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Neuropsychiatric Aspects of Vascular Cognitive Impairment

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Neuropsychiatric Symptoms of Cerebrovascular Diseases

Part of the book series: Neuropsychiatric Symptoms of Neurological Disease ((NSND))

Abstract

Vascular cognitive impairment (VCI) is a term that describes all the forms of cognitive decline deriving from, or associated with, vascular diseases. The brain changes of vascular origin that may cause deficits in cognitive functions are various in terms of underlying pathology and territorial distribution. For this reason, the cognitive profile in VCI is not homogeneous and strongly depends on the pathological subtype. In addition to cognitive deficits, brain vascular diseases may cause also several psychiatric disturbances that may or may not coexist with the cognitive disturbances.

In the first part of this chapter, we discuss the concept of VCI, while in the second part, the cognitive and psychiatric manifestations of VCI are illustrated. This overview emphasizes the need of additional research to better understand the exact impact of cerebral vascular lesions, and the role of their distribution and severity, on the occurrence of cognitive and psychiatric symptoms in VCI. This approach might require tools more specifically developed for cerebrovascular diseases.

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References

  1. O’Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST. Vascular cognitive impairment. Lancet Neurol. 2003;2:89–98.

    Article  PubMed  Google Scholar 

  2. Hachinski VC. The decline and resurgence of vascular dementia. Can Med Assoc J. 1990;142:107–11.

    CAS  Google Scholar 

  3. Román GC. Facts, myths, and controversies in vascular dementia. J Neurol Sci. 2004;226:49–52.

    Article  PubMed  Google Scholar 

  4. Pantoni L. Subtypes of vascular dementia and their pathogenesis: a critical overview. In: Bowler J, Hachinski V, editors. Vascular cognitive impairment: preventable dementia. Oxford: Oxford University Press; 2003. p. 217–29.

    Google Scholar 

  5. Hachinski VC, Bowler JV. Vascular dementia. Neurology. 1993;43:2159–60.

    Article  PubMed  CAS  Google Scholar 

  6. Romàn GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research study. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43:250–60.

    Article  PubMed  Google Scholar 

  7. Rockwood K, Wentzel C, Hachinski V, Hogan DB, MacKnight C, McDowell I. Prevalence and outcomes of vascular cognitive impairment. Vascular Cognitive Impairment investigators of the Canadian Study of Health and Aging. Neurology. 2000;54:447–51.

    Article  PubMed  CAS  Google Scholar 

  8. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701.

    Article  PubMed  Google Scholar 

  9. Ciolli L, Poggesi A, Salvadori E, Valenti R, Nannucci S, Pasi M, Pescini F, Inzitari D, Pantoni L. The VAS-COG clinic: an out-patient service for patients with cognitive and behavioral consequences of cerebrovascular diseases. Neurol Sci. 2012;33:1277–83.

    Article  PubMed  Google Scholar 

  10. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100.

    Article  PubMed  CAS  Google Scholar 

  11. Desmond DW. The neuropsychology of vascular cognitive impairment: is there a specific cognitive deficit? J Neurol Sci. 2004;226:3–7.

    Article  PubMed  Google Scholar 

  12. van de Pol L, Gertz H-J, Scheltens P, Wolf H. Hippocampal atrophy in subcortical vascular dementia. Neurodegener Dis. 2011;8:465–9.

    Article  PubMed  Google Scholar 

  13. Qiu C, Zhang Y, Bronge L, Herlitz A, Aspelin P, Bäckman L, Fratiglioni L, Wahlund LO. Medial temporal lobe is vulnerable to vascular risk factors in men: a population-based study. Eur J Neurol. 2012;19:876–83.

    Article  PubMed  CAS  Google Scholar 

  14. Gemmell E, Bosomworth H, Allan L, Hall R, Khundakar A, Oakley AE, Deramecourt V, Polvikoski TM, O’Brien JT, Kalaria RN. Hippocampal neuronal atrophy and cognitive function in delayed poststroke and aging-related dementias. Stroke. 2012;43:808–14.

    Article  PubMed  Google Scholar 

  15. Pantoni L, Basile AM, Romanelli M, Piccini C, Sarti C, Nencini P, Inzitari D. Abulia and cognitive impairment in two patients with capsular genu infarct. Acta Neurol Scand. 2001;104:185–90.

    Article  PubMed  CAS  Google Scholar 

  16. Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, Stern Y. Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome? Neurology. 1992;42:1966–79.

    Article  PubMed  CAS  Google Scholar 

  17. Benisty S, Gouw AA, Porcher R, Madureira S, Hernandez K, Poggesi A, van der Flier WM, Van Straaten EC, Verdelho A, Ferro J, Pantoni L, Inzitari D, Barkhof F, Fazekas F, Chabriat H, LADIS Study Group. Location of lacunar infarcts correlates with cognition in a sample of non-disabled subjects with age-related white-matter changes: the LADIS study. J Neurol Neurosurg Psychiatry. 2009;80:478–83.

    Article  PubMed  CAS  Google Scholar 

  18. Vermeer SE, Longstreth Jr WT, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.

    Article  PubMed  Google Scholar 

  19. Pantoni L, Poggesi A, Inzitari D. The relation between white-matter lesions and cognition. Curr Opin Neurol. 2007;20:390–7.

    Article  PubMed  Google Scholar 

  20. Gunning-Dixon FM, Raz N. The cognitive correlates of white matter abnormalities in normal aging: a quantitative review. Neuropsychology. 2000;14:224–32.

    Article  PubMed  CAS  Google Scholar 

  21. Ferro JM, Madureira S. Age-related white matter changes and cognitive impairment. J Neurol Sci. 2002;203–204:221–5.

    Article  PubMed  Google Scholar 

  22. Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Cerebral white matter lesions and the risk of dementia. Arch Neurol. 2004;61:1531–4.

    Article  PubMed  Google Scholar 

  23. Schmidt R, Petrovic K, Ropele S, Enzinger C, Fazekas F. Progression of leukoaraiosis and cognition. Stroke. 2007;38:2619–25.

    Article  PubMed  Google Scholar 

  24. Savva GM, Wharton SB, Ince PG, Forster G, Matthews FE, Brayne C, Medical Research Council Cognitive Function and Ageing Study. Age, neuropathology, and dementia. N Engl J Med. 2009;360:2302–9.

    Article  PubMed  CAS  Google Scholar 

  25. Poels MM, Ikram MA, van der Lugt A, Hofman A, Niessen WJ, Krestin GP, Breteler MM, Vernooij MW. Cerebral microbleeds are associated with worse cognitive function: the Rotterdam Scan Study. Neurology. 2012;78:326–33.

    Article  PubMed  CAS  Google Scholar 

  26. Werring DJ, Gregoire SM, Cipolotti L. Cerebral microbleeds and vascular cognitive impairment. J Neurol Sci. 2010;299:131–5.

    Article  PubMed  Google Scholar 

  27. Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L, LADIS Study Group. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. 2009;339:b2477. doi:10.1136/bmj.b2477.

    Article  PubMed  Google Scholar 

  28. Gouw AA, Seewann A, van der Flier WM, Barkhof F, Rozemuller AM, Scheltens P, Geurts JJ. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry. 2011;82:126–35.

    Article  PubMed  Google Scholar 

  29. Schmidt R, Ropele S, Ferro J, Madureira S, Verdelho A, Petrovic K, Gouw A, van der Flier WM, Enzinger C, Pantoni L, Inzitari D, Erkinjuntti T, Scheltens P, Wahlund LO, Waldemar G, Rostrup E, Wallin A, Barkhof F, Fazekas F, LADIS Study Group. Diffusion-weighted imaging and cognition in the leukoaraiosis and disability in the elderly study. Stroke. 2010;41:e402–8.

    Article  PubMed  Google Scholar 

  30. Azermai M, Petrovic M, Elseviers MM, Bourgeois J, Van Bortel LM, Vander Stichele RH. Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Res Rev. 2012;11:78–86.

    Article  PubMed  Google Scholar 

  31. Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr. 1996;8(Suppl3):497–500.

    PubMed  Google Scholar 

  32. Bettney L, Butt S, Morris J, Connolly A, McCollum C, Burns A, Purandare N. Investigating the stability of neuropsychiatric sub-syndromes with progression of dementia: a 2-year prospective study. Int J Geriatr Psychiatry. 2012;27:1118–23.

    Article  PubMed  Google Scholar 

  33. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288:1475–83.

    Article  PubMed  Google Scholar 

  34. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease I: disorders of thought content. Br J Psychiatry. 1990;157:72–6.

    Article  PubMed  CAS  Google Scholar 

  35. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease II: disorders of perception. Br J Psychiatry. 1990;157:76–81.

    Article  PubMed  CAS  Google Scholar 

  36. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease. III: disorders of mood. Br J Psychiatry. 1990;157:81–6.

    Article  PubMed  CAS  Google Scholar 

  37. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease. IV: disorders of behaviour. Br J Psychiatry. 1990;157:86–94.

    Article  PubMed  CAS  Google Scholar 

  38. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157:708–14.

    Article  PubMed  CAS  Google Scholar 

  39. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord. 2000;59:97–106.

    Article  PubMed  CAS  Google Scholar 

  40. Srikanth S, Nagaraja AV, Ratnavalli E. Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer’s disease, vascular dementia and frontotemporal dementia. J Neurol Sci. 2005;236:43–8.

    Article  PubMed  CAS  Google Scholar 

  41. Aharon-Peretz J, Kliot D, Tomer R. Behavioral differences between white matter lacunar dementia and Alzheimer’s disease: a comparison on the neuropsychiatric inventory. Dement Geriatr Cogn Disord. 2000;11:294–8.

    Article  PubMed  CAS  Google Scholar 

  42. Kim JM, Lyons D, Shin IS, Yoon JS. Differences in the behavioral and psychological symptoms between Alzheimer’s disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Hum Psychopharmacol. 2003;18:215–20.

    Article  PubMed  Google Scholar 

  43. Johnson DK, Watts AS, Chapin BA, Anderson R, Burns JM. Neuropsychiatric profiles in dementia. Alzheimer Dis Assoc Disord. 2011;25:326–32.

    Article  PubMed  Google Scholar 

  44. Starkstein SE, Sabe L, Vazquez S, Teson A, Petracca G, Chemerinski E, Di Lorenzo G, Leiguarda R. Neuropsychological, psychiatric, and cerebral blood flow findings in vascular dementia and Alzheimer’s disease. Stroke. 1996;27:408–14.

    Article  PubMed  CAS  Google Scholar 

  45. Ikeda M, Fukuhara R, Shigenobu K, Hokoishi K, Maki N, Nebu A, et al. Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. J Neurol Neurosurg Psychiatry. 2004;75:146–8.

    PubMed  CAS  Google Scholar 

  46. Fuh JL, Wang SJ, Cummings JL. Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry. 2005;76:1337–41.

    Article  PubMed  Google Scholar 

  47. Pinto C, Seethalakshmi R. Behavioral and psychological symptoms of dementia in an Indian population: comparison between Alzheimer’s disease and vascular dementia. Int Psychogeriatr. 2006;18:87–93.

    Article  PubMed  CAS  Google Scholar 

  48. Chiu PY, Liu CH, Tsai CH. Neuropsychiatric manifestations in vascular cognitive impairment patients with and without dementia. Acta Neurol Taiwan. 2007;16:86–91.

    PubMed  Google Scholar 

  49. Fernández-Martínez M, Castro J, Molano A, Zarranz JJ, Rodrigo RM, Ortega R. Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Curr Alzheimer Res. 2008;5:61–9.

    Article  PubMed  Google Scholar 

  50. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.

    Article  PubMed  CAS  Google Scholar 

  51. Staekenborg SS, Su T, van Straaten EC, Lane R, Scheltens P, Barkhof F, van der Flier WM. Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease. J Neurol Neurosurg Psychiatry. 2010;81:547–51.

    Article  PubMed  Google Scholar 

  52. Andin U, Gustafson L, Brun A, Passant U. Clinical manifestations in neuropathologically defined subgroups of vascular dementia. Int J Geriatr Psychiatry. 2006;21:688–97.

    Article  PubMed  Google Scholar 

  53. Botez SA, Carrera E, Maeder P, et al. Aggressive behavior and posterior cerebral artery stroke. Arch Neurol. 2007;64:1029–33.

    Article  PubMed  Google Scholar 

  54. Kim JS, Choi S, Kwon SU, et al. Inability to control anger or aggression after stroke. Neurology. 2002;58:1106–8.

    Article  PubMed  CAS  Google Scholar 

  55. Staekenborg SS, Gillissen F, Romkes R, Pijnenburg YA, Barkhof F, Scheltens P, van der Flier WM. Behavioural and psychological symptoms are not related to white matter hyperintensities and medial temporal lobe atrophy in Alzheimer’s disease. Int J Geriatr Psychiatry. 2008;23:387–92.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Anna Poggesi MD, PhD & Leonardo Pantoni MD, PhD

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  1. Anna Poggesi MD, PhD
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  2. Leonardo Pantoni MD, PhD
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Correspondence to Leonardo Pantoni MD, PhD .

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  1. , Serviço de Neurologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, 1649-035, Portugal

    José M. Ferro

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Poggesi, A., Pantoni, L. (2013). Neuropsychiatric Aspects of Vascular Cognitive Impairment. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_11

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  • DOI: https://doi.org/10.1007/978-1-4471-2428-3_11

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