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Global cerebrovascular burden and long-term clinical outcomes in Asian elderly across the spectrum of cognitive impairment

Published online by Cambridge University Press:  18 April 2018

Xin Xu*
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Yiong Huak Chan
Affiliation:
Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
Qun Lin Chan
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
Bibek Gyanwali
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
Saima Hilal
Affiliation:
Department of Epidemiology & Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
Boon Yeow Tan
Affiliation:
St. Luke Hospital, Singapore
Mohammad Kamran Ikram
Affiliation:
Department of Epidemiology & Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
Narayanaswamy Venketasubramanian
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Raffles Neuroscience Centre, Raffles Hospital, Singapore
Christopher Li-Hsian Chen
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
*
Correspondence should be addressed to: Dr. Xin Xu, Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore. Phone: +65-6592-3962. Email: xu.xin@ntu.edu.sg.

Abstract

Background/Aim:

To investigate the predictive ability of the previously established global cerebrovascular disease (CeVD) burden scale on long-term clinical outcomes in a longitudinal study of Asian elderly participants across the spectrum of cognitive impairment.

Methods:

A case-control study was conducted over a 2-year period involving participants with no cognitive impairment, cognitive impairment-no dementia (CIND), and Alzheimer's disease (AD). Annually, cognitive function was assessed with a comprehensive neuropsychological battery and the clinical dementia rating (CDR) scale was used to stage disease severity.

Results:

Of 314 participants, 102 had none/very mild CeVD, 31 mild CeVD, 94 moderate CeVD, and 87 severe CeVD at baseline. There was a 1.14 and 1.42 units decline per year on global cognitive z-scores in moderate and severe CeVD groups, respectively, compared to none/very mild CeVD. Moderate-severe CeVD predicted significant functional deterioration at year 2 (HR = 2.0, 95% CI = 1.2–3.4), and conversion to AD (HR = 6.3, 95% CI = 1.7–22.5), independent of medial temporal atrophy.

Conclusion:

The global CeVD burden scale predicts poor long-term clinical outcome independent of neurodegenerative markers. Furthermore, CeVD severity affects the rate of cognitive and functional deterioration. Hence, cerebrovascular burden, which is potentially preventable, is a strong prognostic indicator, both at preclinical and clinical stages of AD, independent of neurodegenerative processes.

Type
Original Research Article
Copyright
Copyright © International Psychogeriatric Association 2018 

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