Vascular dementia Cognitive, functional and behavioral assessment Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part II.

Engelhardt, Eliasz; Tocquer, Carla; André, Charles; Moreira, Denise Madeira; Okamoto, Ivan Hideyo; Cavalcanti, José Luiz de Sá

doi:10.1590/S1980-57642011DN05040004

Abstract

Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition.

Key words:
recommendations; vascular dementia; neuropsychology; activities of daily living; behavioral and psychological symptoms; diagnosis disclosure.

Resumo

A demência vascular (DV) é a forma de demência secundária mais prevalente e a segunda entre todas as demências. O presente artigo visa estabelecer diretrizes dos princípios básicos para o atendimento de pacientes com suspeita de DV (e comprometimento cognitivo vascular - não demência), fundamentadas em evidência. O material foi obtido e selecionado a partir de busca em bases de dados (Medline, Scielo, Lilacs), preferencialmente dos últimos 15 anos, para propor a sistemática da avaliação cognitiva, funcional e comportamental, além do estadiamento da gravidade, com instrumentos adaptados para o nosso meio, e a revelação do diagnóstico. A presente proposta contribui para a definição dos padrões de diagnóstico da DV através de evidência comprovada em vários níveis. É ressaltado que apenas cerca da metade da população dos pacientes com comprometimento cognitivo vascular apresenta quadro de demência, o que torna necessária, futuramente, uma proposta visando o estabelecimento de critérios e elaboração diagnóstica dessa condição.

Palavras-chave:
recomendações; demência vascular; neuropsicologia; atividades de vida diária; sintomas de comportamento e psicológicos; revelação do diagnóstico.

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References

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Publication Dates

Publication in this collection
Oct-Dec 2011

History

Received
03 Sept 2011
Accepted
02 Nov 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Gauthier S, Rockwood K. Does vascular MCI progress at a different rate than does amnestic MCI? Int Psychogeriatr 2003;15(Suppl 1):257-259.

[2] Hachinski V. Vascular dementia: a radical redefinition. Dementia 1994;5:130-132.

[3] Ingles JL, Wentzel C, Fisk JD, Rockwood K. Neuropsychological predictors of incident dementia in patients with vascular cognitive impairment, without dementia. Stroke 2002; 33:1999-2002.

[4] Loeb C. Clinical criteria for the diagnosis of vascular dementia. Eur Neurol 1988;28:87-92.

[5] Meyer JS, Xu G, Thornby J, Chowdhury MH, Quach M. Is mild cognitive impairmentprodromal for vascular dementia like Alzheimer's disease? Stroke 2002;33 :1981-1985.

[6] Jellinger KA, Attems J. Is there pure vascular dementia in old age? J Neurol Sci 2010;299:150-154.

[7] Engelhardt E. Demência mista: do conceito ao tratamento. Rev Bras Neurol 2004;40:33-54.

[8] McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging and the Alzheimer's Association workgroup on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:263-269.

[9] Zekry D, Hauw JJ, Gold G. Mixed dementia: epidemiology, diagnosis, and treatment. J Am Geriatr Soc 2002;50:1431-1438.

[10] Sachdev P. Vascular cognitive disorder. Int J Geriatr Psychiatry 1999;14:402-403.

[11] Rockwood K, Davis H, MacKnight C, et al. The consortium to investigate vascular impairment of cognition: mnethods and first findings. Can J Neurol Sci 2003;30:237-243.

[12] Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLS. Demência vascular. Criterios diagnosticos e exames complementares. Dement Neuropsychol 2011 June;5(Suppl 1):49-77.

[13] Gorelick PB, Scuteri A, Black SE, et al. American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2011;42(9):2672-2713.

[14] Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke -Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006;37:2220-2241

[15] Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: Diagnosis of dementia (an evidence-based review). Neurology 2001;56:1143-1153.

[16] Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil. Critérios diagnósticos e exames complementares recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia Arq Neuropsiquiatr 2005;63:713-719.

[17] Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil. Avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.

[18] Rockwood K, Parhad I, Hachinski V, et al. Diagnosis of vascular dementia: consortium of canadian Centres for Clinical Cognitive Research concensus statement. Can J Neurol Sci 1994;21:358-364.

[19] Rockwood K, Moorhouse PK, Song X, et al. Disease progression in vascular cognitive impairment: cognitive, functional and behavioural outcomes in the Consortium to Investigate Vascular Impairment of Cognition (CIVIC) cohort study. J Neurol Sci 2007;252(2):106-112.

[20] Madureira S, Verdelho A, Ferro J, et al. Development of a neuropsychological battery for the Leukoaraiosis and Disability in the Elderly Study (LADIS): experience and baseline data. Neuroepidemiology 2006;27:101-116.

[21] Waldemar G, Dubois B, Emre M, et al. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol 2007;14:1-26.

[22] Zhao Q, Zhou Y, Wang Y, Dong K, Wang Y. A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity. Chinese Med Journal 2010;123:311-319.

[23] Brainin M, Barnes M, Baron JC, et al. Guidance for the preparation of neurological management guidelines by EFNS scientific task forces - revised recommendations 2004. Eur J Neurol 2004;11:577-581.

[24] Desmond DW. The neuropsychology of vascular cognitive impairment: Is there a specific cognitive deficit? J Neurol Sci 2004;226:3-7.

[25] Garrett KD, Browndyke JN, Whelihan W, et al. The neuropsychological profile of vascular cognitive impairment-no dementia: comparisons to patients at risk for cerebrovascular disease and vascular dementia. Arch Clin Neuropsychol 2004;19:745-757.

[26] Nyenhuis DL, Gorelick PB, Geenen EJ, et al. The pattern of neuropsychological deficits in vascular cognitive impairment-no dementia (vascular CIND). Clin Neuropsychol 2004;18:41-49.

[27] O'Sullivan M, Morris RG, Markus HS. Brief cognitive assessment for patients with cerebral small vessel disease. J Neurol Neurosurg Psychiatry 2005;76:1140-1145.

[28] Mitrushina MN, Boone KB, D'Elia LF. Handbook of normative data for neuropsychological asserssment. New York: Oxford University Press, 1999.

[29] Smith GE, Ivnik RJ. MCI. Normative neuropsychology. In: Petersen RC (Eds), Mild cognitive impairment. Oxford: Oxford University Press; 2003:63-88.

[30] Spreen O, Strauss E. A compendium of neuropsychological tests. 2nd ed, New York: Oxford University Press ; 1998: p.16-28.

[31] 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.

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