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26 results

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  • Neuropsychiatric symptoms are associated with exacerbated cognitive impairment in covert cerebral small vessel disease

  • Anne Arola, Tuuli Levänen, Hanna M. Laakso, Johanna Pitkänen, Juha Koikkalainen, Jyrki Lötjönen, Antti Korvenoja, Timo Erkinjuntti, Susanna Melkas, Hanna Jokinen
  • Journal:
    Journal of the International Neuropsychological Society / Volume 29 / Issue 5 / June 2023
    Published online by Cambridge University Press:
    30 August 2022, pp. 431-438
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  • Objectives:

    Neuropsychiatric symptoms are related to disease progression and cognitive decline over time in cerebral small vessel disease (SVD) but their significance is poorly understood in covert SVD. We investigated neuropsychiatric symptoms and their relationships between cognitive and functional abilities in subjects with varying degrees of white matter hyperintensities (WMH), but without clinical diagnosis of stroke, dementia or significant disability.

    Methods:

    The Helsinki Small Vessel Disease Study consisted of 152 subjects, who underwent brain magnetic resonance imaging (MRI) and comprehensive neuropsychological evaluation of global cognition, processing speed, executive functions, and memory. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory Questionnaire (NPI-Q, n = 134) and functional abilities with the Amsterdam Instrumental Activities of Daily Living questionnaire (A-IADL, n = 132), both filled in by a close informant.

    Results:

    NPI-Q total score correlated significantly with WMH volume (r s = 0.20, p = 0.019) and inversely with A-IADL score (r s = −0.41, p < 0.001). In total, 38% of the subjects had one or more informant-evaluated neuropsychiatric symptom. Linear regressions adjusted for age, sex, and education revealed no direct associations between neuropsychiatric symptoms and cognitive performance. However, there were significant synergistic interactions between neuropsychiatric symptoms and WMH volume on cognitive outcomes. Neuropsychiatric symptoms were also associated with A-IADL score irrespective of WMH volume.

    Conclusions:

    Neuropsychiatric symptoms are associated with an accelerated relationship between WMH and cognitive impairment. Furthermore, the presence of neuropsychiatric symptoms is related to worse functional abilities. Neuropsychiatric symptoms should be routinely assessed in covert SVD as they are related to worse cognitive and functional outcomes.

  • Diagnosis of Vascular Dementia: Consortium of Canadian Centres for Clinical Cognitive Research Concensus Statement

  • Kenneth Rockwood, Irma Parhad, Vladimir Hachinski, Timo Erkinjuntti, Barry Rewcastle, Andrew Kertesz, M. Robin Eastwood, Stephen Phillips
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 21 / Issue 4 / November 1994
    Published online by Cambridge University Press:
    18 September 2015, pp. 358-364
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  • Interest in vascular causes for cognitive impairment is increasing, in recognition that such causes are common, and possibly preventable. This has led to attempts to better define vascular dementia and its natural history. Several sets of criteria for the diagnosis of vascular dementia have been proposed. We provide a brief overview of the background to the initiation of a Canadian consensus conference, established by the Consortium of Canadian Centres for Clinical Cognitive Research (C5R) and report the conclusions reached at that conference. To date, no one set of criteria is demonstrably superior to another; we have therefore not endorsed any of the competing sets, nor have we recommended our own. Instead we suggest that empiric studies are required to establish valid criteria. A diagnostic checklist, which combines existing criteria and additional data, is attached for clinicians wishing to participate in such studies.

  • Relationship between progression of brain white matter changes and late-life depression: 3-year results from the LADIS study

  • Michael J. Firbank, Andrew Teodorczuk, Wiesje M. Van Der Flier, Alida A. Gouw, Anders Wallin, Timo Erkinjuntti, Domenico Inzitari, Lars-Olof Wahlund, Leonardo Pantoni, Anna Poggesi, Giovanni Pracucci, Peter Langhorne, John T. O'Brien,
  • Journal:
    The British Journal of Psychiatry / Volume 201 / Issue 1 / July 2012
    Published online by Cambridge University Press:
    02 January 2018, pp. 40-45
    Print publication:
    July 2012
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  • Background

    Brain white matter changes (WMC) and depressive symptoms are linked, but the directionality of this association remains unclear.

    Aims

    To investigate the relationship between baseline and incident depression and progression of white matter changes.

    Method

    In a longitudinal multicentre pan-European study (Leukoaraiosis and Disability in the elderly, LADIS), participants aged over 64 underwent baseline magnetic resonance imaging (MRI) and clinical assessments. Repeat scans were obtained at 3 years. Depressive outcomes were assessed in terms of depressive episodes and the Geriatric Depression Scale (GDS). Progression of WMC was measured using the modified Rotterdam Progression scale.

    Results

    Progression of WMC was significantly associated with incident depression during year 3 of the study (P = 0.002) and remained significant after controlling for transition to disability, baseline WMC and baseline history of depression. There was no significant association between progression of WMC and GDS score, and no significant relationship between progression of WMC and history of depression at baseline.

    Conclusions

    Our results support the vascular depression hypothesis and implicate WMC as causal in the pathogenesis of late-life depression.

Vascular Cognitive Impairment in Clinical Practice
  • Edited by Lars-Olof Wahlund, Timo Erkinjuntti, Serge Gauthier
  • Published online:
    15 September 2009
    Print publication:
    12 February 2009
  • Vascular cognitive impairment is the second most common cause of dementia after Alzheimer's disease and is expected to grow in prevalence with the aging global population. The purpose of this authoritative book is to give a broad clinical perspective on vascular cognitive impairment and thus create a foundation for the implementation of good dementia care. The book focuses on pathophysiology, diagnosis, treatment and prevention. It demonstrates the underlying causes of the disorder, such as the manner in which vascular risk-factors influence the onset of vascular cognitive impairment. The concept of mixed forms of vascular dementia, Alzheimer's dementia and other vascular diseases is discussed as well as the influence of vascular changes with regard to the onset of Alzheimer's disease. The detailed section on pathophysiology will enhance clinicians' understanding of this complex disorder. Finally there is a section on pharmacological and neuropsychological treatment of cognitive and psychiatric symptoms.

  • 1 - Diagnosing vascular cognitive impairment and dementia: concepts and controversies

  • from Section 1 - Diagnosis
  • Edited by Lars-Olof Wahlund, Karolinska Institutet, Stockholm, Timo Erkinjuntti, University of Helsinki, Serge Gauthier, McGill University, Montréal
  • Book:
    Vascular Cognitive Impairment in Clinical Practice
    Published online:
    15 September 2009
    Print publication:
    12 February 2009, pp 3-10

  • Summary

    Vascular cognitive impairment (VCI) is currently considered the most recent modification of the terminology to reflect the all-encompassing effects of vascular disease or lesions on cognition and incorporates the complex interactions between vascular etiologies, risk factors and cellular changes within the brain and cognition. The recognition of Alzheimer's disease (AD) as the commonest cause of dementia led to the development of operational criteria for the diagnosis of dementia in general. Post-stroke cognitive impairment is frequent, although it has been a neglected consequence of stroke. The main subtypes of vascular dementia (VaD) included in current classifications are cortical VaD or MID, also referred to as post-stroke VaD, subcortical ischemic vascular disease and dementia (SIVD) or small vessel dementia, and strategic infarct dementia. AD with cerebrovascular disease (CVD) can present clinically either as AD with evidence of vascular lesions upon brain imaging, or with clinical features of both AD and VaD.

  • 15 - Treatment of cognitive changes

  • from Section 3 - Treatment
  • Edited by Lars-Olof Wahlund, Karolinska Institutet, Stockholm, Timo Erkinjuntti, University of Helsinki, Serge Gauthier, McGill University, Montréal
  • Book:
    Vascular Cognitive Impairment in Clinical Practice
    Published online:
    15 September 2009
    Print publication:
    12 February 2009, pp 195-199

  • Summary

    This chapter summarizes the data of some biomarkers that are associated with the presence of vascular disease, and potential markers of different brain pathologies relevant to vascular dementia (VaD) and for differential diagnosis. Many prospective population-based studies have reported an association between increased plasma levels of inflammation markers and an increased risk of atherosclerotic vascular diseases and dementia. Accumulation of extracellular neuritic plaques with a core of fibrillar β-amyloid protein (Aβ) is a characteristic feature of Alzheimer's disease (AD). The main pool of plasma Aβ seems to originate from platelets although a proportion of it originates from cerebrospinal fluid (CSF) and brain. The endothelial cells of the brain capillaries are sealed together by continuous tight junctions and there are few channels running through the cells. These restrictive characteristics constitute the basis of the blood-brain barrier (BBB). The presence of BBB damage supports the diagnosis of VaD.

  • 9 - Small-vessel diseases of the brain

  • from Section 2 - Pathophysiology
  • Edited by Lars-Olof Wahlund, Karolinska Institutet, Stockholm, Timo Erkinjuntti, University of Helsinki, Serge Gauthier, McGill University, Montréal
  • Book:
    Vascular Cognitive Impairment in Clinical Practice
    Published online:
    15 September 2009
    Print publication:
    12 February 2009, pp 118-130

  • Summary

    Vascular cognitive impairment (VCI) is currently considered the most recent modification of the terminology to reflect the all-encompassing effects of vascular disease or lesions on cognition and incorporates the complex interactions between vascular etiologies, risk factors and cellular changes within the brain and cognition. The recognition of Alzheimer's disease (AD) as the commonest cause of dementia led to the development of operational criteria for the diagnosis of dementia in general. Post-stroke cognitive impairment is frequent, although it has been a neglected consequence of stroke. The main subtypes of vascular dementia (VaD) included in current classifications are cortical VaD or MID, also referred to as post-stroke VaD, subcortical ischemic vascular disease and dementia (SIVD) or small vessel dementia, and strategic infarct dementia. AD with cerebrovascular disease (CVD) can present clinically either as AD with evidence of vascular lesions upon brain imaging, or with clinical features of both AD and VaD.

  • White matter changes and late-life depressive symptoms: Longitudinal study

  • Andrew Teodorczuk, John T. O'Brien, Michael J. Firbank, Leonardo Pantoni, Anna Poggesi, Timo Erkinjuntti, Anders Wallin, Lars-Olof Wahlund, Alida Gouw, Gunhild Waldemar, Reinhold Schmidt, José M. Ferro, Hugues Chabriat, Hansjörg Bäzner, Domenico Inzitari
  • Journal:
    The British Journal of Psychiatry / Volume 191 / Issue 3 / September 2007
    Published online by Cambridge University Press:
    02 January 2018, pp. 212-217
    Print publication:
    September 2007
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  • Background

    Evidence from cross-sectional studies suggests a link between cerebral age-related white matter changes and depressive symptoms in older people, although the temporal association remains unclear.

    Aims

    To investigate age-related white matter changes on magnetic resonance imaging (MRI) as an independent predictor of depressive symptoms at 1 year after controlling for known confounders.

    Method

    In a pan-European multicentre study of 639 older adults without significant disability, MRI white matter changes and demographic and clinical variables, including cognitive scores, quality of life, disability and depressive symptoms, were assessed at baseline. Clinical assessments were repeated at 1 year.

    Results

    Using logistic regression analysis, severity of white matter changes was shown to independently and significantly predict depressive symptoms at 1 year after controlling for baseline depressive symptoms, quality of life and worsening disability (P<0.01).

    Conclusions

    White matter changes pre-date and are associated with the development of depressive symptoms. This has implications for treatment and prevention of depression in later life.

  • Behavioral and Psychological Symptoms of Dementia and Vascular Dementia

  • Timo Erkinjuntti, Risto Vataja, Antero Leppävuori
  • Journal:
    International Psychogeriatrics / Volume 12 / Issue S1 / July 2000
    Published online by Cambridge University Press:
    10 January 2005, pp. 195-200

  • Behavioral and psychological symptoms of dementia (BPSD) have long been assumed to be an intrinsic clinical feature of vascular dementia. This assumption is based on case histories and selected series of patients with probable vascular dementia, especially those with small vessel disease, and has been further fueled by the inclusion of features of BPSD in clinical diagnostic algorithms (Cummings, 1994; Hachinski et al., 1975; Wallin et al., 1996). However, controlled empiric research on BPSD in vascular dementia is lacking. The existing literature does not fully support the assumption that BPSD are integral to vascular dementia.

  • Subcortical Ischemic Vascular Disease and Dementia

  • Timo Erkinjuntti
  • Journal:
    International Psychogeriatrics / Volume 15 / Issue S1 / July 2003
    Published online by Cambridge University Press:
    10 January 2005, pp. 23-26

  • Subcortical ischemic vascular disease and dementia (SIVD) incorporate small vessel disease as the chief vascular etiology, lacunar infarct and ischemic white-matter lesions (WMLs) as primary type of brain lesions, subcortical location as the primary location of lesions, and subcortical syndrome as the primary clinical manifestation. It incorporates two clinical entities: Binswanger's syndrome and the lacunar state. Patients with SIVD present with extensive white-matter lesions and multiple lacunae on neuroimaging. SIVD is expected to be a more homogenous subtype of vascular cognitive impairment and dementia. Recently modified NINDS-AIREN research criteria for SIVD have been proposed. Further empirical research is needed to refine the syndrome and stages and validate the brain imaging criteria, as well as to detail the natural history and outcomes of SIVD.

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