Identification of VaD and AD Prodromes: The Cache County Study

Authors

K. M. Hayden, Duke University Medical Center
L. H. Warren, University of North Carolina at Chapel Hill
C. F. Pieper, Duke University Medical Center
Truls Østbye, Utah State UniversityFollow
JoAnn T. Tschanz, Utah State UniversityFollow
Maria C. Norton, Utah State UniversityFollow
J.C. S. Breitner, University of Washington School of Medicine
K. A. Welsh-Bohmer, Duke University Medical Center

Document Type

Article

Journal/Book Title/Conference

Alzheimer's and Dementia: The Journal of the Alzheimer's Association

Volume

1

Issue

1

Publisher

Elsevier

Publication Date

2005

First Page

19

Last Page

29

Abstract

Background: It is unclear whether vascular dementia (VaD) has a cognitive prodrome, akin to the mild cognitive impairment (MCI) prodrome to Alzheimer’s dementia (AD). To evaluate whether VaD has a cognitive prodrome, and if it can be differentiated from prodromal AD, we examined neuropsychological test performance of participants in a nested case-control study within a population-based cohort aged 65 or older. Methods: Participants (n = 485) were identified from the Cache County Study, a large population-based study of aging and dementia. After an average of 3 years of follow-up, a total of 62 incident dementia cases were identified (14 VaD, 48 AD). We identified a number of neuropsychological tests (executive and memory) that discriminated between diagnosed VaD and AD cases. Multivariate analyses sought to differentiate between these same groups 3 years before clinical diagnosis. Results: The Consortium to Establish a Registry for Alzheimer’s Disease Word List Recognition Test correct recognition of foils (mean difference, 1.25; 95% confidence interval [CI], 0.42 to 2.07; p < 0.01), Logical Memory I (mean difference, 7.16; 95% CI, 0.78 to 13.55, p < 0.05), Logical Memory II delayed recall (mean difference, 8.67; 95% CI, 1.59 to 15.74, p < 0.05), and percent savings (mean difference, 51.07; 95% CI, 32.58 to 69.56, p < 0.0001) differentiated VaD from AD cases after adjustment for age, sex, education, and dementia severity. Three years before dementia diagnosis, word list recognition (“no” responses mean difference, 1.40; 95% CI, 0.64 to 2.17; p < 0.001, and “yes” responses mean difference, –1.14; 95% CI, –2.14 to –0.13; p < 0.03) discriminated between prodromal VaD and AD. Conclusion: These results suggest that VaD has a prodromal syndrome, the cognitive features of which are distinguishable from the cognitive prodrome of AD.

Comments

Originally published by Elsevier. Publisher's PDF and HTML fulltext available through remote link.

Recommended Citation

Hayden KM, Warren LH, Pieper CF, Østbye T, Tschanz JT, Norton M, Breitner JCS, Welsh-Bohmer KA. Identification and differentiation of prodromal VaD. The Cache County Study. Alzheimer's Disease and Dementia 2005;1:19-29.