Longitudinal outcome among patients with ischemic vascular dementia(1)

Longitudinal studies carried out in this laboratory for the past 12 years among patients with ischemic vascular dementia (IVD) are summarized. The criteria for the diagnosis of probable IVD and definite IVD are described and are consonant with the State of California Alzheimer's Disease Diagnostic and Treatment Centers recommended criteria. Demography of IVD patients and associated risk factors are described, and the types of cerebral infarcts causing IVD are listed. Control of risk factors for stroke stabilizes patients with IVD as judged by serial cognitive testing. Control of hypertension and cigarette smoking and a reduction in hyperlipidemia all benefit IVD patients. Best cognitive results are obtained if hypertension is controlled within the upper limits of normal with mean systolic blood pressure values maintained above and around 137 mm Hg. Serial measurements of cerebral perfusion indicate that cognition and cerebral perfusion fluctuate together. When demented and nondemented patients with stroke are compared, overall cerebral perfusion is reduced to a greater extent in the stroke patients with dementia, particularly within cortical gray matter and subcortical white matter. Leuko-araiosis is twice as great in demented stroke patients compared to stroke patients who are cognitively intact. In longitudinal studies, cerebral perfusion declined further among stroke patients with cognitive deterioration, but, when cerebral perfusion became stabilized, cognitive performance likewise stabilized or improved.