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Neuropsychological Profile and Performance Variability in Vascular Cognitive Impairment

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DOI: 10.4236/ijcm.2014.517135    2,456 Downloads   3,085 Views   Citations

ABSTRACT

Background: Cognitive impairment from cerebrovascular disease varies in scope. Methods: We studied healthy elderly individuals and those with mild cognitive impairment (MCI) or mild dementia attributed to vascular pathology, in order to assess the diagnostic utility of intra-individual variability across neuropsychological domains and the cognitive profile of vascular cognitive disorders. A large battery of tests was used to create z-scores for seven neuropsychological domains by principle components analysis. Results: We did not find group differences in the average intra-individual variance across neuropsychological domains. We did find group differences in the within-domain variability for Language, reflecting increased performance variability in those participants with vascular pathology. There was a lower inter-correlation of domain scores in the MCI group than in the mild vascular dementia (VD) group. The MCI group had the largest deficits in Executive Function, Fluency and Memory relative to the healthy control (HC) group. The VD group evidenced a broad range of further cognitive decline relative to the MCI group, with the largest difference on Visuoconstruction. Conclusions: While intra-individual performance variability may increase early in the course of cognitive decline from vascular pathology, this is not because of greater across-domain variability or because impairments occur in only one particular cognitive domain or small cluster of inter-related domains. Early cognitive change includes decreased executive function that cannot be attributed to slow information processing or response time.

Conflicts of Interest

The authors declare no conflicts of interest.

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Hart, R. and Best, A. (2014) Neuropsychological Profile and Performance Variability in Vascular Cognitive Impairment. International Journal of Clinical Medicine, 5, 1047-1058. doi: 10.4236/ijcm.2014.517135.

References

[1] Bowler, J.V. and Hachinski, V.C. (2003) Vascular Cognitive Impairment. Oxford University Press, Oxford and New York.
[2] Román, G.C., Sachdev, P., Royall, D.R., Bullock, R.A., Orgogozo, J.M., López-Pousa, S., et al. (2004) Vascular Cognitive Disorder: A New Diagnostic Category Updating Vascular Cognitive Impairment and Vascular Dementia. Journal of the Neurological Sciences, 226, 81-87.
http://dx.doi.org/10.1016/j.jns.2004.09.016
[3] Soriano-Raya, J.J., Miralbell, J., Lopez-Cancio, E., Bargalló, N., Arenillas, J.F., Barrios, M., et al. (2012) Deep versus Periventricular White Matter Lesions and Cognitive Function in a Community Sample of Middle-Aged Participants. Journal of the International Neuropsychological Society, 18, 874-885.
http://dx.doi.org/10.1017/S1355617712000677
[4] Ylikoski, R., Ylikoski, A., Erkinjuntti, T., Sulkava, R., Raininko, R. and Tilvis, R. (1993) White Matter Changes in Healthy Elderly Persons Correlate with Attention and Speed of Mental Processing. Archives of Neurology, 50, 818-824.
http://dx.doi.org/10.1001/archneur.1993.00540080029009
[5] Pantoni, L., Poggesi, A. and Inzitari, D. (2007) The Relation between White-Matter Lesions and Cognition. Current Opinion in Neurology, 20, 390-397.
http://dx.doi.org/10.1097/WCO.0b013e328172d661
[6] Jellinger, K.A. (2013) Pathology and Pathogenesis of Vascular Cognitive Impairment—A Critical Update. Frontiers in Aging Neuroscience, 5, 1-19.
http://dx.doi.org/10.3389/fnagi.2013.00017
[7] Elias, M.F., Sullivan, L.M., D’Agostino, R.B., Elias, P.K., Beiser, A., Au, R., et al. (2004) Framingham Stroke Risk Profile and Lowered Cognitive Performance. Stroke, 35, 404-409.
http://dx.doi.org/10.1161/01.STR.0000103141.82869.77
[8] Ingles, J.L., Wentzel, C., Fisk, J.D. and Rockwood, K. (2002) Neuropsychological Predictors of Incident Dementia in Patients with Vascular Cognitive Impairment, without Dementia. Stroke, 33, 1999-2002.
http://dx.doi.org/10.1161/01.STR.0000024433.36590.1B
[9] Vannorsdall, T.D., Waldstein, S.R., Kraut, M., Pearlson, G.D. and Schretlen, D.J. (2009) White Matter Abnormalities and Cognition in a Community Sample. Archives of Clinical Neuropsychology, 24, 209-217.
http://dx.doi.org/10.1093/arclin/acp037
[10] Canning, S.J., Leach, L., Stuss, D., Ngo, D.L. and Black, S.E. (2004) Diagnostic Utility of Abbreviated Fluency Measures in Alzheimer Disease and Vascular Dementia. Neurology, 62, 556-562.
http://dx.doi.org/10.1212/WNL.62.4.556
[11] Cohen, R.A., Paul, R.H., Ott, B.R., Moser, D.J., Zawacki, T.M., Stone, W., et al. (2002) The Relationship of Subcortical MRI Hyperintensities and Brain Volume to Cognitive Function in Vascular Dementia. Journal of the International Neuropsychological Society, 8, 743-752.
http://dx.doi.org/10.1017/S1355617702860027
[12] Garrett, K.D., Browndyke, J.N., Whelihan, W., Paul, R.H., DiCarlo, M., Moser, J.D., et al. (2004) The Neuropsychological Profile of Vascular Cognitive Impairment-No Dementia: Comparisons to Patients at Risk for Cerebrovascular Disease and Vascular Dementia. Archives of Clinical Neuropsychology, 19, 745-757.
http://dx.doi.org/10.1016/j.acn.2003.09.008
[13] Nyenhuis, D.L., Gorelick, P.B., Geenen, E.J., Smith, C.A., Gencheva, E., Freels, S., et al. (2004) The Pattern of Neuropsychological Deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND). The Clinical Neuropsychologist, 18, 41-49.
http://dx.doi.org/10.1080/13854040490507145
[14] O’Sullivan, M., Morris, R.G. and Markus, H.S. (2005) Brief Cognitive Assessment for Patients with Cerebral Small Vessel Disease. Journal of Neurology, Neurosurgery & Psychiatry, 76, 1140-1145.
http://dx.doi.org/10.1136/jnnp.2004.045963
[15] Seo, S.W., Lee, B.H., Kim, E.J., Chin, J., Cho, Y.S., Yoon, U., et al. (2007) Clinical Significance of Microbleeds in Subcortical Vascular Dementia. Stroke, 38, 1949-1951.
http://dx.doi.org/10.1161/STROKEAHA.106.477315
[16] Geerlings, M.I., Appelman, A.P., Vincken, K.L., Mali, W.P. and van der Graff, Y. (2009) Association of White Matter Lesions and Lacunar Infarcts with Executive Functioning: The SMART-MR Study. American Journal of Epidemiology, 170, 1147-1155.
http://dx.doi.org/10.1093/aje/kwp256
[17] Price, C.C., Jefferson, A.L., Merino, J.G., Heilman, K.M. and Libon, D.J. (2005) Subcortical Vascular Dementia: Integrating Neuropsychological and Neuroradiologic Data. Neurology, 65, 376-382.
http://dx.doi.org/10.1212/01.WNL.0000168877.06011.15
[18] Price, C.C., Garrett, K.D., Jefferson, A.L., Cosentino, S., Tanner, J.J., Penney, D.L., et al. (2009) Leukoaraiosis Severity and List-Learning in Dementia. The Clinical Neuropsychologist, 23, 944-961.
http://dx.doi.org/10.1080/13854040802681664
[19] De Groot, J.C., De Leeuw, F.E., Oudkerk, M., van Gijn, J., Hofman, A., Jolles, J. and Breteler, M.M.B. (2000) Cerebral White Matter Lesions and Cognitive Function: The Rotterdam Scan Study. Annals of Neurology, 47, 145-151.
http://dx.doi.org/10.1002/1531-8249(200002)47:2<145::AID-ANA3>3.0.CO;2-P
[20] van Swieten, J.C., Geyskes, G.G., Derix, M.M., Peeck, B.M., Ramos, L.M., van Latum, J.C. and van Gijn, J. (1991) Hypertension in the Elderly Is Associated with White Matter Lesions and Cognitive Decline. Annals of Neurology, 30, 825-830.
http://dx.doi.org/10.1002/ana.410300612
[21] DeCarli, C., Murphy, D.G., Tranh, M., Grady, C.L., Haxby, J.V., Gillette, J.A., et al. (1995) The Effect of White Matter Hyperintensity Volume on Brain Structure, Cognitive Performance, and Cerebral Metabolism of Glucose in 51 Healthy Adults. Neurology, 45, 2077-2084.
http://dx.doi.org/10.1212/WNL.45.11.2077
[22] Schretlen, D.J. (2013) Novel Methods of Inference in Clinical Neuropsychology. Meeting of the American Academy of Clinical Neuropsychology, Chicago, IL, 19-22 June 2013.
[23] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) Mini-Mental State. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6
[24] Holtzer, R., Verghese, J., Wang, C., Hall, C.B. and Lipton, R.B. (2008) Within-Person Across-Neuropsychological Test Variability and Incident Dementia. The Journal of the American Medical Association, 300, 823-830.
http://dx.doi.org/10.1001/jama.300.7.823
[25] Jak, A.J., Bondi, M.W., Delano-Wood, L., Wierenga, C., Corey-Bloom, J., Salmon, D.P. and Delis, D.C. (2009) Quantification of Five Neuropsychological Approaches to Defining Mild Cognitive Impairment. American Journal of Geriatric Psychiatry, 17, 368-375.
http://dx.doi.org/10.1097/JGP.0b013e31819431d5
[26] Linkenhoker, D. and McCarron, L. (1980) Manual for Adaptive Behavior: The Street Survival Skills Questionnaire. McCarron-Dial Systems, Dallas, TX.
[27] Ingraham, L.J. and Aiken, C.B. (1996) An Empirical Approach to Determining Criteria for Abnormality in Test Batteries with Multiple Measures. Neuropsychology, 10, 120-124.
http://dx.doi.org/10.1037/0894-4105.10.1.120
[28] Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., et al. (2006) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 2220-2241.
http://dx.doi.org/10.1161/01.STR.0000237236.88823.47
[29] Gorelick, P.B., Scuteri, A., Black, S.E., Decarli, C., Greenberg, S.M., Iadecola, C., et al. (2011) Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 42, 2672-2713.
http://dx.doi.org/10.1161/STR.0b013e3182299496
[30] Emery, V.O.B., Gillie, E.X. and Smith, J.A. (1996) Reclassification of the Vascular Dementias: Comparisons of Infarct and Noninfarct Vascular Dementias. International Psychogeriatrics, 8, 33-61.
http://dx.doi.org/10.1017/S1041610296002475
[31] Rosen, W.G., Terry, R.D., Fuld, P.A., Katzman, R. and Peck, A. (1980) Pathological Verification of Ischemic Score in Differentiation of Dementias. Annals of Neurology, 7, 486-488.
http://dx.doi.org/10.1002/ana.410070516
[32] Wechsler, D. (1997) Wechsler Memory Scale. 3rd Edition, The Psychological Corporation, San Antonio.
[33] Wechsler, D. (1997) Wechsler Adult Intelligence Scale. 3rd Edition, The Psychological Corporation, San Antonio.
[34] Golden, C.J. (1978) Stroop Color and Word Test: Manual for Clinical and Experimental Uses. Stoetling, Chicago.
[35] Rey, A. (1964) L’examen Clinique en Psychologie. Presses Universitaires de France, Paris.
[36] Trahan, D.E. and Larrabee, G.J. (1988) Continuous Visual Memory Test. Psychological Assessment Resources, Odessa, FL.
[37] Osterrieth, P.A. (1944) Le test de copie d’une figure complexe. Archives de Psychologie, 30, 286-356.
[38] Goodglass, H. and Kaplan, E. (1972) The Assessment of Aphasia and Related Disorders. Henry Klimpton, London.
[39] Wechsler, D. (1999) Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation, San Antonio.
[40] Hart, R.P., Kwentus, J.A., Wade, J.B. and Taylor, J.R. (1988) Modified Wisconsin Card Sorting Test in Elderly Normal, Depressed and Demented Patients. The Clinical Neuropsychologist, 2, 49-56.
http://dx.doi.org/10.1080/13854048808520085
[41] Hart, R.P. and Bean, M.K. (2010) Executive Function, Intellectual Decline and Daily Living Skills. Aging, Neuropsychology and Cognition, 18, 64-85.
http://dx.doi.org/10.1080/13825585.2010.510637
[42] Benton, A.L. (1968) Differential Behavioral Effects in Frontal Lobe Disease. Neuropsychologia, 6, 53-60.
http://dx.doi.org/10.1016/0028-3932(68)90038-9
[43] Guilford, J.P., Christensen, P.R., Merrifield, P.R. and Wilson, R.C. (1978) Alternate Uses: Manual of Instructions and Interpretation. Sheridan Psychological Services, Orange, CA.
[44] Hart, R.P. and Wade, J.B. (2006) Divergent Thinking in Alzheimer’s and Frontotemporal Dementia. Aging, Neuropsychology, and Cognition, 13, 281-290.
http://dx.doi.org/10.1080/13825580490904246
[45] Clark, L.R., Delano-Wood, L., Libon, D.J., McDonald, C.R., Nation, D.A., et al. (2013) Are Empirically-Derived Subtypes of Mild Cognitive Impairment Consistent with Conventional Subtypes? Journal of the International Neuropsychological Society, 19, 635-645.
http://dx.doi.org/10.1017/S1355617713000313
[46] Delano-Wood, L., Bondi, M.W., Sacco, J., Abeles, N., Jak, A.J., Libon, D.J. and Bozoki, A. (2009) Heterogeneity in Mild Cognitive Impairment: Differences in Neuropsychological Profile and Associated White Matter Lesion Pathology. Journal of the International Neuropsychological Society, 15, 906-914.
http://dx.doi.org/10.1017/S1355617709990257
[47] Leys, D., Pruvo, J.P., Parent, M., Vermersch, P., Soetaert, M., Steinling, M., Delacourte, A., Défossez, A., Rapoport, A. and Clarisse, J. (1991) Could Wallerian Degeneration Contribute to “Leuko-Araiosis” in Subjects Free of Any Vascular Disorder? Journal of Neurology, Neurosurgery, and Psychiatry, 54, 46-50.
http://dx.doi.org/10.1136/jnnp.54.1.46
[48] Fazekas, F., Schmidt, R. and Scheltens, P. (1998) Pathophysiologic Mechanisms in the Development of Age-Related White Matter Changes of the Brain. Dementia and Geriatric Cognitive Disorders, 9, 2-5.
http://dx.doi.org/10.1159/000051182
[49] Leszek, J., Sochocka, M. and Gasiorowski, K. (2012) Vascular Factors and Epigenetic Modifications in the Pathogenesis of Alzheimer’s Disease. Journal of the Neurological Sciences, 323, 25-32.
http://dx.doi.org/10.1016/j.jns.2012.09.010
[50] Schneider, J.A., Arvanitakis, Z., Leurgans, S.E. and Bennett, D.A. (2009) The Neuropathology of Probable Alzheimer Disease and Mild Cognitive Impairment. Annals of Neurology, 66, 200-208.
http://dx.doi.org/10.1002/ana.21706
[51] Stricker, N.H., Salat, D.H., Foley, J.M., Zink, T.A., Kellison, I.L., McFarland, C.P., et al. (2013) Decreased White Matter Integrity in Neuropsychologically Defined Mild Cognitive Impairment Is Independent of Cortical Thinning. Journal of the International Neuropsychological Society, 19, 925-937.
http://dx.doi.org/10.1017/S1355617713000660
[52] Nilsson, J., Thomas, A.J., O’Brien, J.T. and Gallagher, P. (2014) White Matter and Cognitive Decline in Aging: A Focus on Processing Speed and Variability. Journal of the International Neuropsychological Society, 20, 262-267.
http://dx.doi.org/10.1017/S1355617713001458

  
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