Abstract
Services dedicated to patients with cognitive and behavioral consequences of cerebrovascular diseases (CVD) are not established. We started an out-patient clinic (the “VAS-COG clinic”) to assess patients with psycho-cognitive disturbances related to CVD. The work-up includes a clinical-neuroimaging diagnostic process and the individuation of the best therapeutic strategies as done in patients with neurodegenerative cognitive impairment. We report the results of the first 5 years of activity. Reasons for patient referral were not only cognitive, language, gait, and psychiatric disturbances related to stroke or chronic CVD, but also neuroimaging evidence of vascular encephalopathy and screening for familial microangiopathies. The patients were evaluated with uniformed protocols. From January 2006 to November 2010, we evaluated 403 patients. Of these, 374 (93%; mean age 69.7 years ± 15.0) were considered appropriate for the VAS-COG clinic. The following diagnoses were made: vascular dementia (8.6%), Alzheimer disease (2.1%), mixed dementia (vascular plus degenerative) (4.8%), vascular mild cognitive impairment (MCI) (9.1%), amnesic-MCI (8.0%), mixed-MCI (4.8%), post-stroke depression (2.7%), post-stroke language disturbances (4.5%), subjective memory complaint (1.3%), familiar microangiopathy (31.3%), vascular encephalopathy evidenced by neuroimaging not associated with specific clinical disturbances (15.3%), and other conditions (7.5%). Psycho-cognitive disturbances associated with CVD are heterogeneous. In addition to acute stroke care strategies, long-term assessment of patients with CVD is required. The VAS-COG clinic may represent a model in this regard and might be important for improving the care of patients and offering counseling to their families. The efficacy of this service needs, however, to be proved by successive work.
Similar content being viewed by others
References
Donnan GA, Fisher M, Macleod M, Davis SM (2008) Stroke. Lancet 10:1612–1623
Pendlebury ST, Rothwell PM (2009) Risk of recurrent stroke, other vascular events and dementia after transient ischaemic attack and stroke. Cerebrovasc Dis 27:1–11
Hackett ML, Yapa C, Parag V, Anderson CS (2005) Frequency of depression after stroke: a systematic review of observational studies. Stroke 36:1330–1340
Sachdev PS, Chen X, Brodaty H, Thompson C, Altendorf A, Wen W (2009) The determinants and longitudinal course of post-stroke mild cognitive impairment. J Int Neuropsychol Soc 15:915–923
Kasner SE (2006) Clinical interpretation and use of stroke scales. Lancet Neurol 5:603–612
Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA, American Heart Association Council on Cardiovascular Nursing and the Stroke Council (2010) Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke 41:2402–2448
Debette S, Markus HS (2010) The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. doi:10.1136/bmj.c3666
Vermeer SE, Longstreth WT Jr, Koudstaal PJ (2007) Silent brain infarcts: a systematic review. Lancet Neurol 6:611–619
Ballabio E, Bersano A, Bresolin N, Candelise L (2007) Monogenic vessel diseases related to ischemic stroke: a clinical approach. J Cereb Blood Flow Metab 27:1649–1662
Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG (2009) CADASIL. Lancet Neurol 8:643–653
de la Torre JC (2010) The vascular hypothesis of Alzheimer’s disease: bench to bedside and beyond. Neurodegener Dis 7:116–121
Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR (1997) Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 277:813–817
O’Brien J, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98
Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG (2007) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 37:2220–2241
The VAS COG society (2012) The international society of behavioural and cognitive vascular disorders web site. http://vas-cog.org/Page.aspx. Accessed January 3 2012
Rigby H (2009) Caring for stroke survivors: baseline and 1-year determinants of caregiver burden. Int J Stroke 4:152–158
McCullagh E, Brigstocke G, Donaldson N, Kalra L (2005) Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke 36:2181–2186
Lodder J (2007) Poststroke cognition and the fight against the hard problem: vascular neurologists, enter the arena! Stroke 38:7–8
Royall DR, Cordes JA, Román G, Velez A, Edwards A, Schillerstrom JS, Polk MJ (2009) Sertraline improves executive function in patients with vascular cognitive impairment. J Neuropsychiatry Clin Neurosci 21:445–454
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186
Yesavage JA (1988) Geriatric Depression Scale. Psychopharmacol Bull 24:709–711
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL (1982) A new clinical scale for the staging of dementia. Br J Psychiatry 140:566–572
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Rey A (1964) L’examen clinique en psychologie. Presses Universitaires de France, Paris
Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. Ital J Neurol Sci 8:1–120
Ferris SH (2003) General measures of cognition. Int Psychogeriatr 15:215–217
Stroop JK (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662
Reitan R (1958) Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 8:271–276
Novelli G, Papagno C, Capitani E, Laiacona M, Vallar G, Cappa SF (1986) Tre test clinici di ricerca e produzione lessicale. Taratura su soggetti normali. Arch Psicol Neurol Psichiatr 47:477–506
Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS (1989) Screening for Alzheimer’s disease by clock drawing. J Am Geriatr Soc 37:730–734
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314
Crook TH, Feher EP, Larrabee GJ (1992) Assessment of memory complaint in age-associated memory impairment: the MAC-Q. Int Psychogeriatr 4:165–176
Sohlberg MM, Johnson L, Paule L, Raskin SA, Mateer CA (2001) Attention process training-II: a program to address attentional deficits for persons with mild cognitive dysfunction, 2nd edn. Lash and Associates, Wake Forest
Van Swieten JC, Hijdra A, Koudstaal PJ, Van Gijn J (1990) Grading white matter lesions on CT and MRI: a simple scale. J Neurol Neurosurg Psychiatry 53:1080–1083
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1. 5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 149:351–356
De Leon MJ, Ferris SH, George AE, Reisberg B, Kricheff II, Gershon S (1980) Computed tomography evaluations of brain-behavior relationships in senile dementia of the Alzheimer’s type. Neurobiol Aging 1:69–79
Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 55:967–972
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E (1999) Mild cognitive Impairment: clinical characterization and outcome. Arch Neurol 56:303–308
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Kokmen E (1997) Aging, memory, and mild cognitive impairment. Int Psychogeriatr 9:65–69
Pantoni L, Pescini F, Nannucci S, Sarti C, Bianchi S, Dotti MT, Federico A, Inzitari D (2010) Comparison of clinical, familial, and MRI features of CADASIL and NOTCH3-negative patients. Neurology 74:57–63
Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L; LADIS Study Group (2009) Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ doi: 10.1136/bmj.b2477
Pohjasvaara T, Mäntylä R, Ylikoski R, Kaste M, Erkinjuntti T (2000) Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences. Stroke 31:2952–2957
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ciolli, L., Poggesi, A., Salvadori, E. et al. The VAS-COG clinic: an out-patient service for patients with cognitive and behavioral consequences of cerebrovascular diseases. Neurol Sci 33, 1277–1283 (2012). https://doi.org/10.1007/s10072-012-0941-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-012-0941-0