Clinical Criteria for the Diagnosis of Vascular Dementia

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Abstract
THE CRITERIA chosen to diagnose vascular dementia (VaD) will influence estimates of its incidence and prevalence, as well as its recognition and treatment.1- 4 Since 1975, the Hachinski Ischemic Score (HIS) in its original5 or modified form6- 9 has provided a principal method for the diagnosis of multi-infarct dementia (MID). The original HIS assigns 1 or 2 points to each of 13 clinical features thought to be associated with MID; the modified HIS constitutes a subset of the original 13 items. The HIS has proven to be fairly sensitive and specific in differentiating pure Alzheimer disease (AD) and MID (approximately 70%-80%), but relatively insensitive to the presence of mixed diseases (17%-50%10). A more recent meta-analysis by Moroney et al11 of 312 pathologically verified cases (191 AD, 80 MID, and 41 mixed AD-MID [MIX]) showed significant group differences in mean HIS, but very few items distinguished MIX from MID or AD. A HIS of 5 or 6 was 93% sensitive, but only 17% specific, in distinguishing MID from MIX, and 84% sensitive, but only 29% specific, in distinguishing AD from MIX.