Vascular Cognitive Impairment (VCI) after non-embolic ischemic stroke during a 12-month follow-up in Brazil

Brucki, Sonia Maria Dozzi; Machado, Michel Ferreira; Rocha, Maria Sheila Guimarães

doi:10.1590/S1980-57642012DN06030009

ABSTRACT

VCI represents a spectrum of cognitive impairments associated with stroke, vascular brain injury, or subclinical disease ranging from the least to most severe manifestations. Few studies are available on the prevalence of post-stroke VCI and none have been conducted in Brazil.

Objective:

To determine the prevalence rates of VCI and associated risk factors in a sample of ischemic stroke patients.

Methods:

We evaluated 172 patients with ischemic stroke for cognitive impairment one year after ictus.

Results:

Patients comprised 81 women (47.1%) and had a mean age of 67.77 (7.86) years, schooling of 3.52 (2.99) years, and MMSE score of 24.94 (3.59) points. After cognitive evaluation, 4.6% were diagnosed as CIND (cognitive impairment no dementia) and 12.2% had a diagnosis of dementia (probable vascular dementia in 20 patients and one subject with cerebrovascular disease and Alzheimer's disease).

Conclusion:

The prevalence of dementia was lower than previous reports but our sample had a lower age than others, while a 12 month-period of follow-up prevented interference from associated neurodegenerative disorders.

Key words:
vascular cognitive impairment; cognitive impairment no dementia; vascular dementia; post-stroke dementia; post-stroke cognitive impairment

RESUMO

CCV representa um espectro de comprometimento cognitivo associado ao AVC, lesão cerebral vascular ou doença subclínica que vai desde as manifestações menos graves às mais graves. Há poucos estudos sobre a prevalência de CCV pós AVC e nenhum no Brasil.

Objetivo:

Determinar a prevalência de VCI em uma amostra de pacientes com AVC isquêmico e fatores de risco associados.

Métodos:

Foram avaliados 172 pacientes com AVC isquêmico após um ano do ictus, em relação ao comprometimento cognitivo.

Resultados:

Os pacientes foram compostos por 81 mulheres (47,1%) e tinham idade média de 67,77 (7,86) anos, a escolaridade de 3,52 (2,99) anos, a pontuação do MEEM de 24,94 (3,59) pontos. Após a avaliação cognitiva, 4,6% foram diagnosticados como CCSD (comprometimento cognitivo sem demência) e 12,2% tiveram diagnóstico de demência (demência vascular provável em 20 pacientes e um com doença cerebrovascular e doença de Alzheimer).

Conclusão:

A prevalência de demência na nossa população está entre as mais baixas, porém, nossos pacientes são mais jovens e foram acompanhados por um período de 12 meses, o que evita a contaminação por doenças neurodegenerativas associadas.

Palavras-chave:
comprometimento cognitivo vascular; comprometimento cognitivo sem demência; demência vascular; demência pós AVC; comprometimento pós AVC

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REFERENCES

Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia. A Statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:2672-2713.
Loeb C. Clinical criteria for the diagnosis of vascular dementia. Eur Neurol 1988;28:87-92.
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.
Meyer JS, Xu G, Thornby J, Chowdhury MH, Quach M. Is mild cognitive impairment prodromal for vascular dementia like Alzheimer's disease? Stroke 2002;33:1981-1985.
O'Brien JT, Erkinjuntti T, Reisber B et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.
Rockwood K, Davis H, MacKnight C, et al. The consortium to investigate vascular impairment of cognition:methods and first findings. Can J Neurol Sci 2003;30:237-243.
Gauthier S, Rockwood K. Does vascular MCI progress at a different rate than does amnestic MCI? Int Psychogeriatr 2003;15(Suppl 1):257-259.
Jellinger KA. Morphologic diagnosis of vascular dementia:a critical update. J Neurol Sci 2008;270:1-12.
Vas CJ, Pinto C, Panikker D, et al. Prevalence of dementia in an urban Indian population. Int Psychogeriatr 2001;13:439-450.
Rocca WA, Hofman A, Brayne C, et al. The prevalence of vascular dementia in Europe:facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group. Ann Neurol 1991;30:817-824.
Herrera Jr. E, Caramelli P, Nitrini R. Population epidemiologic study of dementia in Catanduva city:state of Sao Paulo, Brazil. Rev Psiquiatr Clín 1998;25:70-73.
Bottino CM, Azevedo D jr, Tatsch M et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26:291-299.
Silva DW, Damasceno BP. Demência na população de pacientes do Hospital das Clínicas da UNICAMP. Arq Neuropsiquiatr 2002;60:996-999.
Vale FA, Miranda SJ. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.
Fujihara S, Brucki SMD, Rocha MSG, Carvalho AA, Piccolo AC. Prevalence of presenile dementia in a tertiary outpatient clinic. Arq Neuropsiquiatr 2004;62:592-595.
Longstreth WT Jr, Bernick C, Manolio TA et al. Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people:the Cardiovascular Health Study. Arch Neurol 1998;55:1217-1225.
Snowdon DA, Grainer LH, Mortimer JA et al. Brain infarction and the clinical expression of Alzheimer disease:the Nun Study. JAMA 1997; 277:813-817.
Cavalieri M, Schmidt R. New development in diagnosis of vascular cognitive impairment. J Neurol Sci 2010;299:11-14.
The LADIS Study Group. 2001-2011:A Decade of the LADIS (Leukoaraiosis And Disability) Study:What have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011;32:577-588.
Smith EE, Schneider JA, Wardlaw JM, Greenberg SM. Cerebral microinfarcts:the invisible lesions. Lancet Neurol 2012;11:272-282.
Deramecourt V, Slade JY, Oakley AE et al. Staging and natural history of cerebrovascular pathology in dementia. Neurology 2012;78: 1043-1050.
Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia:a systematic review and meta-analysis. Lancet Neurol 2009;8:1006-1018.
Mackowiak-Coroliani MA, Bombois S, Memin A, Hénon H, Pasquier F. Poststroke dementia in the elderly.Drugs Aging 2005;22:483-493.
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia three months after stroke:baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 1997;28:785-792.
Inzitari D, Di Carlo A, Pracucci G et al. Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry. Stroke 1998;29:2087-2093.
Desmond DW, Moroney JT, Paik MC et al. Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000;54:1124-1131.
Barba R, Martinez-Espinosa S, Rodriguez-Garcia E et al. Poststroke dementia:clinical features and risk factors. Stroke 2000;31:1494-1501.
Henon H, Durieu I, Guerouaou D et al. Poststroke dementia:incidence and relationship to prestroke cognitive decline. Neurology 2001;57: 1216-1222.
Klimkowicz A, Dziedzic T, Slowik A, Szczudlik A. Incidence of pre- and poststroke dementia:Cracow stroke registry. Dement Geriatr Cogn Disord 2002;14:137-40.
Zhou DHD, Wang JYJ, Deng J, Gao C, Chen M. Study on frequency and predictors of dementia after ischemic stroke:the Chongqing stroke study. J Neurol 2004;251:421-427.
Altieri M, Di Piero V, Pasquini M et al. Delayed poststroke dementia:a 4-year follow-up study. Neurology 2004;62:2193-2197.
Tang WK, Chan SSM, Chiu HFK et al. Frequency and determinants of poststroke dementia in Chinese. Stroke 2004;35:930-935.
De Koning I, Van Kooten F, Koudstaal PJ, Dippel DWJ. Diagnostic value of the Rotterdam-CAMCOG in post-stroke dementia. J Neurol Neurosurg Psychiatry 2005;76:263-265.
Béjot Y, Aboa-Eboulé C, Durier J et al. Prevalence of early dementia after first-ever stroke:a 24-year population-based study. Stroke 2011;42:607-612.
Delgado C, Donoso A, Orellana P et al. Frequency and determinants of poststroke cognitive impairment at three and twelve months in Chile. Dement Geriatr Cogn Disord 2010;29:397-405.
Snaaphaan L, de Leeuw FE. Poststroke memory function in nondemented patients:a systematic review on frequency and neuroimaging correlates. Stroke 2007;38:198-203.
Adams HPJr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke:definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41 TOAST- Trial of Org 10172 in Acute Stroke Treatment.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-81.
Bonita R, Beaglehole R. Modification of Rankin Scale:Recovery of motor function after stroke. Stroke 1988;19:1497-1500.
Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia:diagnostic criteria for research studies:report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-260.
Gold G, Bouras C, Canuto A et al. Clinicopathological validation study of four sets of clinical criteria for vascular dementia. Am J Psychiatry 2002;159:82-87.
Ebrahim S, Nouri F, Barer D. Cognitive impairment after stroke. Age Ageing 1985;14:345-348.
Patel MD, Coshall C, Rudd AG, Wolfe CDA. Cognitive impairment after stroke:clinical determinants and its associations with long-term stroke outcomes. J Am Geriatr Soc 2002;50:700-706.
Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLS and Working group on Alzheimer's disease and Vascular Dementia of the Brazilian Academy of Neurology . Vascular Dementia. Cognitive, functional and behavioral assessment. Part II. Dement Neuropsychol 2011;5:264-274.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
20 Feb 2012
Accepted
20 May 2012

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

[1] Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia. A Statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:2672-2713.

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

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

[5] O'Brien JT, Erkinjuntti T, Reisber B et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.

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

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

[8] Jellinger KA. Morphologic diagnosis of vascular dementia:a critical update. J Neurol Sci 2008;270:1-12.

[9] Vas CJ, Pinto C, Panikker D, et al. Prevalence of dementia in an urban Indian population. Int Psychogeriatr 2001;13:439-450.

[10] Rocca WA, Hofman A, Brayne C, et al. The prevalence of vascular dementia in Europe:facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group. Ann Neurol 1991;30:817-824.

[11] Herrera Jr. E, Caramelli P, Nitrini R. Population epidemiologic study of dementia in Catanduva city:state of Sao Paulo, Brazil. Rev Psiquiatr Clín 1998;25:70-73.

[12] Bottino CM, Azevedo D jr, Tatsch M et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26:291-299.

[13] Silva DW, Damasceno BP. Demência na população de pacientes do Hospital das Clínicas da UNICAMP. Arq Neuropsiquiatr 2002;60:996-999.

[14] Vale FA, Miranda SJ. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.

[15] Fujihara S, Brucki SMD, Rocha MSG, Carvalho AA, Piccolo AC. Prevalence of presenile dementia in a tertiary outpatient clinic. Arq Neuropsiquiatr 2004;62:592-595.

[16] Longstreth WT Jr, Bernick C, Manolio TA et al. Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people:the Cardiovascular Health Study. Arch Neurol 1998;55:1217-1225.

[17] Snowdon DA, Grainer LH, Mortimer JA et al. Brain infarction and the clinical expression of Alzheimer disease:the Nun Study. JAMA 1997; 277:813-817.

[18] Cavalieri M, Schmidt R. New development in diagnosis of vascular cognitive impairment. J Neurol Sci 2010;299:11-14.

[19] The LADIS Study Group. 2001-2011:A Decade of the LADIS (Leukoaraiosis And Disability) Study:What have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011;32:577-588.

[20] Smith EE, Schneider JA, Wardlaw JM, Greenberg SM. Cerebral microinfarcts:the invisible lesions. Lancet Neurol 2012;11:272-282.

[21] Deramecourt V, Slade JY, Oakley AE et al. Staging and natural history of cerebrovascular pathology in dementia. Neurology 2012;78: 1043-1050.

[22] Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia:a systematic review and meta-analysis. Lancet Neurol 2009;8:1006-1018.

[23] Mackowiak-Coroliani MA, Bombois S, Memin A, Hénon H, Pasquier F. Poststroke dementia in the elderly.Drugs Aging 2005;22:483-493.

[24] Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia three months after stroke:baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 1997;28:785-792.

[25] Inzitari D, Di Carlo A, Pracucci G et al. Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry. Stroke 1998;29:2087-2093.

[26] Desmond DW, Moroney JT, Paik MC et al. Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000;54:1124-1131.

[27] Barba R, Martinez-Espinosa S, Rodriguez-Garcia E et al. Poststroke dementia:clinical features and risk factors. Stroke 2000;31:1494-1501.

[28] Henon H, Durieu I, Guerouaou D et al. Poststroke dementia:incidence and relationship to prestroke cognitive decline. Neurology 2001;57: 1216-1222.

[29] Klimkowicz A, Dziedzic T, Slowik A, Szczudlik A. Incidence of pre- and poststroke dementia:Cracow stroke registry. Dement Geriatr Cogn Disord 2002;14:137-40.

[30] Zhou DHD, Wang JYJ, Deng J, Gao C, Chen M. Study on frequency and predictors of dementia after ischemic stroke:the Chongqing stroke study. J Neurol 2004;251:421-427.

[31] Altieri M, Di Piero V, Pasquini M et al. Delayed poststroke dementia:a 4-year follow-up study. Neurology 2004;62:2193-2197.

[32] Tang WK, Chan SSM, Chiu HFK et al. Frequency and determinants of poststroke dementia in Chinese. Stroke 2004;35:930-935.

[33] De Koning I, Van Kooten F, Koudstaal PJ, Dippel DWJ. Diagnostic value of the Rotterdam-CAMCOG in post-stroke dementia. J Neurol Neurosurg Psychiatry 2005;76:263-265.

[34] Béjot Y, Aboa-Eboulé C, Durier J et al. Prevalence of early dementia after first-ever stroke:a 24-year population-based study. Stroke 2011;42:607-612.

[35] Delgado C, Donoso A, Orellana P et al. Frequency and determinants of poststroke cognitive impairment at three and twelve months in Chile. Dement Geriatr Cogn Disord 2010;29:397-405.

[36] Snaaphaan L, de Leeuw FE. Poststroke memory function in nondemented patients:a systematic review on frequency and neuroimaging correlates. Stroke 2007;38:198-203.

[37] Adams HPJr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke:definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41 TOAST- Trial of Org 10172 in Acute Stroke Treatment.

[38] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-81.

[39] Bonita R, Beaglehole R. Modification of Rankin Scale:Recovery of motor function after stroke. Stroke 1988;19:1497-1500.

[40] Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[41] Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia:diagnostic criteria for research studies:report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-260.

[42] Gold G, Bouras C, Canuto A et al. Clinicopathological validation study of four sets of clinical criteria for vascular dementia. Am J Psychiatry 2002;159:82-87.

[43] Ebrahim S, Nouri F, Barer D. Cognitive impairment after stroke. Age Ageing 1985;14:345-348.

[44] Patel MD, Coshall C, Rudd AG, Wolfe CDA. Cognitive impairment after stroke:clinical determinants and its associations with long-term stroke outcomes. J Am Geriatr Soc 2002;50:700-706.

[45] Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLS and Working group on Alzheimer's disease and Vascular Dementia of the Brazilian Academy of Neurology . Vascular Dementia. Cognitive, functional and behavioral assessment. Part II. Dement Neuropsychol 2011;5:264-274.

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