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Vol. 22, No. 1, 2003
Issue release date: January–February 2003
Neuroepidemiology 2003;22:1–12

Evaluation of Dementia in the Cardiovascular Health Cognition Study

Lopez O.L. · Kuller L.H. · Fitzpatrick A. · Ives D. · Becker J.T. · Beauchamp N.
Departments of aNeurology and bPsychiatry and Psychology, University of Pittsburgh School of Medicine, cEpidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa.; dUniversity of Washington, Seattle, Wash.; eJohns Hopkins University, Baltimore, Md., USA

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Objective: To describe a methodology to evaluate dementia and frequency of different types of dementia and prevalence of the Cardiovascular Health Study (CHS). Methods: The CHS is a longitudinal study of cardiovascular disease among community-dwelling individuals over the age of 65. Of the 5,888 participants in the original study, 3,608 had a magnetic resonance imaging (MRI) of the brain in 1991, and formed the cohort for the dementia study. The CHS included yearly measures of cognitive function and, from 1998 to 2000, participants were evaluated for dementia by detailed neurological, and neuropsychological examinations. The possible cases of dementia and mild cognitive impairment (MCI) were adjudicated by a review committee of neurologists and psychiatrists. Results: There were 480 cases of (13.3%) incident dementia in the total sample, 227 (6.3%) prevalent dementia, 577 (16.0%) MCI, and 2,318 (64.4%) normal. The adjudication committee classified 69% of the incident dementia as Alzheimer’s disease (AD), 11% as vascular dementia (VaD), 16% as both, and 4% as other types. There was a substantial agreement between pre- and postMRI diagnosis of types of dementia. The frequency of dementia within the CHS cohort which survived to the end of the study in 1998–1999, was 13.5% for white men, 14.5% for white women, 22.2% for black men and 23.4% for black women. Conclusion: The CHS has developed a methodology for longitudinal studies of dementia in large cohorts and represents the largest study of dementia including cognitive testing, MRI and genetic markers.

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  1. Kachaturian ZS, Mesulam MM (eds): Alzheimer’s Disease: A Compendium of Current Theories. Ann NY Acad Sci. New York, New York Academy of Sciences, 2000, vol 924.
  2. Kalaria RN, Ince P (eds): Vascular Factors in Alzheimer’s Disease. Ann NY Acad Sci. New York, New York Academy of Sciences, 2000, vol 903.
  3. Growdon JH, Wurtman RJ, Corkin S, Nitsch RM (eds): The Molecular Basis of Dementia. Ann NY Acad Sci. New York, New York Academy of Sciences, 2000, vol 920.
  4. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: Clinical characterization and outcome. Arch Neurol 1999;56:303–308.
  5. Fried LP, Borhani NO, Enright P, Furberg CD, Garden JM, Kronmal RA, Kuller LH, Manolio TA, Mittelmark MB, Newman A: The Cardiovascular Health Study: Design and rationale. Ann Epidemiol 1991;1:263–276.
  6. Teng EL, Chui HC: The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry 1987;48:314–318.
  7. Wechsler D: Wechsler Adult Intelligence Scale – Revised. New York, Psychological Corporation, 1981.
  8. Steffens DC, Welsh KA, Burke JR; et al: Diagnosis of Alzheimer’s disease in epidemiological studies by staged review of clinical data. Neuropsychiatry Neuropsychol Behav Neurol 1996;9:107–113.
  9. Gallo JJ, Breitner JCS: Alzheimer’s disease in the NAS-NRC Registry of aging twin veterans. 4. Performance characteristics of a two-stage telephone screening procedure for Alzheimer’s dementia. Psychol Med 1995;25:1211–1219.
  10. Jorrm AF, Jacob PA: The Informant Questionnaire on Cognitive Decline in the Elderly (IQ CODE): Socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989;19:1015–1022.
  11. Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Garden JM: Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. JAMA 1998;279:585–592.
  12. Fillenbaum GG: Screening the elderly: A brief instrument activities of daily living. J Am Geriatr Soc 1985;33:698–706.
  13. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW, Cleveland MA: The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.
  14. Kuller LH, Shemanski L, Manolio T, Haan M, Fried L, Bryan N, Burke GL, Tracy R, Bhadelia R: Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study. Stroke 1998;29:388–398.
  15. Manolio TA, Kronmal RA, Burke GL, Poirier V, O’Leary DH, Garden JM, Fried LP, Steinberg EP, Bryan RN: Magnetic resonance abnormalities and cardiovascular disease in older adults. The Cardiovascular Health Study. Stroke 1994;25:318–327.
  16. Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, Enright PL, O’Leary D, Fried L: Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3,301 elderly people. The Cardiovascular Health Study. Stroke 1996;27:1274–1282.
  17. Bryan RN, Wells SW, Miller TJ, Elster AD, Jungreis CA, Poirier VC, Lind BK, Manolio TA: Infarct-like lesions in the brain: Prevalence and anatomic characteristics at MR imaging of the elderly – data from the Cardiovascular Health Study. Radiology 1997;202:47–54.
  18. Nelson HE: National Adult Reading Test. Windsor, NFER-Nelson, 1982.
  19. Raven JC: Coloured Progressive Matrices. Los Angeles, Western Psychological Services, 1956.
  20. Delis DC, Kramer JH, Kaplan E, Ober BA: The California Verbal Learning Test. New York, Psychological Corporation, 1987.
  21. Rey A: L’examen psychologique dans les cas d’encéphalopathie traumatique. Arch Psychol 1941;30:286–340.
  22. Osterreith PA: Le test de copie d’un figure complexe. Arch Psychol 1944;30:206–356.
  23. Huff FJ, Collins C, Corkin S, Rosen TJ: Equivalent forms of the Boston Naming Test. J Clin Exp Neuropsychol 1986;8:556–562.
  24. Benton AL: Differential behavioral effects in frontal lobe disease. Neuropsychologia 1968;6:53–60.

    External Resources

  25. Trenerry MR, Crosson B, DeBoe J, Leber WR: STROOP Neuropsychological Screening Test. Odessa, Psychological Assessment Resources, 1989.
  26. Reitan RM: Validity of the trial making test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271–276.
  27. Baddeley AD, Della Sala S, Papagno C, Spinnler H: Dual task performance in dysexecutive and non-dysexecutive patients with a frontal lesion. Neuropsychology 1997;11:187–194.
  28. Klove H: Clinical neuropsychology; in Forster FM (ed): The Medical Clinics of North America. New York, Saunders, 1963.
  29. Fahn S, Elton RI: UPDRS Development Committee: Unified Parkinson’s Rating Scale; in Fahn S, Marsden CD, Caine D, Goldstein M (eds): Recent Developments in Parkinson’s Disease. Florham Park, MacMillan Healthcare Information, 1987, pp 153–163.
  30. Hachinski VC, Iliff LD, Zihka E, DuBoulay GH, McAllister VL, Marshall J, Russell RW, Simon L: Cerebral blood flow in dementia. Arch Neurol 1975;32:632–637.
  31. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.
  32. American Psychiatric Association: Diagnostic and Statistic Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  33. McKhann G, Drachman DA, Folstein MF, Katzman R, Price DL, Stadlan E: Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984;34:939–944.
  34. Chui HC, Victoroff JIB, Margolin D, Jagust W, Shankle R, Katzman R: Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centers. Neurology 1992;42:473–480.
  35. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo HM, Brun A, Hofman A: Vascular dementia: Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250–260.
  36. Wenning GK, Shlomo YB, Magalhaes M, Daniel SE, Quin NP: Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain 1994;117:843–845.
  37. Litvan I, Agid Y, Calne D, Campbell G, DuBois B, Duvoisin RC, Goetz CG, Globe LI, Grafman J, Growon JH, Hallett M, Jankovic J, Quinn NP, Torosa E, Zee DS: Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski Syndrome): Report of the NINDS-SPSP International Workshop. Neurology 1996;47:1–9.
  38. Lund and Manchester Groups: Clinical and neuropathological criteria for frontotemporal dementia. Consensus Statement. J Neurol Neurosurg Psychiatry 1994;57:416–418.
  39. McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mitra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, de Vos RA, Wilcock GK, Jellinger KA, Perry RH: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report on the consortium on DLB international workshop. Neurology 1996;47:1113–1124.
  40. Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF: Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria. Neurology 1998;51:1546–1554.
  41. Kawas C, Segal J, Stewart WF, Corrada M, Thal LJ: A validation study of the dementia questionnaire. Arch Neurol 1994;51:901–906.
  42. Canadian Study of Health, and Aging Working Group: Canadian Study of Health and Aging: Study methods and prevalence of dementia. Can Med Assoc J 1994;350:899–913.
  43. Elias MF, Beiser A, Wolf P, Au R, White R, D’Agostino RB: The preclinical phase of Alzheimer’s disease: A 22-year prospective study of the Framingham Cohort. Arch Neurol 2000;57:808–813.
  44. Killiany RJ, Gomez-Isla T, Moss M, Kikinis R, Sandor T, Jolesz F, Tanzi R, Jones K, Hyman BT, Albert MS: Use of structural magnetic resonance imaging to predict who will get Alzheimer’s disease. Ann Neurol 2000;47:430–439.
  45. Bookheimer SY, Strojwas MH, Cohen MS, Saunders AM, Pericak-Vance MA, Mazziotta JC, Small GW: Patterns of brain activation in people at risk for Alzheimer’s disease. N Engl J Med 2000;343:450–456.
  46. Jack CR Jr, Petersen RC, Xu YC, O’Brien PC, Waring SC, Tangalos EG, Smith GE, Ivnik RJ, Thibodeau SN, Kokmen E: Hippocampal atrophy and apolipoprotein E genotype are independently associated with Alzheimer’s disease. Ann Neurol 1998;43:303–310.
  47. Snowdon DA, Greener LH, Mortimer JA, Riley KP, Griener PA, Markesbery WR: Brain infarction and the clinical expression of Alzheimer’s disease. The Nun Study. JAMA 1997;277:813–817.
  48. Snowdon DA, Greener LH, Markesbery WR: Linguistic ability in early life and neuropathology of Alzheimer’s disease and cerebrovascular disease. Findings from the Nun Study. Ann NY Acad Sci 2000;903:34–38.
  49. Wolfson C, Wolfson DB, Asgharian M, M’Lan CE, Østbye T, Rockwood K, Hogan DB: A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001;344:1111–1116.
  50. Moroney JT, Bagiella E, Hachinski VC, Molsa PK, Gustafson L, Brun A, Fischer P, Erkinjuntti T, Rosen W, Paik MC, Tatemichi TK, Desmond DW: Misclassification of dementia subtype using the Hachinski Ischemic Score: Results of a meta-analysis of patients with pathologically verified dementias. Ann NY Acad Sci 1997;826:490–492.
  51. Wade JP, Mirsen TR, Hachinski VC, Fisman M, Lau C, Merskey H: The clinical diagnosis of Alzheimer’s disease. Arch Neurol 1987;44:24–29.
  52. Neuropathology Group of the Medical Research Council Cognitive Function and Aging Study (MRC CFAS): Pathological correlates of late-onset dementia in a multicenter, community-based population in England and Wales. Lancet 2001;357:169–175.
  53. Ott A, Breteler MMB, van Harskamp F, Stijnen T, Hofman A: Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol 1998;147:574–580.
  54. Hebert R, Lindsay J, Verreault R, Rockwood K, Hill G, Dubois MF: Vascular dementia. Incidence and risk factors in the Canadian Study of Health and Aging. Stroke 2000;31:1487–1493.
  55. Chui HC, Mack W, Jackson E, Mungas D, Reed BR, Tinklenberg J, Chang FL, Skinner K, Tasaki C, Jagust WJ: Clinical criteria for the diagnosis of vascular dementia. A multicenter Study of Comparability and Interrater Reliability. Arch Neurol 2000;57:191–196.
  56. Esiri M, Nagy Z, Smith MZ, Barnetson L, Smith AD: Cerebrovascular disease and threshold for dementia in the early stages of Alzheimer’s disease. Lancet 1999;354:919–920.
  57. Pohjasvaara T, Mantyla R, Salonen O, Aronen HJ, Ylikoski R, Hietanen M, Kaste M, Erkinjuntti T: How complex interactions of ischemic brain infarcts, white matter lesions, and atrophy relate to poststroke dementia. Arch Neurol 2000;57:1295–1300.
  58. Bernick C, Kuller I, Dulberg C, Longstreth WT Jr, Manolio T, Beauchamp N, Price T: Silent MRI infarcts and the risk of future stroke: The Cardiovascular Health Study. Neurology 2001;57:1222–1229.
  59. Lopez OL, Litvan I, Catt KE, Stowe R, Klunk W, Kaufer DI, Becker JT, DeKosky ST: Accuracy of four clinical diagnostic criteria for the diagnosis of neurodegenerative dementias. Neurology 1999;53:1292–1299.

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