Review of the Efficacy of Methods in the Early Detection of Vascular Dementia

Various assessments are used to detect cognitive decline throughout the stages of vascular dementia (VaD); however, the literature lacks a review of assessment efficacy. Early signs of VaD may include a decline in executive functioning, processing speed, attention, visuospatial abilities, and memory retrieval deficits. This review examines peer-reviewed publications addressing the validity and efficacy of widely accepted (and some lesser-known) neuropsychological assessments used to detect cognitive dysfunction in VaD. in addition to some common related medical assessments. Articles reviewed here include selected case-control studies and a case. The Cambridge Cognitive Examination (CAMCOG) and the Montreal Cognitive Assessment (MoCA) surpassed the Mini-Mental Status Examination (MMSE) in the efficacy of early diagnosis. The MMSE and Mattis Dementia Rating Scale (DRS) had good power in diagnostic differentiation. The Clinical Dementia Rating (CDR) effectively detected the early transitional stage prior to the onset of clinical dementia. At the same time, Addenbrooke's Cognitive Examination-III (ACE-III) and the Wechsler Memory Scales (WMS-III) exhibited high diagnostic accuracy and differentiation power, indicating strong efficacy in early detection. Tests like the Clock Drawing Test (CDT), Olfactory Function Test (OFT), and Pocket Smell Test (PST) are valuable complements to other assessments. Results indicated support for the use of multiple assessments to increase diagnostic confidence. Effective methods to detect VaD early may assist in early treatment intervention, and additional exploration of this topic is indicated. Objective: The objective of this review was to compare methods of assessing for the early detection of vascular neurocognitive disorder (VaD) to understand what assessments aid clinicians in forming the most accurate diagnosis. Data Selection: Peer-reviewed studies conducted between 1998 and 2020 were abstracted from the EBSCO and the ScienceDirect database. Search criteria was confined to vascular dementia, early detection/cognitive decline, and neuropsychological assessment efficacy. Data on late-stage/non-vascular dementia, medical conditions, and mental disorders were excluded. A final selection of fourteen articles were reviewed based on criteria that excluded information on outdated assessments, assessments integrated with other tests, and any references to data obtained prior to DSM-III-R. An additional six articles on commonly used medical assessments were reviewed. Data Synthesis: Synthesis of findings revealed the Cambridge Cognitive Examination (CAMCOG) and Montreal Cognitive Assessment (MoCA) surpassed the efficacy of the Mini Mental Status examination (MMSE) in early diagnosis. The MMSE and Mattis Dementia Rating Scale (DRS) exhibited good diagnostic differentiation power. The Clinical Dementia Rating (CDR) effectively detected early features of a transitional stage prior to the onset of full-blown dementia. There were findings for the usefulness of the Addenbrooke’s Cognitive Examination-III (ACE-III) and Wechsler Memory Scale-3rd Edition (WMS-III). The Clock Drawing Test (CDT), Olfactory Function Test (OFT), and Pocket Smell Test (PST) can supplement other assessments for early VaD. Conclusions: Support was found for administering more than one assessment to increase confidence in diagnosis. Each test had its own strengths and weaknesses such that using only one test results in less accurate diagnosis.

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