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Cognitive and Neurologic Predictors of Functional Impairment in Vascular Dementia

Received August 16, 2001; revised January 14, February 21, 2002; accepted February 22, 2002. From the Department of Psychiatry, Brown Medical School, Providence, RI (PAB,RP,TZ,NG,RC), The Miriam Hospital, Providence, RI (RP,TZ,NG,RC), and the Department of Psychiatry, University of Iowa (DM). Address correspondence to Dr. Boyle, Brown University Medical School, Department of Psychiatry, Box G-BH, Providence, RI 02912. e-mail: pboyle{at}lifespan.org

OBJECTIVE: The purpose of this study is to investigate associations between executive dysfunction, neuroimaging findings, and functional impairment in patients with vascular dementia (VaD). METHODS: Twenty-nine VaD patients completed the Dementia Rating Scale and underwent MRI scanning to generate quantitative ratings of subcortical hyperintensities (SH) and cortical volume. Patients' caregivers completed items from the Lawton and Brody Activities of Daily Living Questionnaire, designed to measure instrumental activities of daily living (IADLs). The authors hypothesized that performance on the Initiation/Perseveration (IP) subscale, a measure of executive abilities, and SH would significantly predict levels of IADLs. RESULTS: A hierarchical multiple-regression analysis revealed that IP and SH accounted for 42% of the variance in IADLs; IP alone accounted for 28%, and SH accounted for 14% beyond the contribution made by IP. CONCLUSION: Findings indicate that specific cognitive and neuropathological factors are associated with functional impairment in VaD.

Key Words: Vascular Dementia • Rating Scales • MRI

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