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Alzheimers Dement. 2012 Nov;8(6):528-35. doi: 10.1016/j.jalz.2011.09.233.

Differential prediction of vascular dementia and Alzheimer's disease in nondemented older adults within 5 years of initial testing.

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  • 1Geriatric Research Unit, Brain Sciences, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To determine whether neuropsychological tests and the Hachinski Ischemic Score (HIS) can differentiate incident vascular dementia (VaD) from Alzheimer's disease (AD) in nondemented older adults within 5 years of initial testing.

METHODS:

The Canadian Study of Health and Aging (CSHA) included three waves: CSHA-1 (1991-1992), CSHA-2 (1996-1997), and CSHA-3 (2001-2002). This analysis included participants of the CSHA who (a) underwent neuropsychological testing and clinical assessment at CSHA-2 and were determined to be nondemented, and (b) underwent diagnostic assessment at CSHA-3. The outcome measure was CSHA-3 diagnosis, classified as VaD (n = 22), probable or possible AD (n = 65), and all other diagnostic outcomes (n = 417). CSHA-3 diagnosticians were blinded to CSHA-2 test scores and diagnoses. Multinomial logistic regression with forward selection was used to determine the ability of the HIS and 15 CSHA-2 neuropsychological tests to predict CSHA-3 diagnostic outcome. The analysis was repeated after removing 15 AD cases with coexisting vascular disease.

RESULTS:

The HIS and four neuropsychological tests were significant predictors of CSHA-3 diagnostic outcome (χ2 (14) = 149.59, P < .001, R2 = 0.38). Relative to developing VaD, higher HIS (odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.57-0.86) and Rey Auditory Verbal Learning Test immediate verbal recall scores (OR: 0.77; 95% CI: 0.62-0.97) were associated with lowered odds of developing AD, whereas higher phonemic fluency scores (OR: 1.21; 95% CI: 1.02-1.17) were associated with increased odds of developing AD. Removing AD cases with vascular disease did not affect results.

CONCLUSIONS:

In an epidemiological sample of nondemented participants, the HIS and two neuropsychological tests contributed to the differential prediction of VaD and AD within 5 years of initial measurement.

Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

PMID:
23102122
[PubMed - indexed for MEDLINE]
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