Comparison of Different Clinical Criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the Diagnosis of Vascular Dementia
Abstract
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%; κ=1.0), between ICD-10/NINDS-AIREN and ADDTC/DSM-IV good to moderate (85.0% and 87.3%; κ=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.
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In a Finnish cohort, combined elevated systolic BP, hypercholesterolemia, and obesity increased Alzheimer disease risk about sixfold, while each factor alone increased risk about twofold.
“For example, in a cohort in Finland, the combination of elevated systolic blood pressure, hypercholesterolemia, and obesity increased the risk of Alzheimer disease by ≈6 times, whereas individually, any of these factors alone increased risk by ≈2 times.494”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [494]
Subjects and Methods (p. 2) describes a Finnish cohort of patients with ischemic stroke, while the Discussion (p. 4) compares criteria for diagnosing vascular dementia. Our copy does not address Alzheimer disease risk from the specified combination of blood pressure, cholesterol, and obesity, or report the claimed sixfold and twofold increases (searched those factors and risk estimates). (LLM, conf=0.78)
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- Authors
- Pohjasvaara, T., Mäntylä, R., Ylikoski, R., Kaste, M., & Erkinjuntti, T.
- Affiliations
- University of Helsinki (FI)
- ORCID
- Kaste, M.
- Venue
- Stroke
- Published
- 2000-12
- Volume
- 31
- Issue
- 12
- Pages
- 2952-2957
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2105948419
- Cited by
- 238
- References
- 22
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 8 · 2022: 2 · 2021: 8 · 2020: 6 · 2019: 12 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 7 · 2014: 10 · 2013: 8 · 2012: 15
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- vascular dementia, diagnostic criteria, post-stroke dementia, ischemic stroke, DSM-III, ICD-10, NINDS-AIREN criteria, DSM-IV, interobserver agreement, focal neurological signs, neuropsychological assessment, post-stroke cognitive impairment
- MeSH terms
- Aged, Brain Ischemia, Cognition Disorders, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neurologic Examination, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychometrics, Dementia, Vascular, Reproducibility of Results, Incidence, Prevalence, Stroke
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