Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia

Background and Purpose-The criteria for vascular dementia (VaD) include def inition of the cognitive syndrome and the vascular cause. Different criteri a 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 an d Statistical Manual of Mental Disorders, Third Edition (DSM-III) definitio n for dementia from a cohort of consecutive patients with ischemic stroke w ho completed a comprehensive neuropsychological test battery and MRI. The m ean age (SD) of the patients was 71.4 (7.6) years. The definitions of vascu lar cause of VaD were those of the DSM-III (1980), Alzheimer's Disease Diag nostic and Treatment Centers (ADDTC; 1992), International Statistical Class ification of Diseases, 10th Revision (ICD-10; 1992), National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recher che 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 th e 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 pe rfect (100%; kappa =1.0), between ICD-10/NINDS-AIREN and ADDTC/DSM-IV good to moderate (85.0% and 87.3%; kappa =0.87 and 0.37, respectively), but othe rwise poor between the other criteria. Only 31 patients fulfilled all the c riteria 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 clus ters of patients and are not interchangeable. Optimally, prospective studie s with clinicopathological correlation could identify new criteria. Meanwhi le, focus on more homogeneous subtypes (eg, small-vessel subcortical VaD) a nd detailed neuroimaging criteria could improve the diagnostics.