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Critical Elements for the Diagnosis of Vascular Dementia (VaD)

Critical Elements for the Diagnosis of Vascular Dementia (VaD). GC Román MD University of Texas HSC San Antonio. Research Definition of VaD. A) Dementia B) Cerebrovascular disease C) A and B must be reasonably related.

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Critical Elements for the Diagnosis of Vascular Dementia (VaD)

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  1. Critical Elements for the Diagnosis of Vascular Dementia (VaD) GC Román MD University of Texas HSC San Antonio

  2. Research Definition of VaD • A) Dementia • B) Cerebrovascular disease • C) A and B must be reasonably related. Based on Román GC, Tatemichi TK, Erkinjuntti T, et al: Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop held at the National Institutes of Health, Bethesda, Md, April 19-21, 1991. Neurology 1993;43:250-260.

  3. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Dementia: Decline in memory and intellectual abilities which causes impaired functioning in daily living. The Neurological Adaptation of of the International Classification of Diseases (ICD-10NA: WHO, 1991)

  4. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Dementia: Confirmation by neuropsychology tests of impairment of memory and decline in 2 or more cognitive domains, including: orientation, language,visuo-spatial functions, attention, executive functions, motor control, praxis.

  5. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Cerebrovascular disease: MUST include confirmation by brain imaging including: multiple large-vessel strokes (MID), single strategic infarct (thalamus, PCA, ACA), lacunes (multiple, basal ganglia, white matter); extensive periventricular white matter lesions

  6. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Cerebrovascular disease: Presence of focal neurological signs consistent with stroke with or without history of stroke. Use of Hachinski Ischemic Scale not recommended.

  7. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Dementia and CVD must be reasonably related: Onset of dementia within 3 months following stroke (post-stroke dementia) Exclude pre-stroke dementia: 5.5%-16.3% of cases of post-stroke dementia had symptoms of AD Abrupt deterioration of cognitive function Fluctuating, stepwise progression

  8. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Clinical features inconsistent with VaD: • Early and severe memory deficit • Worsening of language (transcortical sensory aphasia) • Apraxia, agnosia, • Absence of focal neurological signs No evidence of CVD on brain CT or MRI

  9. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) Clinical features consistent with VaD: • Early gait disturbances, frequent falls • Parkinsonian features • Early urinary symptoms • Personality change, mood disorders (vascular depression), psychomotor retardation • Abnormal executive function

  10. Research Definition of VaDBased on Román GC et al (Neurology 1993;43:250-260) The prototype of subcortical vascular dementia is CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)mapped to chromosome 19.

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