01).Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co-existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.
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Stroke and dementia are frequent and often associated in the same patient. Their association can be encountered either in the diagnostic workup of patients attending a memory clinic, or during the follow-up of stroke patients The term ‘vascular dementia’ (VaD) is used to describe a dementia syndrome likely to be the direct consequence of stroke lesions, while the term post-stroke dementia (PSD) is a more general term that includes all types of dementia occurring after a stroke, irrespective of the presumed cause. Therefore, VaD accounts for only a part of PSD, while it may sometimes occur without any clinical history of stroke and be the consequence of so-called ‘silent’ lesions of the brain of vascular origin. VaD is the second most common cause of dementia after Alzheimer’s disease (AD): it accounts for 10–50% of all cases of dementia, depending on regional variations and criteria used. Both ischaemic and haemorrhagic strokes lead to a high risk of cognitive impairment and dementia. About one in ten patients is demented before having a first-ever stroke, one in ten develops new-onset dementia after a first-ever stroke, and more than one in three develops dementia after a recurrent stroke. A vascular origin of cognitive impairment is frequent, and often preventable: therefore, patients could benefit from early detection and therapy. An accurate diagnosis of vascular cognitive impairment or VaD is necessary. Dementia is probably the tip of the iceberg, accounting for a small part of the cognitive consequences of stroke, as most of these consequences are represented by cognitive impairment without dementia, and are due to the coexistence of vascular and degenerative lesions of the brain.
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Objective To explore whether P300 can be the method for early diagnosis of vascular dementia.Methods 123 cases of multi infarct dementia(dementia group) were examined and compared with non dementia groups and healthy control groups according to 3 different age ranges respectively.Results There were significant differences between the dementia groups and the non dementia groups(P0.05) and between the non dementia and the healthy groups(P0.05).The latent period of P300 in patients over 60 years old of the dementia groups was longer than that in non dementia groups and the healthy controls.The latent period of P300 was prolonged by 1.5 S for every increase in one year of age.Conclusions The results suggest that the change in P300 can occur ealier than that in the intellective score of Haseyakawa Dementia Scales(HDS),P300 can be one of the methods for diagnosis of vascular dementia and favor early diagnosis and early treatment.Early treatment of vascular dementia with Ginaton is effective.
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One hundred and one patients with dementia, treated at Psychiatric department of GH Bjelovar were studied regarding the sort and frequency of complications, the evidence of other psychiatric or physical illnesses and psychopharmacological therapy. Of all the patients diagnosed with dementia, 21.78% were diagnosed with primary dementia, 70.3% with secondary dementia and 7.92% with combined (both primary and secondary) dementia. The number of patients diagnosed with vascular and primary dementia and the number of the registered complications vs. the so called other psychiatric diagnoses accompanying dementia reflects the difficulties in diagnosing Alzheimer's disease and the complications of dementia. The results of therapy are thoroughly discussed.
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In the UK, an estimated 954 000 people have dementia. Vascular dementia (VaD) is the second most common type of dementia and affects around 257 607 people ( Prince et al, 2014:16 —Table 4). This article, the third in a series, explains about the pathophysiology and clinical features of VaD, how it can be prevented, how it is diagnosed and the medication used to treat VaD.
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Vascular dementias, VD, are dementias due to cerebrovascular lesions. Subgroups of VD include multi-infarct dementia, single infarct (or strategic infarct) dementia, subcortical ischemic vascular dementia, hemorrhagic dementia, hypoperfusion dementia. VD are also related to post-stroke dementia, mixed Alzheimer's disease and vascular dementia and vascular cognitive impairment. These various entities allow to characterize more homogenous subgroups within the heterogeneous group of vascular dementias. However, ambiguities in their definitions, associated with frequent overlaps as well as lack of consensual definition for mixed dementia limit both their theoretical value and use in clinical practice. The diagnosis of cerebrovascular diseases should be dissociated from that of dementia, which could be associated with other pathologies.
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Dementia is world’s fifth leading cause of mortality. It is an term for several diseases affecting memory, other cognitive abilities and behavior. There are mainly three types of dementia are seen commonly allover the world, there are Vascular dementia, Alzheimer disease and Mixed dementia. Vascular dementia cover 40% in the whole dementia, Alzheimer's disease occupy nearly 60% of dementia but Mixed dementia is more prevalent it is due to other types of dementia are less prevalent. dementia is influenced by several factors like hypertension,age, obesity etc… but main risk factor is hypertension and it is also differ based on age as mid life hypertension seen in people of middle age 40-65years and late life hypertension see in people of 75years or above. In this article we come over about dementia, types of dementia with etiology, pathophysiology and diagnosis of each type and influence of hypertension on dementia with recent evidences…
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Alzheimers disease associated with cerebrovascular disease is now considered as the most frequent type of dementia. The aim was to study some clinical characteristics of mixed dementia (Alzheimer-type dementia associated with cerebral atherosclerosis) comparatively with «pure» Alzheimers disease (AD) and vascular dementia (VaD). A sample made up all patients diagnosed as mild/moderate dementia admitted for the first time to the psychogeriatric unit of one of Moscow psychiatric hospital. A total 283patients (81m and 202f) aged 48-93years were evaluated. The main group made up 94patients with a diagnosis of mixed dementia (33,2%). Two control groups included 75patients with VaD (26,5 %) and 114 patients with AD (40,3 %) without clinical and MRI signs of cerebral atherosclerosis. Mean duration of dementia didnt differ in all cases of dementia. Mixed dementia is more frequent in females (m/f 1:3,9); late onset is more common for mixed dementia (90,4%); there is a high risk of delirium-like confusional states in patients with mixed dementia closed to its frequency in vascular dementia; prevalence of vascular risk factors in mixed dementia is closed to its frequency in VaD. Strokes and TIA occurred before dementia as well as in the course of dementia in cases of mixed dementia (35,1%). A high frequency of focal vascular changes in mixed dementia didnt differ from MRI picture in cases of VaD. Due to complex genesis of disorders mixed dementia needs a multimodal therapeutical intervention.
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To build a dementia screening system in the community to facilitate collaboration among patients/caregiver(s), family clinic physicians and memory clinic specialists.We placed a Dementia Network Promoter (DNP) in four cities in Mie prefecture, Japan. Based on requests from patients/caregiver(s), family clinic physicians ordered dementia screening from the DNP. The DNP carried out screenings at the clinic using an IT device (iPad), and sent the results to a dementia specialist at the Mie University Hospital Dementia Center. The dementia specialist assessed the results of the screening tests, and made a treatment recommendation for a follow-up consultation with a memory clinic or continuing observation by the family clinic. The DNP reported the recommendation of the dementia specialist to the family clinic physician, who provided this information to the patients/caregiver(s). We investigated the characteristics of the patients referred for consultation with the memory clinic.A total of 158 patients participated in the screening. The majority of patients were in vulnerable living situations characterized by minimal social and family support. The mean score on the Mini-Mental State Examination was 24.1 ± 5.2. Of patients screened, 62% were referred for consultation at the memory clinic, and 57% of those referred completed a consultation at the memory clinic. Patients referred to the memory clinic showed significantly worse cognitive function and ability to complete activities of daily living.A dementia screening system might facilitate early consultation and intervention for patients with dementia, and build a more effective network to connect families and memory clinics. Geriatr Gerontol Int 2018; 18: 599-606.
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