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Alzheimer disease with cerebrovascular disease and vascular dementia: clinical features and course compared with Alzheimer disease
  1. A Bruandet1,2,
  2. F Richard1,2,
  3. S Bombois3,4,
  4. C A Maurage4,5,
  5. V Deramecourt3,4,
  6. F Lebert3,4,
  7. P Amouyel1,2,
  8. F Pasquier3,4
  1. 1
    INSERM, U744, Lille, France
  2. 2
    Institut Pasteur de Lille, Santé publique et épidémiologie moléculaire du vieillissement, Lille, France
  3. 3
    EA2691, Lille, France
  4. 4
    University Hospital of Lille, Lille, France
  5. 5
    INSERM, U837, Lille, France
  1. Professor F Pasquier, Clinique Neurologique, CMRR, Hôpital Salengro, CHRU Lille, 59037 Lille, France; pasquier{at}chru-lille.fr

Abstract

Objective: Vascular dementia (VaD) and Alzheimer disease with cerebrovascular disease (AD+CVD) are the leading causes of dementia after Alzheimer disease alone (AD). Little is known about the progression of either VaD or AD+CVD. The aim of this study was to compare demographic features, cognitive decline and survival of patients with VaD, AD+CVD and AD alone attending a memory clinic.

Methods: This study included 970 patients who were followed at the Lille-Bailleul memory clinic, France. Cognitive functions were measured with the Mini Mental State Examination (MMSE) and the Dementia Rating Scale (DRS). Survival rate was analysed with a left-truncated Cox model. Analyses were adjusted for age, sex, education, hypertension, diabetes and baseline MMSE and DRS.

Results: Of 970 patients, 141 had VaD, 663 AD alone and 166 AD+CVD. The latter were significantly older than AD or VaD patients at onset (71 (SD 7) vs 69 (9) and 68 (9) years, p = 0.01) and at first visit (75 (6) vs 73 (8) and 72 (8) years, p = 0.0002). Baseline MMSE and DRS evaluations were highest for VaD compared with AD alone or AD+CVD patients (p<0.006). Cognitive decline during follow-up was slowest for VaD, intermediate for AD+CVD and fastest for AD alone (p = 0.03). After adjustment, compared with AD patients, mortality risk was similar for those with VaD (relative mortality risk (RR) = 0.7 (0.5 to 1.1)) and tended to be lower for AD+CVD (RR = 0.7 (0.5 to 1.0)). The shorter the delay between first symptoms and first visit, the longer patients survived.

Conclusion: This clinical cohort study shows that patients with VaD, AD+CVD and AD present different characteristics at baseline and during follow-up, and underlines the need to distinguish between them.

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Footnotes

  • Competing interests: None.

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