title: Cognitive and functional decline in African Americans with VaD, AD, and stroke without dementia.
abstract: OBJECTIVE
  To compare the rates of cognitive and functional decline in African American patients diagnosed at baseline with vascular dementia (VaD) (n = 79), AD (n = 113), or stroke without dementia (SWD) (n = 56) and followed for up to 7 years with annual neuropsychological and other examinations.
  
  
  METHODS
  Study patients were diagnosed using established criteria for dementia and were administered cognitive screening, functional screening, and neuropsychological measures. Baseline dementia severity was rated using the Clinical Dementia Rating Scale. Random effects modeling was used to examine rates of decline and to compare the rates of decline in the three groups.
  
  
  RESULTS
  Both patients with VaD and those with AD showed significant cognitive and functional decline during follow-up; patients with VaD declined at a slower rate than patients with AD; and patients diagnosed with SWD at baseline did not show cognitive or functional decline during follow-up.
  
  
  CONCLUSIONS
  Patients with VaD decline at a slower rate than patients with AD. Patients who do not meet criteria for dementia soon after stroke may not be at high risk for developing dementia. Future studies are needed to follow VaD patients with longitudinal, specialized MR protocols, concurrent neuropsychological examinations, and neuropathologic examination to determine possible neuroimaging predictors of progressive cognitive and functional decline and to assess the contribution of Alzheimer's pathology to decline in patients diagnosed with VaD.
authors.affiliation: Center for Stroke Research, Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA. dnyenhui@rush.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Nyenhuis
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Sally
authors.initials: S
authors.lastname: Freels
authors.forename: David C
authors.initials: DC
authors.lastname: Garron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000208:ethnology / Q000523:psychology*; D044383:Black People; D015140:Dementia, Vascular / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D020521:Stroke / Q000523:psychology*; D001741:Black or African American