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From the Division of Geriatric Medicine (Drs. Rockwood, Wentzel, and MacKnight), Dalhousie University, Halifax, Nova Scotia; the Department of Clinical Neurological Sciences, University of Western Ontario (Dr. Hachinski), London, Ontario; the Division of Geriatric Medicine (Dr. Hogan), University of Calgary, Alberta; and the Department of Epidemiology and Community Medicine (Dr. McDowell), University of Ottawa, Ontario, Canada.
Address correspondence and reprint requests to Prof. Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, QEII Health Sciences Centre, 5955 Jubilee Road, Halifax, Nova Scotia, Canada B3H 2E1; e-mail: rockwood{at}is.dal.ca
OBJECTIVE: To assess the importance of vascular cognitive impairment and its three subgroups (cognitive impairment, no dementia; vascular dementia; and AD with a vascular component) to the prevalence and burden of cognitive impairment in elderly people.
BACKGROUND: Vascular lesions may produce a spectrum of cognitive changes. Omitting elderly patients whose cognitive impairment falls short of dementia (vascular cognitive impairment, no dementia) may give a falsely low indication of the prevalence and burden of disease. To test this proposition, we compared the rates of adverse outcomes for patients with no cognitive impairment, vascular cognitive impairment (and its subgroups), and probable AD.
METHODS: The Canadian Study of Health and Aging is a prospective cohort study of 10,253 randomly selected community-dwelling and institution-dwelling respondents aged 65 years or older. In the community, all participants (n = 9,008) were screened for cognitive impairment; those who screened positive and a sample of those who screened negative received a clinical assessment (n = 1,659). All patients living in institutions received a clinical assessment (n = 1,255). Participants were reassessed 5 years after the original survey.
RESULTS: Vascular cognitive impairment without dementia was the most prevalent form of vascular cognitive impairment among those aged 65 to 84 years. Rates of institutionalization and mortality for those with vascular cognitive impairment were significantly higher than those of people who had no cognitive impairment, and the mortality rate for patients with vascular cognitive impairment was similar to that of patients with AD.
CONCLUSIONS: Failure to consider vascular cognitive impairment without dementia underestimates the prevalence of impairment and the risk for adverse outcomes associated with vascular cognitive impairment.
Key words: Vascular cognitive impairment—Dementia—Diagnosis
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