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Determinants of vascular dementia in the Cardiovascular Health Cognition Study

From the Department of Epidemiology (Dr. Kuller), University of Pittsburgh, Pittsburgh, PA; Departments of Neurology and Psychiatry (Drs. Lopez, Becker, and DeKosky), University of Pittsburgh, Pittsburgh, PA; Department of Neurology (W. Jagust), University of California-Davis, Sacramento, CA; Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry (Dr. Kyketsos), John Hopkins University, Baltimore, MD; Department of Neurology (Dr. Kawas), University of California-Irvine, Irvine, CA; Division of Geriatric Psychiatry, Psychiatry and Behavioral Sciences (Dr. Breitner), VA Puget Sound Health Care System; Department of Epidemiology (Dr. Fitzpatrick), University of Washington, Seattle, WA; Department of Biostatistics (Dr. Dulberg), University of Washington, Seattle, WA.

Address correspondence and reprint requests to Dr. Lewis H. Kuller, University of Pittsburgh, Department of Epidemiology, 130 N. Bellefield Avenue, Room 550, Pittsburgh, PA 15213; e-mail: KullerL{at}edc.pitt.edu

Objective: The authors evaluated 3,375 participants without dementia at the time of MRI in 1991 to 1994 over 5.7 years for incident dementia and type of dementia.

Methods: Incidence of and risk factors for vascular dementia (VaD) were measured using both pre-MRI and modified State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) post-MRI review and further classified Alzheimer disease (AD) by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria.

Results: Approximately 44% (213) of 480 incident dementia cases were classified as possible or probable VaD by ADDTC. The incidence of VaD increased with age and was greater in blacks than whites. Risk factors for VaD included age, Modified Mini-Mental State Examination, high white matter grade, number of MRI infarcts, ventricular size, and history of stroke.

Conclusions: Vascular disease in the brain is prevalent among incident dementia cases. There is a substantial overlap between cases classified as Alzheimer disease by Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association and vascular dementia (VaD) by modified State of California Alzheimer's Disease Diagnostic and Treatment Centers criteria. The substantial contribution of vascular disease would be missed without inclusion of MRI. Treatment of risk factors for VaD could have an important impact on incidence of dementia.

See also page 1539

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 10 issue to find the link for this article.

For full list of participating CHS investigators and institutions, see "About CHS: Principal Investigators and Study Sites" at http://www.chs-nhlbi.org

Supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01-HC-15103 from the National Heart, Lung, and Blood Institute, and grant AG15928 from the National Institute on Aging.

Received August 20, 2004. Accepted in final form January 5, 2005.

Related articles in Neurology:

Classification of vascular dementia in the Cardiovascular Health Study Cognition Study

O. L. Lopez, L. H. Kuller, J. T. Becker, W. J. Jagust, S. T. DeKosky, A. Fitzpatrick, J. Breitner, C. Lyketsos, C. Kawas, and M. Carlson
Neurology 2005 64: 1539-1547. [Abstract] [Full Text]  

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