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      Clinical Determinants of Dementia and Mild Cognitive Impairment following Ischaemic Stroke: The Sydney Stroke Study

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          Background: Dementia following stroke is common but its determinants are still incompletely understood. Methods: In the Sydney Stroke Study, we performed detailed neuropsychological and medical-psychiatric assessments on 169 patients aged 50–85 years, 3–6 months after a stroke, and 103 controls with a majority of both groups undergoing MRI brain scans. Stroke subjects were diagnosed as having vascular mild cognitive impairment (VaMCI) or vascular dementia (VaD) or no cognitive impairment by consensus. Demographic, functional, cerebrovascular risk factors and neuroimaging parameters were examined as determinants of dementia using planned logistic regression. Results: 21.3% of subjects were diagnosed with VaD, with one case in those aged 50–59 years, 24% in those aged 60–69 years and 23% in those 70–79 years. There was no difference by sex. The prevalence of VaMCI was 36.7%. VaD subjects had lower premorbid intellectual functioning and had 0.9 years less education than controls. The VaD and VaMCI groups did not differ from the no cognitive impairment group on any specific cerebrovascular risk factor, however overall those with impairment had a greater number of risk factors. They did not differ consistently on depression severity, homocysteine levels and neuroimaging parameters (atrophy, infarct volume and number of infarcts) except for an excess of white matter lesions on MRI and greater number of infarcts in the VaD and VaMCI groups. On a series of logistic regression analyses, stroke volume and premorbid function were significant determinants of cognitive impairment in stroke patients. Conclusion: Post-stroke dementia and MCI are common, especially in older individuals. Cerebrovascular risk factors are not independent risk factors for VaD, but stroke volume is a significant determinant of dementia. Premorbid functioning is a determinant of post- stroke impairment.

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          Most cited references 13

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          Neuropsychological tests' norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO

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              The topography of white matter hyperintensities on brain MRI in healthy 60- to 64-year-old individuals.

              We report the topography of brain white matter hyperintensities (WMHs) on T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging in 477 healthy subjects aged 60-64 years selected randomly from the community. WMHs were delineated by using a computer algorithm. We found that all subjects had periventricular WMHs and 96.6% subjects also had deep WMHs. The mean volume of WMHs was 4.9 ml, comprising 0.83% of the white matter, of which 1.2 ml was severe in intensity. The deep WMHs were distributed throughout the cerebral hemispheres, with the occipital and frontal white matter bearing the greatest burden. The territory of the lenticulostriate arteries had the greatest WMHs. A white matter region of 4 mm adjacent to the cortex was not affected by hyperintensities. The mean (SD) number of discrete WMHs was 19.6 (7.1) per subject, of which 6.1 (4.4) were severe in intensity. Nearly half (48.6%) of the subjects had at least one large WMH (>12 mm diameter) and one eighth (12.5%) of the subjects had at least one large WMH that appeared to be severe in MRI. The overall load of WMHs was similar in men and women, but the latter had a higher proportion of their white matter so affected. This study provides the first detailed topographic analysis of WMHs in a large representative middle-aged sample, emphasizes their high prevalence in mid-adult life and raises issues about their etiology and significance.

                Author and article information

                Dement Geriatr Cogn Disord
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                May 2006
                12 May 2006
                : 21
                : 5-6
                : 275-283
                Schools of aPsychiatry and bClinicalMedicine, University of New South Wales, cNeuropsychiatric Institute, dDepartment for Old Age Psychiatry, eInstitute of Neurological Sciences, the Prince of Wales Hospital, Sydney, fPsychiatry of Old Age, Australian National University, Canberra, and gResearch Centre for the Neurosciences of Ageing, Calvary Hospital, Bruce, Australia
                91434 Dement Geriatr Cogn Disord 2006;21:275–283
                © 2006 S. Karger AG, Basel

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                Page count
                Tables: 3, References: 34, Pages: 9
                Original Research Article


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