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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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“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]
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“The various diagnostic criteria are neither perfect nor interchangeable and none of these criteria have the required sensitivity and specificity to identify patients with mixed VaD reliably.(26,27) This accounts for the variations in published prevalence and incidence rates and in treatment outcomes.”
BackgroundThe Efficacy of Pentoxifylline in the Treatment of Vascular Dementia: A Systematic Review
Sha, M. C., & Callahan, C. M. (2003) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-200301000-00006 · Cited by 57
Clinical diagnosis of dementia
Robillard, A. (2007) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2007.08.002 · Cited by 53
Invited Commentary: Albuminuria and Microvascular Disease of the Brain--A Shared Pathophysiology
Knopman, D. S. (2010) · American Journal of Epidemiology · doi:10.1093/aje/kwp429 · Cited by 54
Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment
Melkas, S., Jokinen, H., Hietanen, M., & Erkinjuntti, T. (2014) · Degenerative Neurological and Neuromuscular Disease · doi:10.2147/dnnd.s37353 · Cited by 53
“23,29 The NINDS–AIREN criteria require evidence of cerebrovascular disease in imaging, whereas the DSM-III and ICD-10-NA do not require such direct evidence.”
Self-citationThe Rest-Activity Rhythm and Physical Activity in Early-Onset Dementia
Hooghiemstra, A. M., Eggermont, L. H. P., Scheltens, P., van der Flier, W. M., & Scherder, E. (2014) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000037 · Cited by 50
The Association between Psychiatric and Cognitive Symptoms after Stroke: A Prospective Study
Rasquin, S. M. C., Lodder, J., & Verhey, F. R. J. (2005) · Cerebrovascular Diseases · doi:10.1159/000084499 · Cited by 46
Genetics of Vascular Cognitive Impairment
Leblanc, G. G., Meschia, J. F., Stuss, D. T., & Hachinski, V. (2005) · Stroke · doi:10.1161/01.str.0000195177.61184.49 · Cited by 42
Wattjes, M. P. (2011) · International Psychogeriatrics · doi:10.1017/s1041610211000913 · Cited by 43
Strategies for molecular imaging dementia and neurodegenerative diseases
Schaller, B. J. (2008) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s2154 · Cited by 38
“Dementia represents a general term used to describe a chronic and substantial decline in two or more areas of cognitive function related to cellular and subcellular changes in the brain (Erkinjuntti et al 1997) underlining the multifactor origin of dementia syndrome (Pohjasvaara et al 2000).”
Diagnostic Criteria of Vascular Dementia in CADASIL
Benisty, S., Hernandez, K., Viswanathan, A., Reyes, S., Kurtz, A., O'Sullivan, M. J., Bousser, M., Dichgans, M., & Chabriat, H. (2008) · Stroke · doi:10.1161/strokeaha.107.490672 · Cited by 41
Nakahori, N., Sekine, M., Yamada, M., Tatsuse, T., Kido, H., & Suzuki, M. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0791-6 · Cited by 39
“The concordance between ICD-10 and the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-Ш) for the diagnosis of vascular dementia is 100% [24].”
MethodC-reactive protein expression in a rodent model of chronic cerebral hypoperfusion
Juma, W. M., Lira, A., Marzuk, A., Marzuk, Z., Hakim, A. M., & Thompson, C. S. (2011) · Brain Research · doi:10.1016/j.brainres.2011.07.047 · Cited by 37
Neurobiology of Vascular Dementia
Enciu, A., Constantinescu, S. N., Popescu, L. M., Muresanu, D. F., & Popescu, B. O. (2011) · Journal of Aging Research · doi:10.4061/2011/401604 · Cited by 34
“Currently, the most widely used criteria for VaD include the Diagnostic and Statistical Manual of Mental Disorders (DSM), Alzheimer’s Disease Diagnostic and Treatment Centers (ADDTC), International Statistical Classification of Diseases (ICD), and National Institute of Neurological Disorders and Stroke—Association Int…”
MethodValidation of clinical criteria for possible vascular dementia in the oldest-old
Bacchetta, J.-P., Kövari, E., Merlo, M. C. G., Canuto, A., Herrmann, F. R., Bouras, C., Gold, G., Hof, P. R., & Giannakopoulos, P. (2006) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2006.02.006 · Cited by 35
Longitudinal changes in the prevalence of dementia in a Japanese rural area
Wakutani, Y., Kusumi, M., Wada, K., KAWASHIMA, M., Ishizaki, K., Mori, M., Mori, N., Ijiri, T., Adachi, Y., ASHIDA, Y., et al. (2007) · Psychogeriatrics · doi:10.1111/j.1479-8301.2007.00203.x · Cited by 36
Cosentino, S., Jefferson, A. L., Carey, M. E., Price, C. C., Garrett, K. D., Swenson, R., & Libon, D. J. (2004) · The Clinical Neuropsychologist · doi:10.1080/13854040490507118 · Cited by 35
The Epidemiology of vascular dementia
Román, G. C. (2008) · Handbook of clinical neurology · doi:10.1016/s0072-9752(07)01259-6 · Cited by 34
Treatment of vascular dementia: evidence from trials with non-cholinergic drugs
Pantoni, L. (2004) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2004.09.014 · Cited by 34
Cerebrovascular disease and dementia
Onyike, C. U. (2006) · International Review of Psychiatry · doi:10.1080/09540260600935421 · Cited by 34
Paradise, M., & Sachdev, P. S. (2019) · Seminars in Neurology · doi:10.1055/s-0039-1678582 · Cited by 33
Jensen, M., Zeller, T., Twerenbold, R., & Thomalla, G. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.12926 · Cited by 30
Vascular cognitive impairment: A preventable component of dementia
Azarpazhooh, M. R., & Hachinski, V. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-12-804766-8.00020-0 · Cited by 33
Arpa, A., del Ser, T., Goda, G., Barba, R., & Bornstein, B. (2003) · Journal of the Neurological Sciences · doi:10.1016/s0022-510x(03)00026-1 · Cited by 31
Liu, C., Li, C., Yang, J., Gui, L., Zhao, L., Evans, A. C., Yin, X., & Wang, J. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2015.04.003 · Cited by 30
Strub, R. L. (2003) · Southern Medical Journal · doi:10.1097/01.smj.0000063470.95541.6b · Cited by 29
Exploratory study on immune phenotypes in Alzheimer’s disease and vascular dementia
D’Angelo, C., Goldeck, D., Pawelec, G., Gaspari, L., Iorio, A. D., & Paganelli, R. (2020) · European Journal of Neurology · doi:10.1111/ene.14360 · Cited by 29
“Diagnosis of probable AD was made according to standard procedures and followed the National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer’s Disease and Related Disorders (NINCDS/ADRDA) and Diagnostic and Statistical Manual of Mental Disorders-III-R criteria [2]; ’mixed dementia’ was…”
BackgroundMethodNeuropsychiatric Symptoms in Alzheimer's Disease and Vascular Dementia
Echávarri, C., Burgmans, S., Uylings, H. B. M., Cuesta, M. J., Peralta, V., Kamphorst, W., Rozemüller, A. J. M., & Verhey, F. R. J. (2013) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-121003 · Cited by 29
Chopard, G., Pitard, A., Ferreira, S., Vanholsbeeck, G., Rumbach, L., & Galmiche, J. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01271.x · Cited by 29
Disturbed oscillatory brain dynamics in subcortical ischemic vascular dementia
van Straaten, E. C. W., de Haan, W., de Waal, H., Scheltens, P., van der Flier, W. M., Barkhof, F., Koene, T., & Stam, C. J. (2012) · BMC Neuroscience · doi:10.1186/1471-2202-13-85 · Cited by 29
Metadata
- 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 › Clinical Neurology › 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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