Distinctive Clinical Features of Mild Cognitive Impairment with Subcortical Cerebrovascular Disease

• Published in: Dementia and geriatric cognitive disorders Vol. 19; no. 4; pp. 196 - 203
• Main Authors: Galluzzi, Samantha, Sheu, Ching-Fan, Zanetti, Orazio, Frisoni, Giovanni B.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2005; S. Karger AG
• Subjects: Aged; Antihypertensive agents; Basal Ganglia Diseases - diagnosis; Basal Ganglia Diseases - epidemiology; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Cerebrovascular Disorders - complications; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Logistic Models; Male; Medical sciences; Memory Disorders - diagnosis; Memory Disorders - epidemiology; Neurology; Neuropsychological Tests; Original Research Article; Pharmacology. Drug treatments; ROC Curve; Severity of Illness Index; Urinary Incontinence - diagnosis; Urinary Incontinence - epidemiology; Small vessel disease; Mild cognitive impairment; Subcortical vascular cognitive impairment; Cerebrovascular disease; Nervous system diseases; Cognitive disorder; Central nervous system disease; mild cognitive impairment; Degenerative disease; Subcortex; Cerebral disorder; Dementia
• ISSN: 1420-8008; 1421-9824
• DOI: 10.1159/000083499

Background and Purpose: Patients with mild cognitive impairment and subcortical cerebrovascular disease (svMCI) can be isolated using criteria modified from those of Erkinjuntti et al. for subcortical vascular dementia and have poorer outcomes (cognitive deterioration, disability, institutionalization, and mortality). The aim of this study was to test which of the core (dysexecutive syndrome with relative sparing of memory, gait disorders and extrapyramidal signs) and supporting (urinary and behavioral symptoms) clinical features are most useful to recognize patients with svMCI and discriminate them from those with amnestic MCI (aMCI). Methods: Twenty-nine svMCI and 14 aMCI patients were seen in a memory clinic. Tests and scales assessing core and supporting features that independently contributed to the discrimination between svMCI and aMCI were identified with stepwise logistic regression analysis. The accuracy of the discrimination was estimated with area under the receiver operating characteristic curve and 95% confidence intervals (CIs). Results: The most accurate scales were the extrapyramidal sign scale by Richards et al. (0.75, 95% CI 0.61–0.89), letter fluency (0.75, 95% CI 0.61–0.90), irritability of the Neuropsychiatric Inventory and urinary dependence (0.66, 95% CI 0.49–0.82 for both), and digit span forward (0.59, 95% CI 0.41–0.77). The overall accuracy of a model compounding information from main and supporting features was 0.98, 95% CI 0.94–1.0. Conclusions: All the domains that are included in the clinical criteria for svMCI independently contribute to the identification of the condition. These criteria can be useful to recognize svMCI patients in clinical settings.