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Problems encountered with longitudinal neurological, psychometric and cerebral CT imaging among stroke data bank
J S Meyer1, K Obara, S Takashima
1Department of Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Tex.
Insights
Cognitive impairments in vascular dementia correlate with cerebral ischemia, not infarct volume. Improved mortality rates are linked to better risk factor control and treatments for cerebrovascular disease.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Medicine
Background:
- Vascular dementia is a significant cause of cognitive impairment.
- Assessing cognitive decline and its relationship with cerebral blood flow is crucial.
- Previous studies have not fully elucidated the correlation between ischemia and cognitive deficits.
Purpose of the Study:
- To investigate the relationship between cerebral ischemia and cognitive impairments in patients with vascular dementia.
- To evaluate the long-term changes in neurological and cognitive status.
- To assess cerebral blood flow using stable xenon-enhanced CT.
Main Methods:
- Longitudinal follow-up of 41 patients with probable ischemic vascular dementia over 7 years.
- Serial neurological and cognitive assessments.
- Cerebral blood flow measurement using stable xenon-enhanced computed tomography (CT).
Main Results:
- Cognitive impairments were found to correlate with cerebral ischemia.
- CT measurements of infarcted brain volume did not correlate with cognitive impairments.
- Mortality rates decreased over time, attributed to risk factor management and treatments.
Conclusions:
- Cerebral ischemia is a key factor in cognitive decline in vascular dementia.
- Effective management of risk factors and appropriate treatments can reduce mortality.
- Stable xenon-enhanced CT is a valuable tool for assessing cerebral blood flow in dementia research.
Abstract:
41 patients (30 men, 11 women, mean age 65.3 +/- 9.7 years) with probable ischemic vascular dementia diagnosed according to stated clinical criteria at least 3 months after hospital discharge and among a few nonhospitalized subjects with thorough clinical, neurovascular and neuroimaging workup have been followed for the past 7 years with serial measures of neurological and cognitive status and cerebral blood flow using stable xenon-enhanced CT. Cognitive impairments correlated with cerebral ischemia rather than CT measurements of infarcted brain volume. A minimum of one follow-up was required and follow-up intervals ranged from 4 months to 6.6 years (mean 3.4 +/- 1.6 years). 9 patients (22.0%) were lost to follow-up, 4.9% died, 9.8% became incapacitated by additional strokes, 2.4% by cancer and 4.9% moved away. Cross-sequential designs adjust for problems of attrition. Mortality rates of 1.4%/year during 1986-1993 are significantly lower than 2.0%/year between 1983 and 1986. Declines in mortality are attributed to control of risk factors and antiplatelet treatment of atherosclerotic cerebral vascular disease and anticoagulant treatment of patients with cardiogenic embolism.