(Stroke. 2000;31:2952.)
© 2000 American Heart Association, Inc.
Original Contributions |
Comparison of Different Clinical Criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the Diagnosis of Vascular Dementia
From the Department of Clinical Neurosciences, Memory Research Unit (T.P., R.Y., T.E.), Stroke Unit (M.K.), and Department of Radiology (R.M.), Helsinki University Central Hospital (Finland).
Correspondence to Timo Erkinjuntti, MD, PhD, Memory Research Unit, Department of Clinical Neurosciences, Helsinki University Central Hospital, PO Box 300, FIN-00029 HYKS, Finland. E-mail Timo.Erkinjuntti{at}hus.fi
Background and Purpose—The criteria for vascular dementia (VaD) include definition of the cognitive syndrome and the vascular cause. Different criteria for dementia identify different frequencies and clusters of patients. In addition, variation in defining the cause and etiology may have an effect. We compared different clinical criteria for VaD in series of patients with poststroke dementia.
Methods—The study group comprised 107 patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) definition for dementia from a cohort of consecutive patients with ischemic stroke who completed a comprehensive neuropsychological test battery and MRI. The mean age (SD) of the patients was 71.4 (7.6) years. The definitions of vascular cause of VaD were those of the DSM-III (1980), Alzheimer’s Disease Diagnostic and Treatment Centers (ADDTC; 1992), International Statistical Classification of Diseases, 10th Revision (ICD-10; 1992), National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN; 1993), and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; 1994).
Results—The number of cases that could be classified as VaD
according to the different criteria varied considerably: 36.4% (n=39)
by DSM-III, 86.9% (n=93) by ADDTC, 32.7% (n=35) by
NINDS-AIREN, 36.4% (n=39) by ICD-10, and 91.6% (n=98) by DSM-IV
criteria. The concordance between DSM-III/ICD-10 was perfect (100%;
=1.0), between ICD-10/NINDS-AIREN and ADDTC/DSM-IV good to moderate
(85.0% and 87.3%; =0.87 and 0.37, respectively), but otherwise
poor between the other criteria. Only 31 patients fulfilled all the
criteria for VaD applied. Major discriminating factors between the
criteria were requirement of (1) focal neurological signs, (2) unequal
distribution of deficits in higher cortical functions, and (3) evidence
of relevant CVD based on brain imaging findings.
Conclusions—Current criteria of VaD identify different frequencies and clusters of patients and are not interchangeable. Optimally, prospective studies with clinicopathological correlation could identify new criteria. Meanwhile, focus on more homogeneous subtypes (eg, small-vessel subcortical VaD) and detailed neuroimaging criteria could improve the diagnostics.
Key Words: dementia • diagnosis • stroke
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