T. Wetterling et al., COMPARISON OF DIFFERENT DIAGNOSTIC-CRITERIA FOR VASCULAR DEMENTIA (ADDTC, DSM-IV, ICD-10, NINDS-AIREN), Stroke, 27(1), 1996, pp. 30-36
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.