COMPARISON OF DIFFERENT DIAGNOSTIC-CRITERIA FOR VASCULAR DEMENTIA (ADDTC, DSM-IV, ICD-10, NINDS-AIREN)

Background and Purpose Vascular dementia (VD) has been an ill-defined term thus far. Recently detailed criteria for the diagnosis of VD have been proposed (Alzheimer's Disease Diagnostic and Treatment Centers [ ADDTC], 1992; Diagnostic and statistical Manual of Mental Disorders, 4 th edition [DSM-IV], 1994; International Classification of Diseases, 1 0th revision [ICD-10], 1992, 1993; and National Institute of Neurologi cal Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS-AIREN], 1993). Until now the clinical feasibility of these diagnostic guidelines has not been eval uated. Methods This study aimed to compare these criteria in an unsele cted sample of 167 elderly patients (mean age, 72.0+/-9.9 years) admit ted with probable dementia. Results The number of cases that could be classified as VD differed widely between the various diagnostic guidel ines. According to DSM-IV criteria, 45 cases were diagnosed as VD. Twe nty-one cases fulfilled the ICD-10 research criteria, but only 12 met the NINDS-AIREN criteria for VD. Twenty-three cases were classified as ischemic VD as defined by the ADDTC criteria. The concordance was ver y poor since only 5 cases met the criteria for VD of all diagnostic gu idelines. Conclusions Our results show that the classification accordi ng to different diagnostic guidelines yields rather distinct groups of patients. The reasons responsible for these findings are as follows: (1) different criteria fur dementia, (2) limitation to ischemic VD in the ADDTC criteria, (3) no further differentiation of VD into subtypes according to CT or MRI findings (DSM-IV). and (4) the multifactorial etiopathology of VD. Major diagnostic difficulties ensue from the very frequent cases with white matter lesions, since their etiology and cl assification remain widely unknown.