Progression of dementia associated with lacunar infarctions

Background: Lacunar stroke (L) is the most common stroke subtype associated with vascular dementia (VaD-L). Objective: To evaluate the cognitive and behavioral course in patients with probable VaD-L. Methods: We longitudinally measured rates of change on MMSE, digit span, logical memory, Controlled Oral Word Association, CERAD battery and neuropsychiatric inventory (NPI) in 77 patients (age at entry 69 ± 8.1 years) with probable VaD-L for 25.75 ± 11 months. Results: The mean number of follow-up visits was 2.6 ± 0.67 (range 2-4). Time interval between any two consecutive visits was at least 5 months (range 5-41). MMSE deteriorated by 1.44 ± 1.8 points annually and NPI increased by 6.01 ± 13.7 points annually (p < 0.0001). The rates of cognitive and behavioral decline were predominantly influenced by the cognitive state at entry into the study and the occurrence of new vascular episodes during follow-up [(-0.95 ± 1.7) MMSE and (+2.02 ± 14.1) NPI points annually without vascular episodes vs. (-2.09 ± 1.6) and (+11.3 ± 11.4) points following vascular episodes (p < 0.0001)]. Impaired cognition was associated with impaired behavior (p < 0.001). VaD-L patients without additional vascular episodes at follow-up have a progressively deteriorating course as well (p < 0.0001). Conclusion: VaD-L is characterized by cognitive and behavioral decline. The rate of decline is determined mainly by the severity of the cognitive and behavioral impairment at baseline and by the occurrence of new vascular episodes.