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Comparative Study
. 2005 May 10;64(9):1548-52.
doi: 10.1212/01.WNL.0000160115.55756.DE.

Determinants of vascular dementia in the Cardiovascular Health Cognition Study

L H Kuller  1 , O L Lopez, W J Jagust, J T Becker, S T DeKosky, C Lyketsos, C Kawas, J C S Breitner, A Fitzpatrick, C Dulberg
Affiliations
Comparative Study

Determinants of vascular dementia in the Cardiovascular Health Cognition Study

L H Kuller et al. Neurology. .

Abstract

Objective: The authors evaluated 3,375 participants without dementia at the time of MRI in 1991 to 1994 over 5.7 years for incident dementia and type of dementia.

Methods: Incidence of and risk factors for vascular dementia (VaD) were measured using both pre-MRI and modified State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) post-MRI review and further classified Alzheimer disease (AD) by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria.

Results: Approximately 44% (213) of 480 incident dementia cases were classified as possible or probable VaD by ADDTC. The incidence of VaD increased with age and was greater in blacks than whites. Risk factors for VaD included age, Modified Mini-Mental State Examination, high white matter grade, number of MRI infarcts, ventricular size, and history of stroke.

Conclusions: Vascular disease in the brain is prevalent among incident dementia cases. There is a substantial overlap between cases classified as Alzheimer disease by Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association and vascular dementia (VaD) by modified State of California Alzheimer's Disease Diagnostic and Treatment Centers criteria. The substantial contribution of vascular disease would be missed without inclusion of MRI. Treatment of risk factors for VaD could have an important impact on incidence of dementia.

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Figures

Figure 1
Figure 1
Criteria for vascular dementia by Alzheimer’s Disease Diagnostic and Treatment Centers criteria, mutually exclusive.
Figure 2
Figure 2
Incidence of vascular dementia (by Alzheimer’s Disease Diagnostic and Treatment Centers criteria) by age, sex, and race. PYs = person-years.
See this image and copyright information in PMC

References

    1. Lopez OL, Kuller LH, Fitzpatrick A, Ives D, Becker JT, Beauchamp N. Evaluation of dementia in the Cardiovascular Health Cognition Study. Neuroepidemiology. 2003;22:1–12. - PubMed
    1. Kuller LH, Lopez OL, Newman A, et al. Risk factors for dementia in the Cardiovascular Health Cognition Study. Neuroepidemiology. 2003;22:13–22. - PubMed
    1. Pohjasvaara T, Mantyla R, Ylikoski R, Kaste M, Erkinjuntti T. Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of VaD. Stroke. 2000;31:2952–2957. - PubMed
    1. Bernick C, Kuller L, Dulberg C, et al. for the Cardiovascular Health Study. Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology. 2001;57:1222–1229. - PubMed
    1. Kuller LH, Longstreth WT, Jr, Arnold AM, Bernick C, Bryan RN, Beauchamp NJ, Jr for the Cardiovascular Health Study Collaborative Research Group. White matter hyperintensity on cranial magnetic resonance imaging. A predictor of stroke. Stroke. 2004;35:1821–1825. - PubMed

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