Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment

Figures & data

Table Ia. The diagnostic criteria for vascular dementia (VaD) in studies comparing pulse wave velocity in VaD, Alzheimer's disease and controls.

	Komai et al., 2002 (18)	Mizushima et al., 2003 (19)	Scuteri et al., 2005 (20)	Hanon et al., 2005 (21)	Ohmine et al., 2008 (23)	Dhoat et al., 2008 (22)
No criteria		+
Cognitive impaired	+MMSE < 23		+MMSE, ADLs	+MMSE, CEP, ADLs	? MMSE > 24	+
Stroke	+		−		−
Hashinski score (>7)	+					+
Multiple lacunae	+MRI		+			+CT or MRI
WML on MRI or CT			+		+periventricular hyperintensities
NINDS-AIRENS or-ADRDA				+		+

WML, white matter hyperintensity lesions; MRI, magnetic resonance imaging; CT, computerized tomography; −, excluded; +, included; ?, unknown; CEP, cognitive efficiency profile.

Table Ib. The diagnostic criteria for Alzheimer's disease (AD) in studies comparing pulse wave velocity in vascular dementia, AD and controls.

	Komai et al., 2002 (18)	Mizushima et al., 2003 (19)	Scuteri et al., 2005 (20)	Hanon et al., 2005 (21)	Ohmine et al., 2008 (23)	Dhoat et al., 2008 (22)
No criteria		+
Cognitive impaired	+MMSE < 23		+	+MMSE, CEP		+
Stroke	−
Hashinski score (<4)	+					+
Brain Atrophy on MRI	+		+			+CT or MRI
DSM or NINDS-AIRENS or-ADRDA			+	+		+

MRI, magnetic resonance imaging; −, excluded; +, included; CEP, cognitive efficiency profile.

Table II. Characteristics of the subjects in studies comparing pulse wave velocity in persons with vascular dementia (VaD), Alzheimer's disease (AD) and controls.

	Komai et al., 2002 (18)	Mizushima et al., 2003 (19)	Scuteri et al., 2005 (20)	Hanon et al., 2005 (21)	Ohmine et al., 2008 (23)	Dhoat et al., 2008 (22)
Age	84 years	73 years	79 years	79 years	70 years	78 years
Men	75%	?	36%	36	37%	47%
HTN	?	44%	66%	76	55%	36%
DM	?	?	25%	?	6.8%	?
Cigarettes	?	?	8%	?	28%	?
AntiHTN meds	?	?	65%	70%	76%	?
Nitrates	?	?	26.2%	?	?
Diuretics	?	?	?	38%	?	9% all patients
Beta-blockers	?	?	?	26%	?	13%
CCB	55% all pt	?	?	30%	?	9%
ACE/ARB	?	?	?	51%	?	4%
Other	?	?	?	10%	?
VaD	n = 24	n = 16	n = 41	n = 19	n = 41	n = 13
AD	n = 25	n = 18	n = 24	n = 126	n = 0	n = 16
Control (neither)	n = 0	n = 44	n = 19	n = 80	n = 39 (39)	n = 16

HTN, hypertension; DM, diabetes mellitus; ACEi, ACE inhibitors; ARB, angiotensin receptor antagonists; CCB, calcium chanel antagonists; ?, unknown.

Figure 1. Pulse wave velocity (PWV) in persons with vascular dementia (VaD) compared with individuals without dementia (Control). (a) The PWV, mean ± SD for persons with vascular dementia and those without dementia is shown for all studies that compared the two. The significance level in each study is also provided. The inset shows the pooled mean + SD and total number of persons with vascular dementia and those without dementia. (b) Comparison of the differences in PWV for all studies that compared vascular dementia and those without dementia. The data is shown as the mean difference and the 95% confidence interval (CI). The weighting that each study contributed to the overall mean is indicated as well as the overall mean (CI) and statistical testing.

Table III. Univariate analysis of the correlation of pulse wave velocity (PWV) and cognitive function.

	Sample size	Cognitive status	Age	PWV	MMSE	Hasegawa Dementia Scale
Komai et al., 2002 (18)	n = 49	Dementia	84 years	baPWV	Not significant +	–
Nagai et al., 2004 (16)	n = 18	Cognitive impaired no VaD	76 years	baPWV	–	r =−0.433 p < 0.05
Scuteri et al., 2005 (20)	n = 84	With and without cognitive impairment	77 years	cfPWV	r = −0.26 p < 0.02 normalized MBP	–
Hanon et al., 2005 (21)	n = 308	74% cognitive impairment	78 years	cfPWV	r =−0.27 p < 0.0001
Muller et al., 2007 (25)	n = 396	Independently living community men	60 years	cfPWV	Borderline not significant +	–
Abbatecola et al., 2008 (26)	n = 140	No cognitive impairment	78 years	cfPWV	r = 0.213 p = 0.04	–
Kim et al., 2009 (27)	n = 370	MMSE	55 years	baPWV	No significant difference in PWV
	n = 30, metabolic syndrome	MMSE	>60 years	baPWV	r = −0.38, p = 0.04
Sugawara et al., 2010 (28)	n = 388	Normal MMSE >24 (n = 347); poor cognition MMSE <24 (n = 47)	∼69 years	baPWV	Not significant but Odds Ratio low MMSE 1.67 in highest vs lowest tertile PWV

VaD, vascular dementia; ba, brachial–ankle; cf, carotid–femoral; MBP, mean blood pressure; MMSE, Mini Mental State Exam; +p not shown, − not known.

Figure 2. Pulse wave velocity (PWV) in persons with vascular dementia compared with individuals with Alzheimer dementia (AD). (a) The PWV, mean ± SD, for persons with vascular dementia (VaD) and those with Alzheimer dementia (AD) is shown for all studies that compared the two. The significance level in each study is also provided. ns, not significant. ND indicated that the p-value was not reported. The inset shows the pooled mean + SD and total number of persons with VaD and AD. (b) Comparison of the differences in PWV for all studies that compared VaD and those with AD. The data is shown as the mean difference and the 95% confidence interval (CI). The weighting that each study contributed to the overall mean is indicated as well as the overall mean (CI) and statistical testing.

Table IV. Multivariate analysis of the correlation of pulse wave velocity (PWV) and cognitive function after adjusting for other factors.

	n	Cognitive status	Age years	Cognitive tests	Correlation	Covariates
Nagai et al., 2004 (16)	27	Cognitive impaired	76	HDS-R	β = 0.54* (all)	Age, sex, mean BP, CVmeds
	18				β = 0.7*(no CV disease)	Age, sex, mean BP
Scuteri et al., 2005 (20)	84	With and without cognitive impairment	77	MMSE	β = −0.28*	Age, sex, education, DM, LDL, HDL, CVD, BPmeds
Hanon et al., 2005 (21)	308	74% cognitive impairment	78	MMSE	β =−0.091***	Age, sex, SBP, CVD, BPmeds
				CEP	β = −0.029***
Poels et al., 2007 (29)	3,714	Population cohort	72	MMSE	β =−0.08*	age, sex and education
				Stroop Test	β =−1.18*	Age, sex, education, BP, HR, SM, DM, BMI, TChol, HDL
Muller et al., 2007 (25)	396	Community	60	MMSE	β =−0.04ns (memory)	Age, education
				Wechsler	β =−0.08ns (processing)
Waldstein et al., 2008 (31)	582	Community	54	Blessed	β = −0.024*	Age, sex, education, SM, BP, CVD, CVmeds
				Benton Visual	β =−0.079*
Elias et al., 2009 (30)	429	Community	61	Weschler, Maine	β =−0.047**	Age
Kearney-Schwartz et al., 2009 (32)	198	Community	69	MMSE, Benton, Grober-Buske, Verbal Fluency	Men, Or = 1.22*	Age, BP, DM, SM, BMI, LDL, TRIG, FBS
Triantafyllidi et al., 2009 (38)	110	Outpatient clinic	54	Folstein's MMSE	β = −0.36*	Age, BMI, SBP, DBP, PP, sex, SM, Chol, TRIG, MAU
Sugawara et al., 2010 (28)	388	Community	68	MMSE	Or = 1.5 ns	Age, sex, education, SM, alcohol intake, BMI, LDL, TRIG, HgbA1c

BP, blood pressure; SBP, systolic BP; DBP, diastolic BP; SM, cigarette smoking; DM, diabetes mellitus; BMI, body mass index; Chol, cholesterol; MAU, microalbuminuria; LDL, low-density lipoprotein-cholesterol, TRIG, triglycerides, HDL, high-density lipoprotein-cholesterol; CV, cardiovascular; CVD, cardiovascular disease; Meds, medications; CEP, cognitive efficiency profile; OR, odds ratio. *p ≤ 0.05; *p ≤ 0.01.

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