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Cerebrovascular Disease and Cognition in Older Adults

  • Gregory A. Seidel
  • Tania Giovannetti
  • David J. LibonEmail author
Chapter
Part of the Current Topics in Behavioral Neurosciences book series (CTBN, volume 10)

Abstract

The well-established association between advanced age, cerebrovascular pathology, and cognitive decline is receiving greater attention as the population attains new levels of longevity. This chapter will provide an overview of vascular anatomy and age-related cerebrovascular disorders and diseases, including stroke and degenerative dementia. The cognitive and functional sequellae of these cerebrovascular disorders will also be described in detail. Throughout this review, we will emphasize topics that have been relatively underrepresented in the literature, including age-related diseases of the cerebral small vessels, nuanced characterization of cognitive impairment associated with insidious small-vessel vascular dementia, and the real-life functional consequences of cerebrovascular changes in older adults.

Keywords

Cerebrovascular disease Cognition Older adults Dementia Small-vessel disease Everyday action Executive function Episodic memory Language 

Notes

Acknowledgments

Portions of chapter were presented at the 39th annual meeting of the International Neuropsychological Society, Boston, MA.

References

  1. Alexander GE, DeLong MR, Strick PL (1986) Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 9:357–381PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  3. Ariesen MJ, Claus SP, Rinkel GJE, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34:2060–2065PubMedCrossRefGoogle Scholar
  4. Benson DF, Marsden CD, Meadows JC (1974) The amnesic syndrome of posterior cerebral artery occlusion. Acta Neurol Scand 50(2):133–145PubMedCrossRefGoogle Scholar
  5. Bernard BA, Wilson RS, Gilley DW, Bennett DA, Fox JH (1992) Memory failure in Binswanger’s disease and Alzheimer’s disease. The Clin Neuropsychol 6:230–240CrossRefGoogle Scholar
  6. Blumenfeld H (2010) Neuroanatomy through clinical cases, 2nd edn. Sinauer Associates, Sunderland, MAGoogle Scholar
  7. Boyle PA, Paul R, Moser D, Zawacki T, Gordon N, Cohen R (2003) Cognitive and neurologic predictors of functional impairment in vascular dementia. Am J Geriatr Psychiatry 11(1):103–106PubMedGoogle Scholar
  8. Boyle PA, Paul RH, Moser DJ, Cohen RA (2004) Executive impairments predict functional declines in vascular dementia. Clin Neuropsychol 18(1):75–82PubMedCrossRefGoogle Scholar
  9. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870PubMedCrossRefGoogle Scholar
  10. Buxbaum L, Schwartz M, Montgomery M (1998) Ideational apraxia and naturalistic action. Cogn Neuropsychol 15:617–643PubMedCrossRefGoogle Scholar
  11. Cannata AP, Alberoni M, Franceschi M, Mariani C (2002) Frontal impairment in subcortical ischemic vascular dementia in comparison to Alzheimer’s disease. Dementia and Geriatr Cogn Disord 13:101–111CrossRefGoogle Scholar
  12. Carew TG, Lamar M, Cloud BS, Grossman M, Libon DJ (1997) Impairment in category fluency in ischaemic vascular dementia. Neuropsychology 11:400–412PubMedCrossRefGoogle Scholar
  13. Cohen RA (2009) Neuropsychology of cardiovascular disease. In: Cohen RA, Gunstad J (eds) Neuropsychology and cardiovascular disease. Oxford University Press, New York, pp 3–18Google Scholar
  14. Davis KL, Price C, Kaplan E, Libon DJ (2002) Error analysis of the nine-word California verbal learning test (CVLT-9) among older adults with and without dementia. Clin Neuropsychol 16:81–89PubMedCrossRefGoogle Scholar
  15. Davson H (1976) The blood–brain barrier. J Physiol 255:1–28PubMedGoogle Scholar
  16. de Reuck J (1971) The human periventricular arterial blood supply and anatomy of cerebral infarctions. Eur Neurol 5:321–334PubMedCrossRefGoogle Scholar
  17. Delis DC, Kramer JH, Kaplan E, Ober BA (1987) The California verbal learning test. Psychology Corporation, New YorkGoogle Scholar
  18. Delis DC, Massman PJ, Butters N, Salmon DP, Cermak LS, Kramer JH (1991) Profiles of demented and amnesic patients on the California verbal learning test: implications for the assessment for the assessment of memory disorders. Psychol Assess: J Consult Clin Psychol 3:19–26Google Scholar
  19. Duffis EJ, Fisher M (2009) Cardioembolic stroke. In: Cohen RA, Gunstad J (eds) Neuropsychology and cardiovascular disease. New York, Oxford University Press, pp 221–232Google Scholar
  20. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E et al (2009) Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease. Stroke 40(6):2276–2293PubMedCrossRefGoogle Scholar
  21. Farias ST, Harrell E, Neumann C, Houtz A (2003) The relationship between neuropsychological performance and daily functioning in individuals with Alzheimer’s disease: ecological validity of neuropsychological tests. Arch Clin Neuropsychol 18(6):655–672PubMedGoogle Scholar
  22. Fisher M (2010) The challenge of mixed cerebrovascular disease. Ann N Y Acad Sci 1207:18–22PubMedCrossRefGoogle Scholar
  23. Fong KNK, Chan CCH, Au DKS (2001) Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Injury 15(5):443–453PubMedCrossRefGoogle Scholar
  24. Fung WK, Poppas A (2009) Overview of cardiovascular physiology and pathology. In: Cohen RA, Gunstad J (eds) Neuropsychology and cardiovascular disease. Oxford University Press, New York, pp 66–80Google Scholar
  25. Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ (2005) Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol 46(6):937–954PubMedCrossRefGoogle Scholar
  26. Galski T, Bruno RL, Zorowitz R, Walker J (1993) Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients—the dominant role of higher-order cognition. Stroke 24(12):1794–1800PubMedCrossRefGoogle Scholar
  27. Giovannetti T, Lamar M, Cloud BS, Swenson R, Fein D, Kaplan E et al (2001) Different underlying mechanisms for deficits in concept formation in dementia. Arch Clin Neuropsychol 16(6):547–560PubMedGoogle Scholar
  28. Giovannetti T, Libon DJ, Buxbaum LJ, Schwartz MF (2002) Naturalistic action impairments in dementia. Neuropsychologia 40(8):1220–1232PubMedCrossRefGoogle Scholar
  29. Giovannetti T, Schmidt KS, Gallo JL, Sestito N, Libon DJ (2006) Everyday action in dementia: evidence for differential deficits in Alzheimer’s disease versus subcortical vascular dementia. J Int Neuropsychol Soc 12(1):45–53PubMedCrossRefGoogle Scholar
  30. Giovannetti T, Bettcher BM, Brennan L, Libon DJ, Kessler RK, Duey K (2008a) Coffee with jelly or unbuttered toast: commissions and omissions are dissociable aspects of everyday action impairment in Alzheimer’s disease. Neuropsychology 22(2):235–245PubMedCrossRefGoogle Scholar
  31. Giovannetti T, Bettcher BM, Brennan L, Libon DJ, Kessler RK, Duey K (2008b) Characterization of everyday functioning in mild cognitive impairment: a direct assessment approach. Dementia and Geriatric Cogn Disord 25:359–365CrossRefGoogle Scholar
  32. Girouard H, Iadecola C (2006) Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol 100(1):328–335PubMedCrossRefGoogle Scholar
  33. Goldberg E (1986) Varieties of perseveration: a comparison of two taxonomies. J Clin Exp Neuropsychol 8(6):710–726PubMedCrossRefGoogle Scholar
  34. Goldmann EE (1909) Die äussere und innere Sekretion des gesunden und kranken organismus im Lichte der ‘vitalen Farbung’. Beiträge zur klinischen Chirurgie 64:192–265Google Scholar
  35. Goldmann EE (1913) Vitalfarbung am Zentralnervensystem. Abhandlungen der Preussischen Akademie der Wissenschaften Phys-Math 1:1–60Google Scholar
  36. Goldstein K, Scheerer M (1941) Abstract and concrete behavior. Psychol Monogr 53:329–401CrossRefGoogle Scholar
  37. Greenberg SM, Grabowski T, Gurol ME, Skehan ME, Nandigam RN, Becker JA et al (2008) Detection of isolated cerebrovascular beta-amyloid with Pittsburgh compound B. Ann Neurol 64(5):587–591PubMedCrossRefGoogle Scholar
  38. Hachinski VC, Potter P, Merskey H (1987) Leuko-araiosis. Arch Neurol 44(1):21–23PubMedCrossRefGoogle Scholar
  39. Hartmann K, Goldenberg G, Daumuller M, Hermsdorfer J (2005) It takes the whole brain to make a cup of coffee: the neuropsychology of naturalistic actions involving technical devices. Neuropsychologia 43(4):625–637PubMedCrossRefGoogle Scholar
  40. Hatzinikolaou-Kotsakou E, Kartasis Z, Tziakas D, Stakos D, Hotidis A, Chalikias G et al (2005) Clotting state after cardioversion of atrial fibrillation: a haemostasis index could detect the relationship with the arrhythmia duration. Thrombosis J 3(1):2CrossRefGoogle Scholar
  41. Hope T, Keene J, Gedling K, Fairburn CG, Jacoby R (1998) Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry 13(10):682–690PubMedCrossRefGoogle Scholar
  42. Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120:897–902PubMedGoogle Scholar
  43. Irani F (2009) Cardiac output and ejection fraction: impact on brain structure and function. In: Cohen RA, Gunstad J (eds) Neuropsychology and cardiovascular disease. Oxford University Press, New York, pp 233–239Google Scholar
  44. Jefferson A (2010) Cardiac output as a potential risk factor for abnormal brain aging. J Alzheimer’s Dis 20:813–821Google Scholar
  45. Kessler RK, Giovannetti T, MacMullen LR (2007) Everyday action in schizophrenia: performance patterns and underlying cognitive mechanisms. Neuropsychology 21(4):439–447PubMedCrossRefGoogle Scholar
  46. Knopman DS, Kitto J, Deinard S, Heiring J (1988) Longitudinal study of death and institutionalization in patients with primary degenerative dementia. J Am Geriatr Soc 36(2):108–112PubMedGoogle Scholar
  47. Kontiola P, Laaksonen R, Sulkava R, Erkinjuntti T (1990) Pattern of language impairment is different in Alzheimer’s disease and multi-infarct dementia. Brain and Language 38:364–383PubMedCrossRefGoogle Scholar
  48. Kramer JH, Delis DC, Blusewicz MJ, Brandt J, Ober BA, Strauss M (1988) Verbal memory errors in Alzheimer’s and Huntington’s dementias. Dev Neuropsychol 4:1–15CrossRefGoogle Scholar
  49. Lafosse JM, Reed BR, Mungas D, Sterling SB, Wahbeh H, Jagust WJ (1997) Fluency and memory differences between ischemic vascular dementia and Alzheimer’s disease. Neuropsychology 11:514–522PubMedCrossRefGoogle Scholar
  50. Laine M, Vuorinen E, Rinne JO (1997) Picture naming deficits in vascular dementia and Alzheimer’s disease. J Clin Exp Neuropsychol 19:126–140PubMedCrossRefGoogle Scholar
  51. Lamar M, Podell K, Carew TG, Cloud BS, Resh R, Kennedy C et al (1997) Perseverative behavior in Alzheimer’s disease and subcortical ischemic vascular dementia. Neuropsychology 11(4):523–534PubMedCrossRefGoogle Scholar
  52. Lamar M, Price CC, Davis KL, Kaplan E, Libon DJ (2002) Capacity to maintain mental set in dementia. Neuropsychologia 40(4):435–445PubMedCrossRefGoogle Scholar
  53. Lamar M, Swenson R, Kaplan E, Libon DJ (2004) Characterizing alterations in executive functioning across distinct subtypes of cortical and subcortical dementia. Clin Neuropsycholo 18(1):22–31CrossRefGoogle Scholar
  54. Lamar M, Price CC, Libon DJ, Penney DL, Kaplan E, Grossman M, Heilman KM (2007) Alterations in working memory as a function of leukoaraiosis in dementia. Neuropsychologia 45:245–254PubMedCrossRefGoogle Scholar
  55. Lamar M, Catani M, Price CC, Heilman KM, Libon DJ (2008) The impact of region specific leukoaraiosis on working memory deficits in dementia. Neuropsychologia 46:2597–2601PubMedCrossRefGoogle Scholar
  56. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186PubMedCrossRefGoogle Scholar
  57. Lewandowsky M (1900) Zur Lehre der Cerebrospinalflussigkeit. Z Klin Med 40:480–494Google Scholar
  58. Libon DJ, Malamut BL, Swenson R, Cloud BS (1996a) Further analyses of clock drawings among demented and non-demented subjects. Arch Clin Neuropsychol 11:193–211PubMedGoogle Scholar
  59. Libon DJ, Mattson RE, Glosser G, Kaplan E, Malamut M, Sands LP, Swenson R, Cloud BS (1996b) A nine word dementia version of the California verbal learning test. Clin Neuropsychol 10:237–244CrossRefGoogle Scholar
  60. Libon DJ, Bogdanoff B, Bonavita J, Skalina S, Cloud BS, Resh R et al (1997) Dementia associated with periventricular and deep white matter alterations: a subtype of subcortical dementia. Arch Clin Neuropsychol 12(3):239–250PubMedGoogle Scholar
  61. Libon DJ, Bogdanoff B, Cloud BS, Skalina S, Carew TG, Gitlin HL, Bonavita J (1998) Motor learning and quantitative measures of the hippocampus and subcortical white alterations in Alzheimer’s disease and ischaemic vascular dementia. J Clin Exp Neuropsychol 20:30–41PubMedCrossRefGoogle Scholar
  62. Libon DJ, Price CC, Davis Garrett K, Giovannetti T (2004) From Binswanger’s disease to leuokoaraiosis: what we have learned about subcortical vascular dementia. Clin Neuropsychol 18(1):83–100PubMedCrossRefGoogle Scholar
  63. Libon DJ, Price CC, Giovannetti T, Swenson R, Bettcher BM, Heilman KM et al (2008) Linking MRI hyperintensities with patterns of neuropsychological impairment: evidence for a threshold effect. Stroke 39(3):806–813PubMedCrossRefGoogle Scholar
  64. Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA et al (1996) Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The cardiovascular health study. Stroke 27(8):1274–1282PubMedCrossRefGoogle Scholar
  65. Lukatela K, Malloy P, Jenkins M, Cohen R (1998) The naming deficit in early Alzheimer’s and vascular dementia. Neuropsychology 12:565–572PubMedCrossRefGoogle Scholar
  66. Luria AR (1980) Higher cortical functions in man, 2nd edn. Basic Books Inc, New York, NYCrossRefGoogle Scholar
  67. Man DWK, Tam SF, Hui-Chan C (2006) Prediction of functional rehabilitation outcomes in clients with stroke. Brain Injury 20(2):205–211PubMedCrossRefGoogle Scholar
  68. Marcotte TD, Scott JC, Kamat R, Heaton RK (2010) Neuropsychology and the prediction of everyday functioning. In: Marcotte TD, Grant I (eds) Neuropsychology of everyday function. Guilford Press, New York, pp 5–38Google Scholar
  69. Marinković S, Gibo H, Milisavljević M, Ćetković M (2001) Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14(3):190–195PubMedCrossRefGoogle Scholar
  70. Marti-Vilalta JL, Arboix A, Mohr JP (2004) Lacunes. In: Mohr JP, Choi DW, Grotta JC, Weir B, Wolf PA (eds) Stroke: pathophysiology, diagnosis, and management, 4th edn. Elsevier Health Sciences, Philadelphia, pp 275–300Google Scholar
  71. Massman PJ, Delis DC, Butters N, Levin B, Salmon DP (1990) Are all subcortical dementias alike?: verbal learning and memory in Parkinson’s and Huntington’s disease patient’s. J Clin Exp Neuropsychol 12:729–744PubMedCrossRefGoogle Scholar
  72. Miller IN, Haynes WG, Moser DJ (2009) Systemic vascular function and cognitive function. In: Cohen RA, Gunstad J (eds) Neuropsychology and cardiovascular disease. Oxford University Press, New York, pp 240–263Google Scholar
  73. Mooradian AD (1988) Effect of aging on the blood–brain barrier. Neurobiol Aging 9:31–39PubMedCrossRefGoogle Scholar
  74. Mysiw WJ, Beegan JG, Gatens PF (1989) Prospective cognitive assessment of stroke patients before inpatient rehabilitation—the relationship of the neuro-behavioral cognitive status examination to functional improvement. Am J Phys Med Rehabil 68(4):168–171PubMedCrossRefGoogle Scholar
  75. Noale M, Maggi S, Minicuci N, Marzari C, Destro C, Farchi G et al (2003) Dementia and disability: impact on mortality. The Italian longitudinal study on aging. Dementia and Geriatr Cogn Disord 16(1):7–14CrossRefGoogle Scholar
  76. Ozdemir F, Birtane M, Tabatabaei R, Ekukle G, Kokino S (2001) Cognitive evaluation and functional outcome after stroke. Am J Phys Med Rehabil 80:410–415PubMedCrossRefGoogle Scholar
  77. Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9(7):689–701PubMedCrossRefGoogle Scholar
  78. Pantoni L, Garcia JH (1997) Cognitive impairment and cellular/vascular changes in the cerebral white matter. Ann N Y Acad Sci 826:92–102PubMedCrossRefGoogle Scholar
  79. Phares TW, Kean RB, Mikheeva T, Hooper DC (2006) Regional differences in blood-brain barrier permeability changes and inflammation in the apathogenic clearance of virus from the central nervous system. J Immunol 176(12):7666–7675PubMedGoogle Scholar
  80. Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ (2005) Subcortical vascular dementia: integrating neuropsychological and neuroradiologic data. Neurology 65(3):376–382PubMedCrossRefGoogle Scholar
  81. Price CC, Garrett KD, Jefferson AL, Cosentino S, Tanner J, Penney DL, Swenson R, Giovannetti T, Bettcher BM, Libon DJ (2009) The role of leukoaraiosis severity on learning and memory in dementia: performance differences on a 9-word list learning test. Clin Neuropsychol 23:1–18CrossRefGoogle Scholar
  82. Reed BR, Mungas DM, Kramer JH, Ellis W, Vinters HV, Zarow C et al (2007) Profiles of neuropsychological impairment in autopsy-defined Alzheimer’s disease and cerebrovascular disease. Brain 130(Pt 3):731–739PubMedCrossRefGoogle Scholar
  83. Rigs HE, Rupp C (1963) Variation in form of Circle of Willis. The relation of the variations to collateral circulation: anatomic analysis. Archives of Neurology 8:8–14Google Scholar
  84. Ritman EL, Lerman A (2007) The dynamic vasa vasorum. Cardiovasc Res 75(4):649–658PubMedCrossRefGoogle Scholar
  85. Roman GC (1987) Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. JAMA 258(13):1782–1788PubMedCrossRefGoogle Scholar
  86. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology 43(2):250–260PubMedCrossRefGoogle Scholar
  87. Schwartz MF, Buxbaum LJ, Montgomery MW, Fitzpatrick-DeSalme E, Hart T, Ferraro M et al (1999) Naturalistic action production following right hemisphere stroke. Neuropsychologia 37:51–66PubMedCrossRefGoogle Scholar
  88. Schwartz MF, Buxbaum LJ, Ferraro M, Veramonti T, Segal M (2003) The naturalistic action test. Thames Valley Test Company, Bury St. Edmunds, United KingdomGoogle Scholar
  89. Seidel GA, Giovannetti T, Price CC, Towler S, Tanner J, Mitchell S, Eppig J, Pennisi A, Libon DJ (2011) Structural neuroimaging correlates of everyday action in dementia. In: DJ Libon, The differential contribution of white and gray matter to the phenotypic expression of dementia. Symposium conducted at the 39th annual meeting of the international neuropsychological society, Boston, MAGoogle Scholar
  90. Severson MA, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Ivnik RJ et al (1994) Patterns and predictors of institutionalization in community-based dementia patients. J Am Geriatr Soc 42(2):181–185PubMedGoogle Scholar
  91. Sharma M, Clark H, Armour T et al (2005) Acute Stroke: evaluation and treatment. Evidence reports/technology assessments, No. 127. Agency for Healthcare Research and Quality (US), Rockville, MDGoogle Scholar
  92. Sultzer D, Mahler M, Cummings J, Van Gorp W, Hinkin C, Brown C (1995) Cortical abnormalities associated with subcortical lesions in vascular dementia. Arch Neurol 52:773–780PubMedCrossRefGoogle Scholar
  93. Szabo K, Forster A, Jager T, Kern R, Griebe M, Hennerici MG et al (2009) Hippocampal lesion patterns in acute posterior cerebral artery stroke: clinical and MRI findings. Stroke 40(6):2042–2045PubMedCrossRefGoogle Scholar
  94. Thoonsen H, Richard E, Bentham P, Gray R, van Geloven N, De Haan RJ et al (2010) Aspirin in Alzheimer’s disease: increased risk of intracerebral hemorrhage: cause for concern? Stroke 41(11):2690–2692PubMedCrossRefGoogle Scholar
  95. Tierney MC, Black SE, Szalai JP, Snow G, Fisher RH, Nadon G, Chui HC (2001) Recognition memory and verbal fluency differentiate probable Alzheimer’s disease from subcortical ischemic vascular dementia. Arch Neurol 58:1654–1659PubMedCrossRefGoogle Scholar
  96. Vasilevko V, Passos GF, Quiring D, Head E, Kim RC, Fisher M et al (2010) Aging and cerebrovascular dysfunction: contribution of hypertension, cerebral amyloid angiopathy, and immunotherapy. Ann N Y Acad Sci 1207:58–70PubMedCrossRefGoogle Scholar
  97. Wilson B (1993) Ecological validity of neuropsychological assessment: do neuropsychological indexes predict performance in everyday activities. Appl Prev Psychol 2:209–215CrossRefGoogle Scholar
  98. Wolf PA, Mitchell JB, Baker CS, Kannel WB, D’Agostino RB (1998) Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 158(3):229–234PubMedCrossRefGoogle Scholar
  99. Zinn S, Dudley TK, Bosworth HB, Hoenig HM, Duncan PW, Horner RD (2004) The effect of poststroke cognitive impairment on rehabilitation process and functional outcome. Arch Phys Med Rehabil 85(7):1084–1090PubMedCrossRefGoogle Scholar
  100. Zlokovic BV (2004) Clearing amyloid through the blood–brain barrier. J Neurochem 89:807–811PubMedCrossRefGoogle Scholar
  101. Zlokovic BV (2008) The blood–brain barrier in health and chronic neurodegenerative disorders. Neuron 57(2):178–201PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Gregory A. Seidel
    • 1
  • Tania Giovannetti
    • 1
  • David J. Libon
    • 2
    Email author
  1. 1.Department of PsychologyTemple UniversityPhiladelphiaUSA
  2. 2.Department of NeurologyDrexel University College of MedicinePhiladelphiaUSA

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