Clinical criteria

Super Memory Formula

How To Cure Memory Loss Naturally

Get Instant Access

Since the 1970s several clinical criteria for vascular dementia have been published. (1!40,4!) The most widely used include those in DSM-IV, (34> ICD-10,(35> and NINDS-AIREN.(30)

The two cardinal elements of any clinical criteria for vascular dementia are the definition of the cognitive syndrome (42) and the definition of the cause. (!.!d 43) All clinical criteria are consensus criteria, derived neither from prospective community-based studies on vascular factors affecting the cognition, nor on detailed natural histories/2 30,4O,4!> All these criteria are based on the concept of ischaemic infarcts. They are designed to have high specificity, but have been poorly validated. (4 44.) An important consequence of the different definitions of the dementia syndrome,(942) and the vascular cause,(! l:!.,) is that the different diagnostic criteria identify different populations.

The DSM-IV definition of vascular dementia (Table !) requires focal neurological signs and symptoms or laboratory evidence of focal neurological damage clinically judged to be related to the disturbance.(34) The course is specified by sudden cognitive and functional losses. The DSM-IV criteria do not detail brain imaging requirements. The DSM-IV definition of vascular dementia is reasonably broad and lacks detailed clinical and radiological guidelines.

Pioai r^ntofsl »»d i> | »vwiwnf-^ w¡ 4ttp r g n# i ■ a tamcr ptüxai* ri l ic ¡putjdofcufair h r. firc ibwmiWik wuk^HL d m lurmkí. w¿c,|

LtbDTfifiry igndwci al fe-:jJ nM-clEfU, diü^|¡ |i

■■Jh'tCEnMU iflBOfa^j íü-T-fc» h"d nUEAf)

Pioai r^ntofsl »»d i> | »vwiwnf-^ w¡ 4ttp r g n# i ■ a tamcr ptüxai* ri l ic ¡putjdofcufair h r. firc ibwmiWik wuk^HL d m lurmkí. w¿c,|

LtbDTfifiry igndwci al fe-:jJ nM-clEfU, diü^|¡ |i

■■Jh'tCEnMU iflBOfa^j íü-T-fc» h"d nUEAf)

tht m^a 1 ijf^i fl (k4+ ittt 'ii in » gkuf c (kltfhkhyi*'idnpiBi n»j pjr.™^ hIJNT IrnP ^

Tlwbnl^unto

:=■ tí i-r

I-=■ z-¿-: J! 7 nbud ihi 4qiiitaKP

r'rt dkkiU it iu

H bou inri II ilj iuwf dH uwu *f liLrfi

ChKMWtlW iJT wl+iT,

M to IVKI-M4 '.* ) mh'^ K^lviw l^tF* hrtlkF>ri hKM

Table 1 The DSM-IV definition of vascular dementia

Table 1 The DSM-IV definition of vascular dementia

The ICD-10 criteria'35» (I.able.2) require unequal distribution of cognitive deficits, focal signs as evidence of focal brain damage, and significant cerebrovascular disease judged to be aetiologically related to the dementia. The criteria do not detail brain imaging requirements. The ICD-10 criteria specify six subtypes of vascular dementia (Tabie S). The ICD-10 criteria for vascular dementia have been shown to be highly selective and only some of those fulfilling the general criteria for ICD-10 vascular dementia can be classified into one of the subtypes.(1 43) The shortcoming of these criteria include lack of detailed guidelines (e.g. of unequal cognitive deficits and changes on neuroimaging), lack of aetiological criteria, and heterogeneity. {l 43)

Uh^fMl hhb tf >1 (»if«- K^vüM hndüM «ih Km*

juciri ""j «fim rftwtv ip«td ttui, itkhf;«! bi Tjrbi-i.Y j^r^i Ah !F :lwJr(. ird rimlm

CT« .Ti+y 'Jv,* iyij mJ-í i#>:lfw tlipi if rwjfint lb*1 kkjl A»)tl. huhn w 1«k w pi ^Ig'T träft«) IpliljC I»WWH «fill* Lmtv aureiwd iüMpi r+flt-«. ■ twtfw plFwv rtip^iw

IHe^t h- [tan dw hdL«í. (nvumn v KK ^^i^rw i jut. itfwh Nr ■*+ w^Ä t-t in h HKMqpuFt '<■ iitd cc ^ oJ ivotí. (^-«ncf oJ

Table 2 The ICD-10 criteria for vascular dementia

Table 3 Characteristics of the vascular dementia subtypes in ICD-10

The NINDS-AIREN research criteria for vascular dementia(30) include a dementia syndrome, cerebrovascular disease, and a relationship between these ( Table 4). Cerebrovascular disease is defined by the presence of focal neurological lesions and brain imaging evidence of ischaemic changes in the brain. A relationship between dementia and cerebrovascular disorder is inferred from the onset of dementia within 3 months following a recognized stroke, or on abrupt deterioration in cognitive functions, or fluctuating stepwise progression of cognitive deficits. The criteria include a list of features consistent with the diagnosis, as well as a list of features that make the diagnosis uncertain or unlikely. Also, different levels of certainty of the clinical diagnosis (probable, possible, definite) are included. The NINDS-AIREN criteria recognize heterogeneity(45) of the syndrome and variability of the clinical course in vascular dementia, and highlight detection of ischaemic lesions and a relationship between lesion and cognition, as well as stroke and dementia onset.

The NINDS-AIREN criteria are currently most widely used in clinical drug trials on vascular dementia. In a neuropathological series, sensitivity of the NINDS-AIREN criteria was 58 per cent and specificity 80 per cent. (4Z> The criteria successfully excluded Alzheimer's disease in 91 per cent of cases, and the proportion of combined cases misclassified as probable vascular dementia was 29 per cent.(47) The inter-rater reliability of the NINDS-AIREN criteria is moderate to substantial (k = 0.46-0.72).(48>

These three sets of criteria for vascular dementia are not interchangeable; they identify different numbers and clusters of patients. The DSM-IV criteria are less restrictive than the ICD-10 and NINDS-AIREN criteria. (1,4£)

Was this article helpful?

0 0
Unraveling Alzheimers Disease

Unraveling Alzheimers Disease

I leave absolutely nothing out! Everything that I learned about Alzheimer’s I share with you. This is the most comprehensive report on Alzheimer’s you will ever read. No stone is left unturned in this comprehensive report.

Get My Free Ebook


Post a comment