Vascular cognitive impairment

Efficacy of home based computerized adaptive cognitive training in patients with post stroke cognitive impairment: a randomized controlled trial

Post-stroke cognitive impairment is a common consequence of stroke, characterized by deficits in language, cognitive functioning, functional abilities. Innovative technological approaches, such as computerized cognitive retraining, offer promising strategies for mitigating the cognitive challenges. Despite their potential, the impact of these interventions on neuropsychological function and daily living capabilities has poor outcomes. In this randomized controlled trial (RCT), we assessed the effectiveness of a 4-week, remotely-delivered, multi-domain, computer-adaptive cognitive retraining (CACT) program in patients with post-cognitive cognitive impairment. Fifty male participants were randomly assigned to either the experimental group, which underwent the CACT program tailored to individual performance levels, or an active control group that received standard care. The evaluation focused on neuropsychological functions such as attention, memory, and executive processes, alongside daily living skills. Results indicated that participants in the CACT group exhibited notable improvements in several cognitive areas, including processing speed, category fluency, and visual confrontation naming, when compared to the control group. Nonetheless, enhancements in functional abilities, encompassing basic and instrumental activities of daily living (ADL), were minimal, with no significant changes reported post-intervention. This study demonstrates that CACT effectively improves cognitive functions in patients with post-stroke cognitive impairment during the spontaneous recovery period, suggesting that training patients at their optimal performance levels can lead to meaningful cognitive benefits. These findings are specific to patients recovering from stroke-induced cognitive deficits and highlight the need for further research to generalize these results to other populations with vascular cognitive impairment.

Apolipoprotein E ε4 allele is associated with vascular cognitive impairment no dementia in Chinese population

BACKGROUND

The association between apolipoprotein E (APOE) ε4 allele and vascular cognitive impairment no dementia (VCIND) is still controversial.

OBJECTIVE

To examine the relationship between the APOE ε4 allele and patients with VCIND after cerebral infarction.

METHODS

This study included first-ever cerebral infarction patients 3-12 months after the attack at the Xuanwu Hospital between June 2012 and December 2014. Patients were divided into VCIND group and normal cognition group (NC group).The APOE ε4 carriers (including ε2/ε4, ε3/ε4 and ε4/ε4 genotypes) and ε4 allele frequency were analyzed in relation to cognition grouping after cerebral infarction. MRI features of infarctions and some known risk factors for VCIND，as confounding factors, were also analyzed for correlation with VCIND at the same time.

RESULTS

Participants (n = 707) were divided into the VCIND (n = 361) and NC (n = 346) groups. The percentage of APOE ε4 carriers was higher in the VCIND group (23.6%) than in the NC group (12.7%, P < .001).The APOE ε4 allele frequency was higher in the VCIND group (12.5%) than in the NC group (6.7%, P = .001). Regardless of other confounding factors, such as male gender (OR = 1.963, 95%CI: 1.394-2.763, P < .001), age (OR = 1.034, 95%CI: 1.017-1.052, P < .001), education (OR = 0.834, 95%CI: 0.795-0.875, P < .001), hypertension (OR = 2.044, 95%CI: 1.460-2.861, P < .001), hyperlipidemia (OR = 0.682, 95%CI: 0.482-0.965, P = .031), infarction lesion diameter (OR = 1.044, 95%CI: 1.017-1.072, P = .001) and white matter lesions (OR = 1.330, 95%CI: 1.126-1.571, P = .001), the APOE ε4 allele was independently associated with VCIND (OR = 2.244, 95%CI: 1.454-3.463, P < .001).

CONCLUSION

These results confirms the hypothesis that the APOE ε4 allele is a risk factor associated with VCIND after cerebral infarction.

Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008

BACKGROUND AND PURPOSE

Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS

We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS

Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS

The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

Cognitive impairment of vascular origin: neuropathology of cognitive impairment of vascular origin

The term cognitive impairment of vascular origin is used to designate global cognitive deficits as well as focal neurological deficits such as aphasia, apraxia and agnosia of vascular/circulatory origin. It has been useful for identifying early clinical and neuroradiological alterations that might permit therapeutic strategies geared to curbing the progression of cerebrovascular disease. Multi-infarct encephalopathy, infarcts in strategic areas, lacunae and lacunar status, Binswanger's encephalopathy, hippocampal sclerosis, cortical granular atrophy and watershed infarcts are common lesions. Hypertension and vascular diseases such as arteriosclerosis, small blood vessel disease, inflammatory diseases of the blood vessels, Sneddon syndrome, cerebral amyloid angiopathies, cerebral autosomic dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and Maeda's syndrome are causative of cognitive impairment of vascular origin. Other less common causes are hereditary endotheliopathy with retinopathy, neuropathy and strokes (HERNS), cerebro-retinian vasculopathy (CRV), hereditary vascular retinopathy (HVR) (all three linked to 3p21.1-p21.3), hereditary infantile hemiparesis with arteriolar retinopathy and leukoencephalopathy (HIHRATL) (not linked to 3p21), fibromuscular dysplasia, and moya-moya disease. Lack of uniformity of clinical manifestations, the variety of vascular diseases and circulatory factors, the diverse, but often convergent, neuropathological substrates, and the common association with unrelated neurodegenerative diseases in the elderly, make it hard to assume a single clinical approach in the diagnosis and treatment of cognitive impairment of vascular origin. Rather, environmental and genetic risk factors, underlying vascular diseases, associated systemic, metabolic and neurodegenerative diseases and identification of extent and distribution of lesions with morphological and functional neuroimaging methods should be applied in every individual patient.