Background: The neuropsychological profile of Vascular Cognitive Impairment (VCI) has not been well characterized, and there is no consensus on its central features.
Study Design: Longitudinal cohort study of consecutive inpatients.
Methods: We examined consecutive stroke (n=176) and TIA (n= 34) inpatients and age-matched healthy controls (n=110 ) at baseline and performed detailed neuropsychological and medical-psychiatric assessments after 3-6 months, with a majority ( 70 %) undergoing MRI brain scans. The neuropsychological and psychiatric assessments were repeated after one year. The subjects were diagnosed as having VaD, VCI and no cognitive impairment (NCI) by consensus based on pre-determined criteria. The neuropsychological tests were classified into cognitive domains, and composite z scores, adjusted for age and education, were used as measures of dysfunction.
Results: Psychomotor speed and frontal-executive function were the domains commonly affected in the VaD group, along with visuoconstructive function, gnosic-practic function, visual memory and language. The pattern was similar in VCI. Episodic verbal memory was unimpaired in both groups. Cognitive performance correlated significantly with deep white matter hyperintensity scores on T2-weighted MRI, in particular those in the frontal white matter and internal capsule, but not with cerebral atrophy. Stroke volume had a small but non-significant (r= -0.22) correlation with cognition. Cognitive deficits in the stroke group had a significant impact on functioning. Stroke patients had a significantly greater decline in their cognitive functioning over one year of follow-up, with the pattern of deficits being relatively preserved.
Conclusions: Our study points to the salience of impairment of frontal-executive functioning and psychomotor speed in VCI and VaD in patients with a history of stroke or TIA, associated with impairment of visuo-constructive function, language and attention, but not episodic verbal memory. We propose that frontal-executive dysfunction is a central feature of VCI, which is embellished by impairment in other cognitive domains. The underlying pathology is ischemic lesions in subcortical regions
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