Vascular dementia in a population-based autopsy study

David S Knopman, Joseph E Parisi, Bradley F Boeve, Ruth H. Cha, Hulya Apaydin, Alessandro Salviati, Steven D. Edland, Walter A Rocca

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Background: The validity of the clinical diagnosis of vascular dementia (VaD) remains suboptimal. Objective: To investigate clinicopathologic correlations in VaD. Methods: We used the medical records-linkage system of the Rochester Epidemiology Project to identify incident cases of dementia in Rochester, Minn, from January 1, 1985, through December 31, 1989. Dementia and Alzheimer disease (AD) were defined by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Vascular dementia was defined by criteria including imaging results. Pathological characteristics of AD were quantified by means of standard scoring methods for neurofibrillary tangles and neuritic plaques. Vascular pathological findings were assessed by expert neuropathological opinion. Results: Of 419 patients with dementia who died before the study, neuropathological examination results were available in 89 (21%) with median age at onset of 80 years (range, 50-96 years; 52 [58%] women). Pathological diagnoses were AD in 45 patients (51%), pure VaD in 12 (13%), combined AD and VaD in 11 (12%), and other diagnoses in the remaining 21 patients. Criteria for VaD that required either a temporal relationship between a stroke and dementia onset or worsening, or bilateral infarctions in specified locations demonstrated on imaging results (Mayo Clinic criteria) had 75% sensitivity and 81% specificity for pure VaD (positive likelihood ratio, 3.9; 95% confidence interval, 2.2-6.7). Five cases of pure VaD lacked the temporal relationship and accounted for the imperfect sensitivity of the criteria. Conclusions: In this population-based autopsy study, the presence of vascular pathological characteristics in the absence of major AD pathological findings was common. Pure VaD without overt clinical strokes remains a challenge for antemortem diagnosis.

Original languageEnglish (US)
Pages (from-to)569-575
Number of pages7
JournalArchives of Neurology
Volume60
Issue number4
DOIs
StatePublished - Apr 1 2003

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Vascular Dementia
Autopsy
Population
Alzheimer Disease
Dementia
Blood Vessels
Medical Record Linkage
Stroke
Neurofibrillary Tangles
Amyloid Plaques
Expert Testimony
Age of Onset
Diagnostic and Statistical Manual of Mental Disorders
Infarction
Epidemiology
Research Design
Confidence Intervals
Sensitivity and Specificity

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Vascular dementia in a population-based autopsy study. / Knopman, David S; Parisi, Joseph E; Boeve, Bradley F; Cha, Ruth H.; Apaydin, Hulya; Salviati, Alessandro; Edland, Steven D.; Rocca, Walter A.

In: Archives of Neurology, Vol. 60, No. 4, 01.04.2003, p. 569-575.

Research output: Contribution to journalArticle

Knopman, DS, Parisi, JE, Boeve, BF, Cha, RH, Apaydin, H, Salviati, A, Edland, SD & Rocca, WA 2003, 'Vascular dementia in a population-based autopsy study', Archives of Neurology, vol. 60, no. 4, pp. 569-575. https://doi.org/10.1001/archneur.60.4.569
Knopman, David S ; Parisi, Joseph E ; Boeve, Bradley F ; Cha, Ruth H. ; Apaydin, Hulya ; Salviati, Alessandro ; Edland, Steven D. ; Rocca, Walter A. / Vascular dementia in a population-based autopsy study. In: Archives of Neurology. 2003 ; Vol. 60, No. 4. pp. 569-575.
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abstract = "Background: The validity of the clinical diagnosis of vascular dementia (VaD) remains suboptimal. Objective: To investigate clinicopathologic correlations in VaD. Methods: We used the medical records-linkage system of the Rochester Epidemiology Project to identify incident cases of dementia in Rochester, Minn, from January 1, 1985, through December 31, 1989. Dementia and Alzheimer disease (AD) were defined by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Vascular dementia was defined by criteria including imaging results. Pathological characteristics of AD were quantified by means of standard scoring methods for neurofibrillary tangles and neuritic plaques. Vascular pathological findings were assessed by expert neuropathological opinion. Results: Of 419 patients with dementia who died before the study, neuropathological examination results were available in 89 (21{\%}) with median age at onset of 80 years (range, 50-96 years; 52 [58{\%}] women). Pathological diagnoses were AD in 45 patients (51{\%}), pure VaD in 12 (13{\%}), combined AD and VaD in 11 (12{\%}), and other diagnoses in the remaining 21 patients. Criteria for VaD that required either a temporal relationship between a stroke and dementia onset or worsening, or bilateral infarctions in specified locations demonstrated on imaging results (Mayo Clinic criteria) had 75{\%} sensitivity and 81{\%} specificity for pure VaD (positive likelihood ratio, 3.9; 95{\%} confidence interval, 2.2-6.7). Five cases of pure VaD lacked the temporal relationship and accounted for the imperfect sensitivity of the criteria. Conclusions: In this population-based autopsy study, the presence of vascular pathological characteristics in the absence of major AD pathological findings was common. Pure VaD without overt clinical strokes remains a challenge for antemortem diagnosis.",
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