Identification of VaD and AD prodromes: The Cache County Study |
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| Affiliation: | 1. Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA;2. Department of Psychology, University of North Carolina, Chapel Hill, NC, USA;3. Department of Biometry and Bioinformatics, Duke University Medical Center, Durham, NC, USA;4. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA;5. Department of Psychology and Center for Epidemiologic Studies, Utah State University, Logan, UT, USA;6. Department of Family Consumer and Human Development, Utah State University, Logan, UT, USA;7. VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA;8. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA;1. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Boston, MA 02115, USA;2. Department of Global Health and Social Medicine, King''s College London, London, UK;3. University of Alberta School of Public Health, Edmonton, Canada;4. Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA;1. Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia;2. Infectious Diseases Institute, Kampala, Uganda;3. Department of Neurology, Emory University School of Medicine, Atlanta, Georgia;4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia;5. Ministry of Health and Sanitation, Monrovia, Liberia;6. Eternal Love Winning Africa Hospital, Monrovia, Liberia |
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| Abstract: | BackgroundIt is unclear whether vascular dementia (VaD) has a cognitive prodrome, akin to the mild cognitive impairment (MCI) prodrome to Alzheimer’s dementia (AD). To evaluate whether VaD has a cognitive prodrome, and if it can be differentiated from prodromal AD, we examined neuropsychological test performance of participants in a nested case-control study within a population-based cohort aged 65 or older.MethodsParticipants (n = 485) were identified from the Cache County Study, a large population-based study of aging and dementia. After an average of 3 years of follow-up, a total of 62 incident dementia cases were identified (14 VaD, 48 AD). We identified a number of neuropsychological tests (executive and memory) that discriminated between diagnosed VaD and AD cases. Multivariate analyses sought to differentiate between these same groups 3 years before clinical diagnosis.ResultsThe Consortium to Establish a Registry for Alzheimer’s Disease Word List Recognition Test correct recognition of foils (mean difference, 1.25; 95% confidence interval [CI], 0.42 to 2.07; p < 0.01), Logical Memory I (mean difference, 7.16; 95% CI, 0.78 to 13.55, p < 0.05), Logical Memory II delayed recall (mean difference, 8.67; 95% CI, 1.59 to 15.74, p < 0.05), and percent savings (mean difference, 51.07; 95% CI, 32.58 to 69.56, p < 0.0001) differentiated VaD from AD cases after adjustment for age, sex, education, and dementia severity. Three years before dementia diagnosis, word list recognition (“no” responses mean difference, 1.40; 95% CI, 0.64 to 2.17; p < 0.001, and “yes” responses mean difference, –1.14; 95% CI, –2.14 to –0.13; p < 0.03) discriminated between prodromal VaD and AD.ConclusionThese results suggest that VaD has a prodromal syndrome, the cognitive features of which are distinguishable from the cognitive prodrome of AD. |
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