Published Online
on July 10, 2003

A more recent version of this article appeared on August 1, 2003

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Submitted on March 18, 2003
Accepted on April 16, 2003

Operational Definitions for the NINDS-AIREN Criteria for Vascular Dementia. An Interobserver Study

Elisabeth C.W. van Straaten MD^*; Philip Scheltens MD, PhD; Dirk L. Knol PhD; Mark A. van Buchem MD, PhD; Ewout J. van Dijk MD; Paul A.M. Hofman MD, PhD; Giorgos Karas MD; Olafur Kjartansson MD; Frank-Erik de Leeuw MD, PhD; Niels D. Prins MD; Reinhold Schmidt MD, PhD; Marieke C. Visser MD, PhD; Henry C. Weinstein MD, PhD; and Frederik Barkhof MD, PhD

From the Department of Neurology and Alzheimer Center (E.C.W. van S., P.S., M.C.V, H.C.W.), Department of Clinical Epidemiology and Biostatistics (D.L.K.), and Department of Radiology and Image Analysis Center (G.K., F.B.), VU Medical Center, Amsterdam, the Netherlands; Department of Radiology, LUMC, Leiden, the Netherlands (M.A. van B.); Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands (E.J. van D., N.D.P.); Department of Radiology, University Hospital, Maastricht, the Netherlands (P.A.M.H.); Department of Radiology, National University Hospital, Reykjavik, Iceland (O.K.); Department of Neurology, University Medical Center, Utrecht, the Netherlands (F.-E. de L.); Department of Neurology, Karl Franzens University, Graz, Austria (R.S.); and Department of Neurology, St Lucas/Andreas Ziekenhuis, Amsterdam, the Netherlands (H.C.W.).

^* To whom correspondence should be addressed. E-mail: i.vanstraaten{at}vumc.nl.

Background and Purpose--Vascular dementia (VaD) is thought to be the most common cause of dementia after Alzheimer's disease. The commonly used International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria for VaD necessitate evidence of vascular disease on CT or MRI of the brain. The purposes of our study were to operationalize the radiological part of the NINDS-AIREN criteria and to assess the effect of this operationalization on interobserver agreement.

Methods--Six experienced and 4 inexperienced observers rated a set of 40 MRI studies of patients with clinically suspected VaD twice using the NINDS-AIREN set of radiological criteria. After the first reading session, operational definitions were conceived, which were subsequently used in the second reading session. Interobserver reproducibility was measured by Cohen's .

Results--Overall agreement at the first reading session was poor (=0.29) and improved slightly after application of the additional definitions (=0.38). Raters in the experienced group improved their agreement from almost moderate (=0.39) to good (0.62). The inexperienced group started out with poor agreement (=0.17) and did not improve (=0.18). The experienced group improved in both the large- and small-vessel categories, whereas the inexperienced group improved generally in the extensive white matter hyperintensities categories.

Conclusions--Considerable interobserver variability exists for the assessment of the radiological part of the NINDS-AIREN criteria. Use of operational definitions improves agreement but only for already experienced observers.

Key words: dementia • magnetic resonance imaging • observer variation • vascular disorders

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