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Identification of VaD and AD prodromes: The Cache County Study
Author(s) -
Hayden K.M.,
Warren L.H.,
Pieper C.F.,
Østbye T.,
Tschanz J.T.,
Norton M.C.,
Breitner J.C.S.,
WelshBohmer K.A.
Publication year - 2005
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2005.06.002
Subject(s) - dementia , prodrome , population , neuropsychology , medicine , vascular dementia , cognition , psychology , psychiatry , disease , psychosis , environmental health
Background It is unclear whether vascular dementia (VaD) has a cognitive prodrome, akin to the mild cognitive impairment (MCI) prodrome to Alzheimer's dementia (AD). To evaluate whether VaD has a cognitive prodrome, and if it can be differentiated from prodromal AD, we examined neuropsychological test performance of participants in a nested case‐control study within a population‐based cohort aged 65 or older. Methods Participants (n = 485) were identified from the Cache County Study, a large population‐based study of aging and dementia. After an average of 3 years of follow‐up, a total of 62 incident dementia cases were identified (14 VaD, 48 AD). We identified a number of neuropsychological tests (executive and memory) that discriminated between diagnosed VaD and AD cases. Multivariate analyses sought to differentiate between these same groups 3 years before clinical diagnosis. Results The Consortium to Establish a Registry for Alzheimer's Disease Word List Recognition Test correct recognition of foils (mean difference, 1.25; 95% confidence interval [CI], 0.42 to 2.07; p < 0.01), Logical Memory I (mean difference, 7.16; 95% CI, 0.78 to 13.55, p < 0.05), Logical Memory II delayed recall (mean difference, 8.67; 95% CI, 1.59 to 15.74, p < 0.05), and percent savings (mean difference, 51.07; 95% CI, 32.58 to 69.56, p < 0.0001) differentiated VaD from AD cases after adjustment for age, sex, education, and dementia severity. Three years before dementia diagnosis, word list recognition (“no” responses mean difference, 1.40; 95% CI, 0.64 to 2.17; p < 0.001, and “yes” responses mean difference, –1.14; 95% CI, –2.14 to –0.13; p < 0.03) discriminated between prodromal VaD and AD. Conclusion These results suggest that VaD has a prodromal syndrome, the cognitive features of which are distinguishable from the cognitive prodrome of AD.