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October 24, 1986, Vol 256, No. 16 >
ARTICLE | October 24, 1986

Improved Cognition After Control of Risk Factors for Multi-infarct Dementia FREE

John Stirling Meyer, MD; Brian W. Judd, MS; Talat Tawaklna, MD; Robert L. Rogers, PhD; Karl F. Mortel, PhD
[+] Author Affiliations

Reprint requests to Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, 2002 Holcombe Blvd, Houston, TX 77211 (Dr Meyer).


JAMA. 1986;256(16):2203-2209. doi:10.1001/jama.1986.03380160061021
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References

A cohort of 52 patients (30 men and 22 women) with multi-infarct dementia (MID) has been followed up prospectively for a mean interval of 22.2 months. Clinical course has been documented by serial history taking and interviews and neurological, medical, and psychological examinations, and correlated with measurements of cerebral blood flow. The clinical course and cognitive performance have been compared with those of age-matched normal volunteers and patients with Alzheimer's disease. Patients with MID were subdivided into hypertensive and normotensive groups, and also into those displaying stabilized or improved cognition and those whose condition deteriorated. Among hypertensive patients with MID, improved cognition and clinical course correlated with control of systolic blood pressure within upper limits of normal (135 to 150 mm Hg), but if systolic blood pressure was reduced below this level, patients with MID deteriorated. Among normotensive patients with MID, improved cognition was associated with cessation of smoking cigarettes.

(JAMA 1986;256:2203-2209)

REFERENCES

1 +
Katzman R:  The prevalence of malignancy of Alzheimer's disease . Arch Neurol 1976;;33:217-218.
2 +
Katzman R, Terry RD: The Neurology of Aging . Philadelphia, FA Davis Co, 1983;, pp 1-14.
3 +
Tomlinson BE, Blessed GI, Roth M:  Observations of brains of old people . J Neurol Sci 1970;;11:205-242.
4 +
Jellinger K:  Neuropathological aspects of dementia resulting from abnormal blood and cerebrospinal fluid dynamics . Acta Neurol Belg 1976;;76:83-102.
5 +
Alexander MP, Geschwind N:  Dementia in the elderly , in Albert M (ed): Clinical Neurology of Aging . New York, Oxford University Press Inc, 1984;, pp 254-276.
6 +
Loeb C:  Vascular dementias , in Fredericks JAM (ed): Handbook of Clinical Neurology: Neurobehavioral Disorders . Amsterdam, Elsevier Science Publishers, 1985;, vol 2, pp 353-369.
7 +
Judd BW, Meyer JS, Rogers RL, et al:  Cognitive performance correlates with cerebrovascular impairments in multi-infarct dementia . J Am Geriatr Soc 1986;;34:355-360.
8 +
Fisher CM:  Small deep cerebral infarcts . Neurology 1965;;15:774-784.
9 +
Wolf P, Kannel WB:  Controllable risk factors for stroke: Preventative implications of trends in stroke mortality , in Meyer JS, Shaw TG (eds): Diagnosis and Management of Stroke and TIAs . Reading, Mass, Addison-Wesley Publishing Co, 1983;, pp 28-61.
10 +
Kannel WB, Dauber TR, Sorlu P, et al:  Components of blood pressure and risk of atherothrombotic brain infarction . Stroke 1976;;3:409-419.
11 +
Loizou LA, Kendal BE, Marshall J:  Subcortical atherosclerotic encephalopathy: A clinical and radiological investigation . J Neurol Neurosury Psychiatry 1981;;44:294-304.
12 +
Rogers RL, Meyer JS, Shaw TG, et al:  Cigarette smoking decreases cerebral blood flow suggesting increased risk for stroke . JAMA 1983;; 250:2796-2800.
13 +
Rogers RL, Meyer JS, Shaw TG, et al:  Reductions in regional cerebral blood flow associated with chronic consumption of alcohol . J Am Geriatr Soc 1983;;31:540-543.
14 +
Rogers RL, Meyer JS, Mortel KF, et al:  Decreased cerebral blood flow precedes onset of multi-infarct dementia but follows symptoms of senile dementia of Alzheimer's type . Neurology 1986;;36:1-6.
15 +
Meyer JS, Rogers RL, Mortel KF:  Prospective analysis of long-term control of mild hypertension on cerebral blood flow . Stroke 1985;;16:985-989.
16 +
Rogers RL, Meyer JS, Shaw TG, et al:  The effects of chronic cigarette smoking on cerebrovascular responsiveness to 5% CO2 and 100% O2 inhalation . J Am Geriatr Soc 1984;;32:415-420.
17 +
Rogers RL, Meyer JS, Judd BW, et al:  Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers . JAMA 1985;;253:2970-2974.
18 +
Strandsgaard S:  Autoregulation of cerebral blood flow in hypertensive patients . Stroke 1976;; 53:720-727.
19 +
Kitigawa Y, Meyer JS, Tachibana H, et al:  CT-CBF correlations of cognitive deficits in multiinfarct dementia . Stroke 1984;;15:1000-1008.
20 +
McKhann G, Drachman D, Folstern M, et al:  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.
21 +
Rosen WG, Terry RD, Field PA, et al:  Pathological verification of ischemic score in differentiation of dementias . Ann Neurol 1980;;7:486-488.
22 +
Hachinski VC, Lassen NA, Marshall J:  Multiinfarct dementia cause of mental deterioration in the elderly . Lancet 1974;;2:201-209.
23 +
Bogousslarsky J, Regli F:  Unilateral watershed infarcts . Neurology 1986;;36:373-377.
24 +
Jacobs JW, Bernhard MR, Delgado A, et al:  Screening for organic mental syndromes in the medically ill . Ann Intern Med 1977;;86:40-46.
25 +
Kaufman DM, Weinberger M, Stain JJ, et al:  Detection of cognitive deficits by a brief mental status examination: The Cognitive Capacity Screening Examination, a reappraisal and a review . Gen Hosp Psychiatry 1979;;1:247-255.
26 +
Obrist WD, Thomson HK, Wang HS, et al:  Regional cerebral blood flow estimated by "'xenon inhalation . Stroke 1975;;6:245-256.
27 +
Meyer JS, Ishikawa N, Deshmukh VD, et al:  Improved method for noninvasive measurement of regional cerebral blood flow by 133Xe inhalation: Part 1 . Stroke 1978;;9:195-205.
28 +
Hulley SB, Feigal D, Ireland C, et al:  Systolic hypertension in the elderly program (SHEP): The first three months . J Am Geriatr Soc 1986;; 34:101-105.
29 +
Fields WS, Lemak NA, Frankowski RF, et al:  Controlled trial of aspirin in cerebral ischemia . Stroke 1977;;8:301-316.
30 +
Bousser MG, Eschwege E, Haguenau M, et al:  'AICLA': Controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombotic cerebral ischemia . Stroke 1983;;14:5-14.
31 +
EC-IC Bypass Study Group:  Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke . N Engl J Med 1985;; 313:1191-1200.
32 +
Meyer JS, Nakajima S, Okabe T, et al:  Redistribution of cerebral blood flow following STA-MCA bypass in patients with hemispheric ischemia . Stroke 1982;;13:774-784.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Katzman R:  The prevalence of malignancy of Alzheimer's disease . Arch Neurol 1976;;33:217-218.
2 +
Katzman R, Terry RD: The Neurology of Aging . Philadelphia, FA Davis Co, 1983;, pp 1-14.
3 +
Tomlinson BE, Blessed GI, Roth M:  Observations of brains of old people . J Neurol Sci 1970;;11:205-242.
4 +
Jellinger K:  Neuropathological aspects of dementia resulting from abnormal blood and cerebrospinal fluid dynamics . Acta Neurol Belg 1976;;76:83-102.
5 +
Alexander MP, Geschwind N:  Dementia in the elderly , in Albert M (ed): Clinical Neurology of Aging . New York, Oxford University Press Inc, 1984;, pp 254-276.
6 +
Loeb C:  Vascular dementias , in Fredericks JAM (ed): Handbook of Clinical Neurology: Neurobehavioral Disorders . Amsterdam, Elsevier Science Publishers, 1985;, vol 2, pp 353-369.
7 +
Judd BW, Meyer JS, Rogers RL, et al:  Cognitive performance correlates with cerebrovascular impairments in multi-infarct dementia . J Am Geriatr Soc 1986;;34:355-360.
8 +
Fisher CM:  Small deep cerebral infarcts . Neurology 1965;;15:774-784.
9 +
Wolf P, Kannel WB:  Controllable risk factors for stroke: Preventative implications of trends in stroke mortality , in Meyer JS, Shaw TG (eds): Diagnosis and Management of Stroke and TIAs . Reading, Mass, Addison-Wesley Publishing Co, 1983;, pp 28-61.
10 +
Kannel WB, Dauber TR, Sorlu P, et al:  Components of blood pressure and risk of atherothrombotic brain infarction . Stroke 1976;;3:409-419.
11 +
Loizou LA, Kendal BE, Marshall J:  Subcortical atherosclerotic encephalopathy: A clinical and radiological investigation . J Neurol Neurosury Psychiatry 1981;;44:294-304.
12 +
Rogers RL, Meyer JS, Shaw TG, et al:  Cigarette smoking decreases cerebral blood flow suggesting increased risk for stroke . JAMA 1983;; 250:2796-2800.
13 +
Rogers RL, Meyer JS, Shaw TG, et al:  Reductions in regional cerebral blood flow associated with chronic consumption of alcohol . J Am Geriatr Soc 1983;;31:540-543.
14 +
Rogers RL, Meyer JS, Mortel KF, et al:  Decreased cerebral blood flow precedes onset of multi-infarct dementia but follows symptoms of senile dementia of Alzheimer's type . Neurology 1986;;36:1-6.
15 +
Meyer JS, Rogers RL, Mortel KF:  Prospective analysis of long-term control of mild hypertension on cerebral blood flow . Stroke 1985;;16:985-989.
16 +
Rogers RL, Meyer JS, Shaw TG, et al:  The effects of chronic cigarette smoking on cerebrovascular responsiveness to 5% CO2 and 100% O2 inhalation . J Am Geriatr Soc 1984;;32:415-420.
17 +
Rogers RL, Meyer JS, Judd BW, et al:  Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers . JAMA 1985;;253:2970-2974.
18 +
Strandsgaard S:  Autoregulation of cerebral blood flow in hypertensive patients . Stroke 1976;; 53:720-727.
19 +
Kitigawa Y, Meyer JS, Tachibana H, et al:  CT-CBF correlations of cognitive deficits in multiinfarct dementia . Stroke 1984;;15:1000-1008.
20 +
McKhann G, Drachman D, Folstern M, et al:  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.
21 +
Rosen WG, Terry RD, Field PA, et al:  Pathological verification of ischemic score in differentiation of dementias . Ann Neurol 1980;;7:486-488.
22 +
Hachinski VC, Lassen NA, Marshall J:  Multiinfarct dementia cause of mental deterioration in the elderly . Lancet 1974;;2:201-209.
23 +
Bogousslarsky J, Regli F:  Unilateral watershed infarcts . Neurology 1986;;36:373-377.
24 +
Jacobs JW, Bernhard MR, Delgado A, et al:  Screening for organic mental syndromes in the medically ill . Ann Intern Med 1977;;86:40-46.
25 +
Kaufman DM, Weinberger M, Stain JJ, et al:  Detection of cognitive deficits by a brief mental status examination: The Cognitive Capacity Screening Examination, a reappraisal and a review . Gen Hosp Psychiatry 1979;;1:247-255.
26 +
Obrist WD, Thomson HK, Wang HS, et al:  Regional cerebral blood flow estimated by "'xenon inhalation . Stroke 1975;;6:245-256.
27 +
Meyer JS, Ishikawa N, Deshmukh VD, et al:  Improved method for noninvasive measurement of regional cerebral blood flow by 133Xe inhalation: Part 1 . Stroke 1978;;9:195-205.
28 +
Hulley SB, Feigal D, Ireland C, et al:  Systolic hypertension in the elderly program (SHEP): The first three months . J Am Geriatr Soc 1986;; 34:101-105.
29 +
Fields WS, Lemak NA, Frankowski RF, et al:  Controlled trial of aspirin in cerebral ischemia . Stroke 1977;;8:301-316.
30 +
Bousser MG, Eschwege E, Haguenau M, et al:  'AICLA': Controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombotic cerebral ischemia . Stroke 1983;;14:5-14.
31 +
EC-IC Bypass Study Group:  Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke . N Engl J Med 1985;; 313:1191-1200.
32 +
Meyer JS, Nakajima S, Okabe T, et al:  Redistribution of cerebral blood flow following STA-MCA bypass in patients with hemispheric ischemia . Stroke 1982;;13:774-784.

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