Journal Reading

Cognitive variations among vascular dementia

subtypes caused by small-, large-, or mixed-
vessel disease
Huang Ying, Chen Jianping, Yuan Jianqing, Zhong Shanquan
Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College,
Jiangxi, China

Sarah Fadlaini
Pembimbing : Dr. dr. Suherman, Sp.S(K)
INTRODUCTION
 Vascular dementia (VaD) is a common type of dementia
that is affecting a growing number of elderly individuals
worldwide and it’s the second type that most caused
dementia (25%)
 The cognitive profiles of different VaD subtypes depend
on the anatomical distribution of the vascular insults.
 The aims of this study were to characterize cognitive
function profiles with respect to domain dysfunction in
different subtypes of VaD patients using
neuropsychological tests and assessing magnetic
resonance imaging (MRI) using well-defined radiological
criteria
MATERIAL & METHODS
 Sample : 402 patients VaD between January 2002-June
2012 in our hospital
 Inclusi :
1. Age ≥ 40 years;
2. Fulfillment of the NINDSAIREN criteria for probable VaD
3. MRI evidence of ischemic cerebrovascular disease,
including ischemic stroke or white matter lesions
4. Mini-Mental State Examination (MMSE) score of 10–26
5. modified Hachinski Ischemia Scale (HIS) score 4 or more
 Variabel :
1. Demographic
2. Assessments of neurobehavioral function
 Abstract thinking : Choynowski’s Memory Scale
 Attention : Digit Span Forward test
 Calculation : MMSE
 Executive : trail-making test B (TMT-B)
 Language : category naming of animals in 1 min
 Mental control : revised Wechsler Memory Scale (WMS-R)
 Neurobehavior : Neuropsychiatric Inventory (NPI)
 Orientation : MMSE
 Praxis-gnosis : Western Aphasia Battery ideomotor apraxia
subtest items
 Visuospatial : MMSE
 Subtype of VAD:
1. Small vessel VAD
2. Large vessel VAD
3. Mix-type vessel VAD

 Statistical Analysis
1. Demographics : descriptive statistics
2. X² test and
3. One-way analysis of variance (ANOVA)
4. Newman-Keuls tests (NK)
RESULT
Demographics
Prevalence
Presentage of Cognitive Domain
DISCUSSION
 Domain profile of cognitive dysfunction differs
among VaD subtypes, and that these subtypes are
associated with specific risk factors.
 Preclinical period of the disease, when neuronal
degeneration has begun, but cellular and
biochemical damage is not yet sufficient for
symptoms to manifest, is the optimal time to initiate
a neuroprotective therapy
Location lesion = Cognitive domain
 Medial temporal location is consistent with the
characteristic amnestic state in large-vessel VaD
 Basal ganglia infarcts : executive dysfunction
 Thalamus : memory impairment
 Poor working memory and executive dysfunction in
subcortical VaD : frontal-subcortical circuits
 VaD subtype cognitive profiles may be explained,
on one hand, by the anatomical distribution of the
vascular insults
 Small artery disease : subcortical VaD (working
memory deficits, visuomotor speed and executive
dysfunction)
 Neurotransmitters (acetylcholine) decreased in
dementia which is a potent vasodilator innervating
local cortical nitroxidergic interneurons, cerebral
capillaries and microarterioles
 Acetylcholine esterase inhibitor : increased CBF
and could be used to treat dementia
 Nonuniform cholinergic cortical innervation could
explain the regional profile variability in dementia
patients
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