The Florence VAS-COG Clinic: A Model for the Care of Patients with Cognitive and Behavioral Disturbances Consequent to Cerebrovascular Diseases

Issue title: Alzheimer's Disease: Detection, Prevention, and Preclinical Treatment

Guest editors: Jack C. de la Torre

Article type: Research Article

Authors: Poggesi, Anna^a | Salvadori, Emilia^a | Valenti, Raffaella^a | Nannucci, Serena^a | Ciolli, Laura^a | Pescini, Francesca^b | Pasi, Marco^a | Fierini, Fabio^a | Donnini, Ida^a | Marini, Sandro^a | Chiti, Guido^a | Rinnoci, Valentina^a | Inzitari, Domenico^a | Pantoni, Leonardo^{b; *}

Affiliations: [a] NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy | [b] Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

Correspondence: [*] Correspondence to: Leonardo Pantoni, MD, PhD, Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy. Tel.: +39 055 7945519; Fax: +39 055 4298461; E-mail: [email protected].

Abstract: Background and objective:Services dedicated to patients with cognitive and behavioral consequences of cerebrovascular diseases are not well established. In this paper, we report on the general organization of such a service (the Florence VAS-COG Clinic) after 9 years of activity, updating a previous work related to the first 5 years. Methods:The Florence VAS-COG clinic, started in 2006, is an outpatient service dedicated to the assessment and follow-up of patients with cerebrovascular diseases and related cognitive, psychiatric, and behavioral disturbances. The staff involved in the clinic is composed of certified neurologists, one neuropsychologist, and neurology residents. The diagnostic protocol includes detailed personal and family history, general and neurologic examinations, and functional, neuropsychological, and neuroimaging assessment. After this work-up, comprehensive diagnoses are made. Results:From January 2006 to March 2014, 600 patients (mean age 67.3 years ± 13.9; 52% females) have been evaluated in the clinic. Cognitive impairment, including mild cognitive impairment and dementia, mainly of vascular origin, was the most common (36.4%) diagnostic category, followed by suspected or confirmed familial micro-angiopathy (35.8%). Compared to the first years of activity, we are now facing the need of augmenting the number of visits due to increasing request and to better implement the multidisciplinarity of the team. Efforts are currently directed towards the definition of management protocols in pharmacological and non-pharmacological strategies. Conclusions:The establishment of a VAS-COG clinic represents an important step for the appreciation of the patient clinical needs and for the implementation of screening, diagnostic, and treatment options in the field of the neuropsychiatric consequences of cerebrovascular diseases.

Keywords: Dementia, mild cognitive impairment, outpatient clinic, post-stroke aphasia, post-stroke depression, small vessel disease, stroke, vascular cognitive impairment

DOI: 10.3233/JAD-141569

Journal: Journal of Alzheimer's Disease, vol. 42, no. s4, pp. S453-S461, 2014