Vascular cognitive impairment: prodromal stages of ischemic vascular dementia.
OBJECTIVE
To describe the natural history of the prodromal stages of ischemic vascular dementia (pVaD).


METHODS
A sample of 314 inpatients with pVaD or a clini- cal diagnosis of vascular dementia (VaD; lacunar state, Binswanger's disease, pure cortical VaD, corticosubcortical and strategic infarctions) admitted to a teaching tertiary center during a 13-year period was assessed (retrospectively n = 88, prospectively n = 226). Prospective neuropsychological assessment consisted of Mini Mental State Examination, Revised Wechsler Adult Intelligence Scale, Exit-25, Trail Making tests, Blessed Dementia Scale and Camdex H, Global Depression Scale and Hamilton Depression Rating Scale tests. Univariate analysis and logistic regressions are displayed.


RESULTS
An unrecognized pVaD was related with a clinical onset with cognitive impairment no dementia (CIND) versus symptomatic cerebrovascular events (p < 0.0001), and with being under therapy with anticoagulant or antiplatelet agents (p < 0.01). Age <85 years at diagnosis of VaD (p < 0.01) correlated with a delayed pVaD diagnosis. CIND onset was associated with a longer prodromal stage (p < 0.01), no clinical strokes during pVaD (p < 0.001), silent ischemia (p < 0.01) and Binswanger's disease (p < 0.01).


CONCLUSIONS
Vascular cognitive impairment remains an underdiagnosed, yet treatable entity. A brief neuropsychological examination and informant interviews should become standard practice in elderly populations with vascular risk factors. Small-vessel disease is a prevalent condition with a distinct natural history.
Ramos-Estébanez
Ciro
C
Albert Einstein College of Medicine, Internal Medicine Department, Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Bronx, NY, USA.
Moral-Arce
Ignacio
I
Muñoz-Arrondo
Roberto
R
González-Mandly
Andrés
A
Matorras-Galán
Pedro
P
González-Macias
Jesús
J
Hernández-Hernández
José Luis
JL
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000473:pathology* / Q000503:physiopathology*; D015140:Dementia, Vascular / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000473:pathology / Q000503:physiopathology; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology / Q000503:physiopathology