Vascular cognitive impairment in small vessel disease: clinical and neuropsychological features of lacunar state and Binswanger's disease.
BACKGROUND
ischaemic cerebrovascular small vessel disease (SVD) is a prevalent and under-diagnosed condition that triggers vascular cognitive impairment (VCI).


OBJECTIVE
to describe the neuropsychological and clinical profiles in SVD (Binswanger's disease, BD; lacunar state, LS) from the clinician's perspective at the VCI stage.


METHODS
a total of 1257 patients admitted to a tertiary center with a diagnosis of stroke, neuroradiological vascular disease, cognitive impairment/dementia, during a 13-year period were investigated. We prospectively assessed cognition in a subset of 141 patients with VCI (LS n = 28, BD n = 69, large vessel disease-LVD-n = 44) with MMSE, CAMDEX-H, WAIS-R, EXIT-25 and Trail making test.


RESULTS
executive dysfunction (ECD) (n = 89, 91.7% versus n = 10, 22.7%; P < 0.001) and gait disturbances (n = 74, 76.3% versus n = 15, 34.1%; P < 0.001) characterized SVD. Prior strokes (n = 9, 9.3% versus n = 23, 52.3%; P < 0.001) and embologenous cardiopathy (n = 39, 40.2% versus n = 28, 63.6%; P < 0.04) featured LVD cases. BD was defined by hypertension (n = 52, 75.4% versus n = 30, 44.1%; P < 0.001), ECD (n = 65, 94.2% versus n = 34, 47.2%; P < 0.001) and VCI onset with cognitive impairment but not strokes (n = 44, 63.8% versus n = 34, 50%; P < 0.01).


CONCLUSIONS
ECD and a frontal gait are SVD's clinical landmarks in our sample. LS and BD cases share a similar cognitive profile.
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. cramoses@bidmc.harvard.edu
Ciro
C
Ramos-Estebanez
Ignacio
I
Moral-Arce
Andres
A
Gonzalez-Mandly
Vinoop
V
Dhagubatti
Jesus
J
Gonzalez-Macias
Roberto
R
Munoz
Jose Luis
JL
Hernadez-Hernandez
D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology; D003071:Cognition; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D015161:Dementia, Multi-Infarct / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D015140:Dementia, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D042241:Early Diagnosis; D056344:Executive Function; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D014057:Tomography, X-Ray Computed