Prevalence Of Vascular Cognitive Impairments And The Change Of Cognitive Condition In 4 Years

Objective(1) To investigate the prevalent rates of vascular cognitive impairment (VCI) and its subtypes in the aged people lived in the community of Beijing and to evaluate their association with vascular risk factors and stroke.(2) To investigate if preclinical cognitive deficits are present in vascular dementia (VD), what the neuropsychological profile of preclinical VD was and how it changed in 4 years. And to learn the cognitive predictors of VD.MethodsA two-stage method was applied in the prevalent investigation. In the first phase 1836 cases of elderly people aged 60 and above were visited by trained interviewers to finish questionnaire together with testing of MMSE. At the second stage all subjects with complaining of memory decline or other cognitive impairment, abnormal in MMSE, having not finished the MMSE test and a part of those subjects who were normal by MMSE underwent a clinical diagnosis procedure of dementia, including collection of history, physical, neurological and psychiatric examination, as well as a series of cognitive tests.The sample of the vascular dementia's cognitive predictor factor study was also taken from the population-based study and consisted of 1792 persons who were no demented at baseline, but out of whom 27 with VD at a 4-year follow-up. In according to the VD group's age constitutes, the study had withdrew 658 normal persons as control. The cognitive outcome measure was the mini-mental state examination (MMSE).ResultsA total of 88 cases of VCI were identified, the crude and age-standardized prevalence in individuals aged 60 years and over were 4.8% and 3.2%. Among the VCI cases, VCIND composed 54.5%, VD39.8%, mixed dementia5.7%. The prevalence rate of VCI increased with age. And was 5.9% in men higher than 3.8% in women (p<0.05). There were more people with VCI in rural area than in urban (p<0.05). People with hypertension, angina pectoris, myocardial infarction had a higher Prevalence rates for VCI and VCIND. The prevalence rate for VCI was remarkable higher in people had quit smoking or drinking than those drinking or smoking currently and never (p<0.01). People had suffered from cerebral hemorrhage, cerebral infarction, and transient ischemic attack (TIA) had a higher prevalence rate for VCI. At the multiple logistic regression analysis, VCI was significantly and independently associated with gender, age, stroke, TIA and alcohol consumption. Hypertension is not an independent risk factor for VCI or VCIND.The cases of incident VD 4 years later exhibited baseline deficits on the total score of the MMSE(p<0.01) and four of the subscales: design copy(p<0.01), calculation(p<0.01), delayed memory(p<0.05) and orientation to time(p<0.05). During the 4–year follow-up period, the incident VD group exhibited precipitous decline on the subscales: design copy,calculation,orientation still(p<0.05). And at the same time attention and following commands decline(p<0.05). Logistic regression analyses showed that the deficit of calculation(p<0.01) at baseline may be a predictor of future development to VD in persons with vascular diseases risk factors. ConclusionsVCIND is the most common form of VCI, The prevalence rate of VCI and VCIND were higher in men, older people, those in rural area. People with history of hypertension, coronary heart disease or cerebral vascular diseases (including cerebral infarction, cerebral hemorrhage and TIA) have a higher prevalence of VCI than people without. We fail to find the connection between diabetes mellitus and VCI. The prevalence of VCI or VCIND of people quitted smoking are much higher than those nerve or always. Moderate drinking every day may be a protective factor against the vascular cognitive impairment. The independent risk factors for VCI include gender, age, low education, stroke, TIA and alcohol consumption; Hypertension is not an independent risk factor for VCI or VCIND.The patients present preclinical cognitive deficits in design copy, calculation, delayed memory and orientation to time 4 years before VD. Design copy, calculation and orientation decline still in the 4 years, attention and following commands decline too, while the delayed memory doesn't markedly fall. The deficit of calculation at baseline may be a predictor of future development to VD in persons with vascular diseases risk factors.