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Updated: Mar 17, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cognitive variations among vascular dementia subtypes caused by small-, large-, or mixed-vessel disease
Huang Ying1, Chen Jianping1, Yuan Jianqing1
1Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College, Jiangxi, China.
Insights
Vascular dementia (VaD) subtypes, identified by MRI, show distinct cognitive profiles. Understanding these subtypes and their vascular causes is key for better treatment and prevention of VaD.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Medicine
Background:
- Vascular dementia (VaD) presents heterogeneously with cognitive profiles influenced by vascular insult locations.
- Identifying VaD subtypes is crucial for understanding disease mechanisms and patient outcomes.
Purpose of the Study:
- To classify VaD subtypes based on vascular mechanisms using MRI.
- To correlate vascular subtypes with prevalent risk factors and cognitive deficits.
Main Methods:
- Retrospective review of demographic, cognitive, and MRI data from 402 clinically diagnosed VaD patients.
- Classification of VaD into large-vessel, small-vessel, or mixed-vessel disease based on MRI findings.
Main Results:
- Small-vessel VaD was most common (70.4%), followed by large-vessel (24.1%). Hypertension was the leading risk factor (81%).
- Large-vessel VaD was associated with hyperlipidemia, cardiac issues, and carotid stenosis.
- Executive dysfunction was prevalent in small-vessel VaD, while large-vessel VaD showed more visuospatial/language deficits.
Conclusions:
- Specific VaD subtypes and their vascular mechanisms correlate with distinct clinical presentations.
- Tailoring treatment and prevention strategies to VaD subtypes can improve patient outcomes.
Introduction:
Vascular dementia (VaD) is a heterogeneous disease that can vary in clinical presentation and cognitive profile. The cognitive profiles of different VaD subtypes depend on the anatomical distribution of the vascular insults that have been documented.
Material And Methods:
We reviewed demographic, cognitive, and imaging data in 402 patients who were clinically diagnosed with VaD between January 2002 and June 2012 at the First Affiliated Hospital of Gan Nan Medical College in Ganzhou, China.
Results:
Based on magnetic resonance imaging (MRI) results, patients were classified as having large- (24.1%), small- (70.4%), or mixed-vessel VaD (5.5%). Hypertension was the most prevalent risk factor (81%), followed by smoking (37%), hyperlipidemia (35%), and diabetes (27%). Hyperlipidemia, cardiac risk factors (history of cardiovascular disease, heart valve disorder) and carotid stenosis were more frequent in patients with large-vessel disease compared to those with small-vessel or mixed-vessel disease (p < 0.001). A median of 4 (maximum 11) cognitive domains were impaired in each VaD patient. After memory dysfunction, executive defects were the most prevalent (68.9%), and neurobehavioral dysfunction was the most rare (13.2%). Patients with small-vessel VaD showed more executive dysfunction than patients with large-vessel and mixed-vessel VaD (p < 0.05), whereas patients with large-vessel VaD had a higher prevalence of visuospatial or language dysfunction (p < 0.05).
Conclusions:
The results indicate that specific subtypes and underlying vascular mechanisms will help predict clinical courses and produce more focused treatment and prevention of VaD.
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