Critical Elements for the Diagnosis of Vascular Dementia VaD

1
Critical Elements for the Diagnosis of Vascular
Dementia (VaD)

• GC Román MD
• University of Texas HSC San Antonio

2
Research Definition of VaD

• A) Dementia
• B) Cerebrovascular disease
• C) A and B must be reasonably related.
• Based on Román GC, Tatemichi TK, Erkinjuntti T,
  et al Vascular dementia Diagnostic criteria
  for research studies. Report of the NINDS-AIREN
  International Workshop held at the National
  Institutes of Health, Bethesda, Md, April 19-21,
  1991.
• Neurology 199343250-260.

3
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Dementia
• Decline in memory and intellectual abilities
  which causes impaired functioning in daily
  living.
• The Neurological Adaptation of of the
  International Classification of Diseases
  (ICD-10NA WHO, 1991)

4
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Dementia
• Confirmation by neuropsychology tests of
  impairment of memory and decline in 2 or more
  cognitive domains, including orientation,
  language,visuo-spatial functions, attention,
  executive functions, motor control, praxis.

5
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Cerebrovascular disease
• MUST include confirmation by brain imaging
  including multiple large-vessel strokes (MID),
  single strategic infarct (thalamus, PCA, ACA),
  lacunes (multiple, basal ganglia, white matter)
  extensive periventricular white matter lesions

6
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Cerebrovascular disease
• Presence of focal neurological signs consistent
  with stroke with or without history of stroke.
• Use of Hachinski Ischemic Scale not recommended.

7
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Dementia and CVD must be reasonably related
• Onset of dementia within 3 months following
  stroke (post-stroke dementia)
• Exclude pre-stroke dementia 5.5-16.3 of cases
  of post-stroke dementia had symptoms of AD
• Abrupt deterioration of cognitive function
• Fluctuating, stepwise progression

8
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Clinical features inconsistent with VaD
• Early and severe memory deficit
• Worsening of language (transcortical sensory
  aphasia)
• Apraxia, agnosia,
• Absence of focal neurological signs
• No evidence of CVD on brain CT or MRI

9
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• Clinical features consistent with VaD
• Early gait disturbances, frequent falls
• Parkinsonian features
• Early urinary symptoms
• Personality change, mood disorders (vascular
  depression), psychomotor retardation
• Abnormal executive function

10
Research Definition of VaD Based on Román GC et
al (Neurology 199343250-260)

• The prototype of subcortical vascular dementia is
  CADASIL
• (cerebral autosomal dominant arteriopathy with
  subcortical infarcts and leukoencephalopathy)
  mapped to chromosome 19.