(Stroke. 1997;28:785-792.)
© 1997 American Heart Association, Inc.
Articles |
Dementia Three Months After Stroke
Baseline Frequency and Effect of Different Definitions of Dementia in the Helsinki Stroke Aging Memory Study (SAM) Cohort
From the Memory Research Unit and Stroke Unit, Department of Neurology, University of Helsinki (Finland).
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Abstract |
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Background and Purpose Vascular dementia is a common cause of dementia, and cerebrovascular disease is related to a higher risk of dementia. The frequency of dementia associated with ischemic stroke and the effects of different definitions of dementia in the diagnosis are still incompletely known. We evaluated the frequency of cognitive decline and dementia 3 months after ischemic stroke in a large stroke cohort.
Methods Our cohort consisted of consecutively admitted ischemic stroke patients (n=486) aged 55 to 85 years in the Helsinki (Finland) Stroke Aging Memory Study (SAM). Subjects were assessed by structured medical, neurological, and radiological examinations and interview with a close informant, as well as by the Mini-Mental State Examination and detailed clinical mental status examination of defined cognitive domains. The criteria for dementia were those of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (DSM-III, DSM-III-R, and DSM-IV), the National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), and the International Classification of Diseases, 10th Revision (ICD-10).
Results We found that 451 (92.8%) of the patients were testable, 239 (49.2%) of the patients were women, and the mean age was 71.2 years. Any cognitive decline was present in 61.7%. In the groups aged 55 to 64, 65 to 74, and 75 to 85 years, the frequency of any cognitive decline was 45.7%, 53.8%, and 74.1% (P=.0008), respectively. The frequency of dementia was 25.5% by DSM-III, 20.0% by DSM-III-R, 18.4% by DSM-IV, 21.1% by NINDS-AIREN, and 6.0% by ICD-10 criteria. The frequency increased with increasing age: by the DSM-III definition, frequency in the aforementioned age groups was 19.3%, 23.7%, and 25.5%, respectively (P=.014). There was an overlap in the cases diagnosed as demented according to the different guidelines. Compared with standard diagnosis, the DSM-III was the most sensitive and ICD-10 the most specific. Concordance was moderate between the DSM criteria and NINDS-AIREN criteria but was poor between ICD-10 and the other criteria.
Conclusions Cognitive decline and dementia were frequent in the cohort of ischemic stroke patients, and the frequency increased with increasing age. Different definitions gave different frequency estimates, and overlap in the cases was observed. Our findings question the validity of current criteria for dementia in the setting of cerebrovascular disease and emphasize the need for further debate and studies to refine the categories of cognitive impairment related to cerebrovascular disease.
Key Words: epidemiology • dementia • diagnosis • Finland • cerebral ischemia
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Introduction |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Vascular dementia is a common cause of dementia, CVD is associated with a higher risk of dementia, and vascular factors are related to other causes of dementia.1 2 3 4 Consequently, it has been suggested that stroke is related to dementia more frequently than previously assumed.5 Since vascular causes can be prevented and treated, the identification of stroke-related cognitive impairment is a challenge.
The frequency of dementia associated with ischemic stroke is
still incompletely known. In an exploratory effort, Tatemichi et
al6 found that dementia was present in 16% (116/726)
of patients in a stroke cohort aged 
60 years. In a subsequent
hospitalized stroke cohort studied 3 months after stroke, dementia was
found in 26% (66/251), and stroke increased the risk of dementia by a
factor of 9.7
Since the definitions of dementia used are based on the clinical presentation of Alzheimer's disease, there has been uncertainty regarding the diagnosis of dementia related to CVD.1 5 8 The effect of different definitions of dementia on the prevalence of dementia in stroke cohorts is not well understood. This question has been raised in only one study,9 in which prevalence was 27% according to the NINDS-AIREN criteria for dementia,8 30% according to the DSM-III criteria,10 and 41% according to the criteria of Cummings and Benson11 .
To further elucidate cognitive impairment and dementia associated with stroke, we studied a large hospitalized cohort of patients with ischemic stroke aged 55 to 85 years using different diagnostic criteria and well-defined, thorough clinical and functional examinations.
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Subjects and Methods |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Subject Selection
We focused on consecutive persons with any ischemic stroke aged 55 to 85 years, speaking the Finnish language, and living in Helsinki, Finland. All patients with suspected CVD admitted to the Emergency Unit of the Helsinki University Central Hospital were identified by daily survey of admissions between December 1, 1993, and March 31, 1995. The unit is responsible for primary acute stroke management in Helsinki. The patients had been examined by the neurologist in charge. We reviewed in detail the charts of the subjects with suspected CVD to locate those with probable CVD, which was defined as sudden or rapidly evolving transient or permanent symptoms or signs indicating focal or global neurological dysfunction of suspected vascular origin.12 A total of 1622 patients with probable CVD were identified during the 16-month period, and after review 175 did not fulfill the criteria for stroke based on current criteria.12 13 14 15 16 17 Of the remaining 1447 patients with stroke, we excluded 229 patients with intracerebral hemorrhage and 69 with subarachnoid hemorrhage.
Of the 1147 patients with ischemic stroke, we further excluded those younger than 55 years (n=258) or older than 85 years (n=88), those not living in Helsinki (n=158), and those not speaking the Finnish language (n=3). A total of 642 patients fulfilled the given inclusion criteria and were invited to a follow-up visit. Reasons for nonenrollment were 71 deaths before the 3-month examination (11.1%), 82 refusals by the patient or the attending physician (12.8%), and 3 whose reasons were not identified (0.5%). Thus, 85.1% (486/571) of the living patients were included in the Helsinki Stroke Aging Memory Study (SAM) cohort.
The 85 patients who refused or were not identified were compared with the 486 patients included in the SAM cohort. The mean (SD) age of the former group was 79.2 (7.68) years, and that of the SAM cohort was 71.2 (7.6) years (P=NS). The percentage of women was 67.1% and 49.2% (P=.023), and the percentage of subjects hospitalized at the time of examination was 60.0% and 16.8% (P=.0001), respectively.
The study was approved by the ethics committee of the Department of Neurology, University of Helsinki (Finland), and the subjects and/or their relatives gave informed consent.
General Clinical Assessment
Three months after the index stroke, the subjects in the SAM
cohort underwent recording of a structured medical and
neurological history based on review of all available hospital charts
and a structured clinical and neurological examination by a
board-certified neurologist (T.P., R.V.); in addition, the subject and
a knowledgeable informant were interviewed. All cases were also
reviewed by a senior neurologist (T.E.). The examination included basic
laboratory examinations and MRI of the head or, in case of MRI
contraindication or refusal, CT of the head. The neurological
examination paid special attention to factors and features related to
dementia and stroke similar to the method of the Memory Research Unit,
Department of Neurology, University of Helsinki,18 and the
Columbia University Stroke Data Bank.19
The clinical mental status examination by the neurologist assessed the following domains included in different definitions for dementia: attention; orientation; short-term memory; long-term memory; executive functions, including abstract thinking, judgment, and problem solving; aphasia; apraxia; agnosia; motor control; constructional and visuospatial abilities; and personality change. The clinical cognitive assessment included the Folstein MMSE (maximum=30),20 the 3MSE (maximum=100),21 and selected brief cognitive tests as described below. For each cognitive domain we used normative values based on a random Finnish-speaking healthy community sample for those younger and older than 75 years.22 23 The 1 SD cutoff points were set to estimate the normality or abnormality.
Attention was assessed with the use of the backward calculation
item from the MMSE, in which the patient was asked to subtract 7 from
100 five times (maximum=5). Attention was considered abnormal at a
score of 0 to 2 in those aged <75 years and at 0 to 1 in those aged
75 years. Orientation was assessed by questioning the date, month,
day, year, name of the hospital, floor, country, county, and city. If
any of these questions were answered incorrectly, orientation was
regarded as abnormal. Short-term memory was assessed by the first and
second recall of three words in the 3MSE, which included credit for
correct responses after the subject received cues in regard to category
and multiple choices (maximum=18). In those aged <75 years, a score of
0 to 12 indicated abnormality, and in those aged 75 years, a score of
0 to 9 indicated abnormality. Long-term memory was assessed by asking
the patient's birth date and place, as well as by clinical judgment
during the interview. Executive functioning was considered abnormal if
any of the following was abnormal: test of similarities (maximum=6)
(aged <75 years, 0 to 2; aged 75 years, 0 to 1); fluency with
four-legged animal category test of 3MSE (maximum=10) (aged <75 years,
0 to 7; aged 75 years, 0 to 5); or presence of clear perseveration in
ornament drawing. Aphasia was assessed clinically and by the Acute
Aphasia Screening Protocol (maximum=50).24 Apraxia was
considered present if the patient was unable to perform one of the
following: combing hair, using a toothbrush, closing eyes, raising a
hand, or shaking a fist; we also considered clinically evident dressing
apraxia, taking into account the physical limitations caused by stroke.
Agnosia was assessed with the use of tactile and visual double
simultaneous stimulation components. Tactile testing
consisted of touching the patient from both right and left parts of the
body simultaneously and asking where the patient felt the
touch. Visual testing consisted of bringing fingers to the patient's
visual field and asking the patient to count them. Motor control was
assessed based on the apraxia tests and clinical judgment.
Constructional and visuospatial functions were examined with the
clock-drawing test and the crossing pentagons item from the MMSE. The
results were considered normal if there were no mistakes.
Assessment of emotional functions included the Beck Depression Scale completed by the patient (maximum=60).25 In addition, the neurologist completed the DSM-IV checklist for major depression,26 the Gottfries Bråne Steen Scale (maximum=144),27 and the noncognitive portion of the Alzheimer's Disease Assessment Scale (maximum=50).28
Assessment of Social Functions
Social functioning was assessed by the patient's ability to
work, by the patient's ability to perform the IADL and ADL based on an
interview with the patient and with a knowledgeable informant, and by
the neurologist's examination. Assessments that reflected functions
before and 3 months after the index stroke were used. The scales used
included the Index of ADL (rating from 1 to 7),29 the IADL
Scale (maximum=8),30 the Functional Activities
Questionnaire (maximum=30),31 and the Blessed Functional
Activity Scale (maximum=17).32 33 In addition, the
neurologist completed the Barthel Index (maximum=100),34
the Schwab England Scale (maximum=100%),35 the Clinical
Dementia Rating (maximum=3),36 and the Global
Deterioration Scale (maximum=7).37
Assessment of prestroke cognitive decline was based on interviews with the patient and a knowledgeable informant. The interviews included structured questions on abnormality in the cognitive domains as well as assessment of social functions before the index stroke. The cases also included those with borderline and definite dementia. However, we were unable to perform structured diagnosis of prestroke dementia.
Education was divided into two categories: low (0 to 6 years of formal education) and high (>6 years of formal education).
Definitions of Dementia
The definitions of dementia used included those of the American
Psychiatric Association's DSM versions DSM-III,10
DSM-III-R,38 and DSM-IV26 ; that of
NINDS-AIREN8 ; and that of the ICD-10.39 The
degree of dementia was rated as mild, moderate, or severe according to
the DSM-III-R guidelines.38 The Clinical Dementia Rating
and Global Deterioration Scale were also used to assess the severity of
dementia.
Data Analysis and Statistics
Basic statistical analysis was performed with the use of
BMDP software (new version 1.0).40 The
2 test was used for categorical data, the
Mann-Whitney U test for ordinal scale variables, and the
pooled t test for continuous data. Independence of dementia
predictors was analyzed by a log-linear model of the SAS
program.41
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Results |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Of the 486 patients in the SAM stroke cohort, 451 (92.8%) were testable. The untestable patients included 1 who refused during the examination, 1 with reduced level of consciousness, 1 with severe hearing impairment, and 32 with severe aphasia. The cohort included 239 women (49.2%); the mean (SD) age of the cohort was 71.2 (7.7) years.
In the whole series, cognitive decline in at least one domain was present in 61.7%, decline in one or two domains in 34.8%, and decline in three or more domains in 26.8%. The frequency of any cognitive decline increased with increasing age: frequency in the groups aged 55 to 64, 65 to 74, and 75 to 85 years was 45.7%, 53.8%, and 74.1%, respectively (P=.0008).
The frequency of dementia in the SAM cohort varied when algorithms for
different definitions of dementia were used (Table 1
).
The frequency of dementia was 25.5% by DSM-III, 20.0% by DSM-III-R,
18.4% by DSM-IV, 21.1% by NINDS-AIREN, and 6.0% by ICD-10 criteria.
The origin of these differences includes the following: (1) requiring
impairment in both short-term and long-term memory in DSM-III-R and
DSM-IV, (2) always requiring impairment in executive functions in
ICD-10, and (3) requiring duration of cognitive decline >6 months in
ICD-10.
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When the DSM-III definition was used, frequency of dementia in the
groups aged 55 to 64, 65 to 74, and 75 to 85 years was 19.3%, 23.7%,
and 25.5%, respectively (P=.014). The frequency of dementia
increased with increasing age by any of the definitions used (Table 2).
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Three hundred fifty-one (77.8%) of the patients had first-ever stroke. Among these patients, the frequency of dementia was 24.2% (85/351) by DSM-III, 18.5% (65/351) by DSM-III-R, 17.1% (60/351) by DSM-IV, 19.9% (70/351) by NINDS-AIREN, and 3.7% (13/351) by ICD-10 criteria.
The patients diagnosed as demented according to any of the definitions
differed from the nondemented subjects in regard to age and level of
education (Table 3). In the whole series age and sex
showed interaction, and therefore we analyzed men and women
separately. Among men, a log-linear model analysis revealed
that a low level of education, but not age, was an independent
predictor of dementia (DSM-III, P=.0053; DSM-III-R,
P=.0042; DSM-IV, P=.0029; NINDS-AIREN,
P=.0030; and ICD-10, P=.0041). Among women, age
was an independent predictor of dementia according to DSM-III-R
(P=.425), NINDS-AIREN (P=.0402), and ICD-10
(P=.0050), as was low level of education according to
DSM-III (P=.0074), DSM-III-R (P=.0050), and
DSM-IV (P=.0391), and there was no interaction.
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As expected, the mean values of the MMSE, Clinical Dementia Rating,
Global Deterioration Scale, and Gott-fries Bråne Steen Scale
differentiated the demented from the nondemented patients (Table 3
).
The ICD-10 definition was the most conservative and identified subjects
who were older, who were more severely demented, and who had cognitive
decline before the index stroke.
A total of 335 subjects did not fulfill the definition of dementia
according to any of the five diagnostic guidelines (Table 4). There was an overlap in the patients diagnosed as
demented by the different definitions: 13 patients were diagnosed by
one definition (DSM-III [12], NINDS-AIREN [1]); 16 by two
(DSM-III+DSM-III-R [3], DSM-III+NINDS-AIREN [13]); 10 by three
(DSM-III+DSM-III-R+NINDS-AIREN [4], DSM-III+DSM-III-R+DSM-IV [6]);
50 by four (DSM-III+DSM-III-R+DSM-IV+NINDS-AIREN); and 27 by all five
definitions of dementia. The concordance between the definitions varied
(Table 5); it was moderate between the DSM and
NINDS-AIREN but poor between the ICD-10 and the others.
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If the "standard" diagnosis of dementia was set as an MMSE score
24, any decline in social functioning, and the presence of normal
consciousness, a total of 130 subjects (28.8%) were diagnosed as
demented. Sensitivity, specificity, and positive and negative
predictive values of the different definitions for the diagnosis are
given in Table 6. The DSM-III was the most sensitive
definition and the ICD-10 the most specific definition.
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In the present study we did not differentiate between the causes of dementia. However, if stroke-related dementia is defined according to Tatemichi et al7 as dementia noted 3 months after the index stroke, the frequency of stroke-related dementia within the demented patients was 67.8% (78/115) by DSM-III, 64.4% (58/90) by DSM-III-R, 63.9% (53/83) by DSM-IV, 65.3% (62/95) by NINDS-AIREN, and 0.0% (0/27) by ICD-10 criteria. Thus, nearly 40% of the patients diagnosed as demented had had cognitive decline before the index stroke. The frequencies of stroke-related dementia were close to each other except when the ICD-10 definition was used, which requires a 6-month duration of cognitive decline; accordingly, no cases with stroke-related dementia were detected.
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Discussion |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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In the present large (n=486) representative stroke cohort, the frequency of cognitive decline and dementia 3 months after ischemic stroke was high in the 451 testable patients, and the frequency increased with increasing age. Different definitions for dementia gave different frequency estimates, and overlap in the cases diagnosed as demented was observed.
Our stroke cohort is thus far the largest one exploring the associations between ischemic stroke and cognition. We studied consecutive stroke patients entering a university clinic responsible for primary care of all patients with acute stroke in a defined geographic area. We were able to investigate in detail 85% of the stroke survivors. The nonparticipants were older, were more often women, and were hospitalized 3 months after stroke. This factor may have caused a slight underestimation of the frequency of cognitive decline and dementia in the present cohort, especially in the older age groups. However, this selection bias is comparable to that in other similar stroke cohorts.7 42
All patients underwent detailed structured clinical and functional assessments. The evaluations of cognitive function consisted of extended clinical mental status examinations using age-specific norms for each cognitive domain based on a random population sample from the same area. Instead of using more extensive neuropsychological test batteries, we used examinations that were closer to the methods used in clinical neurological practice as well as in epidemiological field studies.
In the present series, decline in one or more cognitive domains was found in 62% and in three or more domains in 27%. In a similar stroke cohort (n=227; mean age, 72 years), Tatemichi et al42 reported any cognitive decline in 78% and decline in four or more domains in 39%.
In our cohort, the frequently influenced domains were constructional and visuospatial functions (37%), memory functions (23% to 34%), executive functions (25%), orientation (23%), attention (22%), and aphasia (14%). Our figures correspond to those in previous stroke cohorts, although different studies have applied different cognitive tests. In the Columbia Stroke cohort,42 impairment in constructional and visuospatial skills was seen in 17% to 25%, in memory functions in 10% to 25%, in executive functions in 16% to 33%, in orientation in 26%, in attention in 20% to 38%, and in aphasia in 13% to 15%. Correspondingly, Desmond et al43 reported impairment in orientation in 22% and in aphasia in 12%. In two older series, Wade and coworkers found disorientation in 27% and impairment in a figure copy task in 26%44 and impairment in memory in 29%.45
According to the DSM-III definition, the frequency of dementia in the present series (mean age, 71 years) was approximately 25% (115/451) and in the groups aged 55 to 64, 65 to 74, and 75 to 85 years was 19% (21/109), 24% (47/197), and 32% (47/145), respectively. In the retrospective analysis of a stroke cohort6 in which the diagnosis of dementia was based on the neurologist's best judgment, the frequency was 16% (116/726); frequency was 24% (42/326) in those aged 64 to 74 years and 32% (47/207) in those aged 75 to 85 years. In the subsequent prospective stroke cohort (mean age, 72 years),7 the frequency of DSM-III dementia 3 months after stroke was 26% (66/251); frequency was 22% (22/102) in the group aged 65 to 74 years and 31% (16/52) in the group aged 75 to 79 years. Previously, in a small series by Hershey and coworkers46 (mean age, 63 years), the frequency of DSM-III dementia was 23% (8/34).
In a recent stroke cohort (mean age, 65 years), the frequency of DSM-III-R dementia after first-ever stroke was 13.6% (15/110).47 In the present cohort (mean age, 71 years), the corresponding frequency was 18.5%.
In the present cohort the frequency of dementia increased with increasing age, as shown in previous stroke cohorts.6 7 Both older age and lower level of education were related to higher risk of dementia. However, only low educational level was an independent factor among men, but both age and low educational level were independent factors according to different definitions among women. According to the DSM-III definition, age but not educational level was related to risk of dementia in one stroke cohort,6 and both age and low educational level were related in another.7 48
We did not differentiate in detail between the causes of dementia in the present analysis, but we estimated the proportion of subjects with stroke-related dementia to be 68% (78/115) using the DSM-III criteria. The corresponding figure in the series of Tatemichi et al7 was 56%. Any cognitive decline before stroke, which includes subjects with borderline and definitive dementia, was evident in 32% to 36% in those diagnosed as demented in the present series but was evident in 100% in those diagnosed as demented by ICD-10 criteria by definition. However, we did not specifically study the frequency of prestroke dementia. Recently, Henon and coworkers49 reported that the frequency of prestroke dementia in a series of stroke patients (mean age, 76 years) was 18% (22/120). These findings emphasize that the pathophysiology of poststroke dementia includes both exclusive ischemic changes in the brain and a combination of degenerative and vascular changes, as well as changes only related to Alzheimer's disease. Thus, vascular factors may cause, contribute to, or only coincide with the cognitive impairment.
This is the first detailed series examining the effects of different definitions of dementia on the frequency of poststroke dementia. The five definitions used resulted in different frequency estimates, and the subjects diagnosed as demented overlapped considerably but much less than they should. The ICD-10 definition was the most conservative, identifying older and more severely impaired subjects and those with prestroke dementia. Compared with the standard diagnosis, the DSM-III was the most sensitive and the ICD-10 the most specific. Concordance between the DSM and NINDS-AIREN definitions was moderate but was poor between ICD-10 and the other definitions. The main factors related to the differences include the following: DSM-III-R and DSM-IV require impairment in both short- and long-term memory, and ICD-10 requires impairment in executive functions as well as longer duration of symptoms. The same magnitude of difference between DSM-III and NINDS-AIREN definitions (30% versus 27%) has been reported previously.9
In a sample of 167 elderly patients studied because of suspected dementia, Wetterling et al50 used four different diagnostic criteria for dementia. The number of subjects diagnosed as demented was similar (85 to 86), but distinct groups emerged; 65% (109/167) of the subjects met at least one of the definitions, but only 35% (58/167) of these complied with all the criteria used.
In community-based studies, the effect of different definitions of
dementia has been studied only rarely. In a community survey of persons
aged 70 years (n=1045), prevalence rates by ICD-10 criteria were
considerably lower than by DSM-III-R criteria (3.2% versus
7.3%).51 In another series of community-dwelling subjects
aged 85 years (n=402), the prevalence according to ICD-10 was 16%
and that according to DSM-III-R was 28%.52
Because the commonly used definitions for dementia are based on the clinical presentation of Alzheimer's disease, there has been uncertainty regarding the diagnosis of dementia related to CVD.1 5 8 The variation in the frequency of dementia shown here questions the validity of current criteria for dementia in the setting of CVD, as shown, for example, by Hachinski and Erkinjuntti1 5 and the NINDS-AIREN group.8
Because the characteristics and natural history of the cognitive impairment and dementia related to CVD are still poorly understood, it has been suggested that dementia no longer be used as an identifier in the setting of CVD5 and that the focus be placed on the entire spectrum of cognitive impairment related to stroke instead of on a vague concept of dementia.
Construct, content, and criterion validity of any diagnostic classification are essential for studies on the epidemiology, risk factors, prevention, and therapy of a disorder. Imprecision in definition and diagnosis of poststroke cognitive impairment and dementia has resulted in confusion regarding prevention, treatment, and incidence of the syndromes.
The cause of Alzheimer's disease is still unknown, and no truly effective treatment exists. By contrast, although we do not know the exact causes of vascular cognitive impairment, we can identify certain highly treatable risk factors. This emphasizes the need for further international debate and studies to refine the categories of cognitive impairment used in the setting of CVD.
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Selected Abbreviations and Acronyms |
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Acknowledgments |
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This study was supported in part by grants from the Medical Council of the Academy of Finland, Helsinki; the Clinical Research Institute of the Helsinki University Central Hospital, Helsinki; and the Finnish Alzheimer Foundation for Research, Helsinki, Finland. Drs T. Pohjasvaara and R. Vataja are supported by the Clinical Research Institute of the Helsinki University Central Hospital, Helsinki. Dr T. Erkinjuntti is supported by the Medical Council of the Academy of Finland, Helsinki, and the Finnish Alzheimer Foundation for Research, Helsinki. We thank Vesa Kuusela, senior research officer, Statistics Finland, Helsinki, and Seppo Sarna, PhD, Department of Public Health, University of Helsinki, for statistical support and review.
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Footnotes |
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Reprint requests to Dr T. Erkinjuntti, Memory Research Unit, Department of Neurology, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland.
Received October 14, 1996; revision received December 16, 1996; accepted December 30, 1996.
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References |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
1. Erkinjuntti T, Hachinski VC. Rethinking vascular dementia. Cerebrovasc Dis. 1993;3:3-23.
2.
Tatemichi TK. How acute brain failure becomes
chronic: a view of the mechanisms and syndromes of dementia related to
stroke. Neurology. 1990;40:1652-1659.
3.
Kokmen E, Whisnat JP, O'Fallon WM, Chu C-P, Beard
CM. Dementia after ischemic stroke: a population-based
study in Rochester, Minnesota (1960-1984).
Neurology. 1996;46:154-159.
4.
Skoog I, Nilsson L, Palmertz B, Andreasson L-A,
Svanborg A. A population-based study on dementia in
85-year-olds. N Engl J Med. 1993;328:153-158.
5. Hachinski VC. Preventable senility: a call for action against the vascular dementias. Lancet. 1992;340:645-648. [Medline] [Order article via Infotrieve]
6.
Tatemichi TK, Foulkes MA, Mohr JP, Hewitt JR, Hier DB,
Price TR, Wolf PA. Dementia in stroke survivors in the Stroke
Data Bank cohort: prevalence, incidence, risk factors, and computed
tomographic findings. Stroke. 1990;21:858-866.
7.
Tatemichi TK, Desmond DW, Mayeux R, Paik M,
Stern Y, Sano M, Remien RH, Williams JBW, Mohr JP, Hauser WA, Figueroa
M. Dementia after stroke: baseline frequency, risks, and
clinical features in a hospitalized cohort.
Neurology. 1992;42:1185-1193.
8.
Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL,
Masdeu JC, Garcia JH, Amaducci L, Orgogozo J-M, Bruun A, Hofman A,
Moody DM, O'Brien MD, Yamaguchi T, Grafman J, Drayer MD, Bennet DA,
Fisher M, Ogata J, Kokmen E, Bermejo F, Wolf PA, Gorelik PB, Bick KL,
Pajeau AK, Bell MA, DeCarli C, Culebras A, Korczyn AD, Bogousslavsky J,
Hartman A, Scheinberg P. Vascular dementia:
diagnostic criteria for research studies: report of the
NINDS-AIREN International Work Group. Neurology. 1993;43:250-260.
9. Tatemichi TK, Desmond DW, Stern Y, Sano M, Mayeux R, Andrews H. Prevalence of dementia after stroke depends on diagnostic criteria. Neurology. 1992;42:413.
10. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 3rd ed. Washington, DC: American Psychiatric Association; 1980.
11. Cummings JL, Benson DF, eds. Dementia: A Clinical Approach. 2nd ed. Stoneham, Mass: Butterworth-Heinemann; 1992.
12.
WHO Task Force on Stroke and Other Cerebrovascular
Disorders. Stroke—1989: recommendations on stroke prevention,
diagnosis, and therapy. Stroke. 1989;20:1407-1431.
13. ARIC-modified from the National Survey of Stroke. Stroke. 1981;12(suppl I):I-32-I-35.
14.
Gent M, Blakely JA, Easton JD, Ellis DJ, Hachinski VC,
Harbison JW, Panake E, Roberts RS, Sicurella J, Turpie AGG, and the
CATS Group. The Canadian American Ticlopidine Study (CATS) in
thromboembolic stroke: design, organization, and baseline results.
Stroke. 1988;19:1203-1210.
15.
National Institute of Neurological Disorders and
Stroke. Special report from the National Institute of Neurological
Disorders and Stroke: classification of cerebrovascular diseases
III. Stroke. 1990;21:637-676.
16. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337:1521-1526. [Medline] [Order article via Infotrieve]
17.
North American Symptomatic Carotid
Endarterectomy Trial (NASCET) Steering Committee.
North American Symptomatic Carotid
Endarterectomy Trial: methods, patient
characteristics, and progress. Stroke. 1991;22:711-720.
18. Erkinjuntti T, Sulkava R, Kovanen J, Palo J. Suspected dementia: evaluation of 323 consecutive referrals. Acta Neurol Scand. 1987;76:359-364. [Medline] [Order article via Infotrieve]
19.
Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB.
The Stroke Data Bank: design, methods, and baseline
characteristics. Stroke. 1988;19:547-554.
20. Folstein MF, Folstein SE, McHugh PR. `Mini-Mental State': a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198. [Medline] [Order article via Infotrieve]
21. Teng EL, Chui HC. The modified Mini-Mental State (3MS) Examination. J Clin Psychiatry. 1987;48:314-318. [Medline] [Order article via Infotrieve]
22. Ylikoski R, Erkinjuntti T, Sulkava R, Juva K, Tilvis R, Valvanne J. Correlation for age, education and other demographic variables in the use of Mini-Mental State Examination in Finland. Acta Neurol Scand. 1992;85:391-396. [Medline] [Order article via Infotrieve]
23. Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Keskivaara P, Tilvis R. Differences in neuropsychological functioning associated with age and education in neurologically healthy elderly individuals. Appl Neuropsychol, In press.
24. Crary MA, Haak NJ, Malinsky AE. Preliminary psychometric evaluation of an acute aphasia screening protocol. Aphasiology. 1989;3:611-618.
25. Becht AT, Beck RW. Screening depressive patients in family practice. Postgrad Med. 1972;11:561-579.
26. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.
27. Gottfries CG, Bråne G, Gullberg B, Steen G. A new rating scale for dementia syndromes. Arch Gerontol Geriatr. 1982;1:311-330. [Medline] [Order article via Infotrieve]
28.
Rosen WG, Mohs RC, Davis KL. A new rating scale
for Alzheimer's disease. Am J
Psychiatry. 1984;141:1356-1364.
29. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;8:20-30. [Medline] [Order article via Infotrieve]
30. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179-186. [Medline] [Order article via Infotrieve]
31.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos
S. Measurement of functional activities in older adults in the
community. J Gerontol. 1982;37:323-329.
32.
Blessed G, Tomlinson BE, Roth M. The
association between quantitative measures of dementia and of senile
change in the cerebral grey matter of elderly subjects.
Br J Psychiatry. 1968;114:797-811.
33. Erkinjuntti T, Hokkanen L, Sulkava R, Palo J. The Blessed Dementia Scale as a screening test for dementia. Int J Geriatr Psychiatry. 1988;3:267-273.
34. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Rehabilitation. 1965:61-65.
35. Schwab R, England A. Projection technique for evaluating surgery in Parkinson's disease. In: Gillingham F, Donaldson I, eds. Theme Symposium on Parkinson's Disease. London, England: E&S Livingstone; 1960.
36.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin
RL. A new clinical scale for the staging of dementia.
Br J Psychiatry. 1982;140:566-572.
37.
Reisberg B, Ferris SH, DeLeon MJ, Crook T. The
Global Deterioration Scale for assessment of primary degenerative
dementia. Am J Psychiatry. 1982;139:1136-1139.
38. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). 3rd ed, revised. Washington, DC: American Psychiatric Association; 1987.
39. World Health Organization. The International Classification of Diseases, 10th Revision (ICD-10). Geneva, Switzerland: World Health Organization; 1989:25-31. WHO typescript document MNH/MEP/87.1.
40. BMDP New System for Windows. Los Angeles, Calif: BMDP; 1994.
41. SAS Procedures Guide, Version 6. 3rd ed. Cary, NC: SAS Institute Inc; 1990.
42.
Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M,
Bagiella E. Cognitive impairment after stroke: frequency,
patterns, and relationship to functional abilities.
J Neurol Neurosurg Psychiatry. 1994;57:202-207.
43. Desmond DW, Tatemichi TK, Figuerola M, Gropen TI, Stern Y. Disorientation following stroke: frequency, course, and clinical correlates. J Neurol. 1994;241:585-591. [Medline] [Order article via Infotrieve]
44. Wade DT, Skilbeck C, Hewer RL. Selected cognitive losses after stroke. Int Disabil Stud. 1989;11:34-39. [Medline] [Order article via Infotrieve]
45. Wade DT, Parker V, Hewer RL. Memory disturbance after stroke: frequency and associated losses. Int Rehabil Med. 1986;8:60-64. [Medline] [Order article via Infotrieve]
46.
Hershey LA, Modic MT, Greenough PG, Jaffe DF.
Magnetic resonance imaging in vascular dementia.
Neurology. 1987;37:29-36.
47.
Censori B, Manara O, Agostinis C, Camerlingo M,
Casto L, Galavotti B, Partziguian T, Servalli MC, Cesana B,
Belloni G, Mamoli A. Dementia after first stroke.
Stroke. 1996;27:1205-1210.
48. Tatemichi TK, Desmond DW, Paik M, Figueroa M, Gropen TI,Stern Y, Sano M, Remien R, Williams JBW, Mohr JP, Mayeux R. Clinical determinants of dementia related to stroke. Ann Neurol. 1993;33:568-575. [Medline] [Order article via Infotrieve]
49. Henon H, Durleu I, Lucas CH, Godefroy O, Pasquir F, Leys D. Prevalence of preexisting dementia in consecutive unselected stroke patients. Neurology. 1996;46:825-853.
50.
Wetterling T, Kanitz R-D, Borgis K-J. Comparison
of different diagnostic criteria for vascular dementia
(ADDTC, DSM-IV, ICD-10, NINDS-AIREN). Stroke. 1996;27:30-36.
51. Henderson AS, Jorm AF, Mackinnon A, Christensen H, Scott LR, Korten AE, Doyle C. A survey of dementia in the Canberra population: experience with ICD-10 and DSM-III-R criteria. Psychol Med. 1994;24:473-482. [Medline] [Order article via Infotrieve]
52.
Fichter MM, Meller I, Schröppel H, Steinkirchner
R. Dementia and cognitive impairment in the oldest old in the
community: prevalence and comorbidity. Br J
Psychiatr. 1995;166:621-629.
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
R. Mantyla, H. J. Aronen, O. Salonen, T. Pohjasvaara, M. Korpelainen, T. Peltonen, C.-G. Standertskjold-Nordenstam, M. Kaste, and T. Erkinjuntti Magnetic Resonance Imaging White Matter Hyperintensities and Mechanism of Ischemic Stroke Stroke, October 1, 1999; 30(10): 2053 - 2058. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
D. Inzitari, A. Di Carlo, G. Pracucci, M. Lamassa, P. Vanni, M. Romanelli, S. Spolveri, P. Adriani, I. Meucci, G. Landini, et al. Incidence and Determinants of Poststroke Dementia as Defined by an Informant Interview Method in a Hospital-Based Stroke Registry Stroke, October 1, 1998; 29(10): 2087 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Zhu, L. Fratiglioni, Z. Guo, H. Aguero-Torres, B. Winblad, and M. Viitanen Association of Stroke With Dementia, Cognitive Impairment, and Functional Disability in the Very Old : A Population-Based Study Stroke, October 1, 1998; 29(10): 2094 - 2099. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Kuller, L. Shemanski, T. Manolio, M. Haan, L. Fried, N. Bryan, G. L. Burke, R. Tracy, and R. Bhadelia Relationship Between ApoE, MRI Findings, and Cognitive Function in the Cardiovascular Health Study Stroke, February 1, 1998; 29(2): 388 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Pohjasvaara, T. Erkinjuntti, R. Ylikoski, M. Hietanen, R. Vataja, and M. Kaste Clinical Determinants of Poststroke Dementia Stroke, January 1, 1998; 29(1): 75 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Erkinjuntti, T. Ostbye, R. Steenhuis, and V. Hachinski The Effect of Different Diagnostic Criteria on the Prevalence of Dementia N. Engl. J. Med., December 4, 1997; 337(23): 1667 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Henon, F. Pasquier, H. Henon, F. Pasquier, F. Durieu, O. Godefroy, C. Lucas, F Lebert, and D. Leys Preexisting Dementia in Stroke Patients : Baseline Frequency, Associated Factors, and Outcome Stroke, December 1, 1997; 28(12): 2429 - 2436. [Abstract] [Full Text]
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