Neuroimaging criteria for vascular dementia
P. Pullicino, R. H. Benedict, D. X. Capruso, N. Vella, S. Withiam-Leitch and P. L. Kwen
Department of Neurology, State University of New York at Buffalo, Buffalo General Hospital, USA.
OBJECTIVE: To examine published imaging criteria that separate cranial
computed tomographic (CT) scans into grades of increasing support for a
diagnosis of vascular dementia (VaD). DESIGN: Patients were divided into 4
grades of increasing extent of vascular lesions on CT. The frequency of VaD
was compared between these grades. SETTING: A university department of
neurology. PATIENTS: Forty-two consecutive patients who underwent
neuropsychological assessment for possible dementia and who had a CT scan
performed within 6 months following any stroke causing dementia. Patients
with delirium, severe aphasia, and motor and/or sensory deficits that
impaired neuropsychological testing and patients with mass lesions or
nonvascular white matter disease shown on CT were excluded. MAIN OUTCOME
MEASURE: The National Institute of Neurological Disorders and Stroke and
the Association Internationale pour la Recherche et l'Enseignement en
Neurosciences criteria for probable VaD. RESULTS: The frequency of VaD was
greater in patients with grade 1 (7 [50%] of 14, P = .01), grade 2 (2[50%]
of 4, P = .2), and grade 3(7[78%] of 9, P = .002) scans than the frequency
of VaD with grade O scans (1[7%] of 15). There was a linear association of
the frequencies of VaD between imaging grades (P = .0008). In a subgroup of
patients with neuropsychological deficits caused by cerebrovascular
disease, there was a linear association of the severity of the deficits
between imaging grades (P = .007). CONCLUSIONS: We conclude that our
criteria can separate CTs into increasing levels of support for a diagnosis
of VaD. The extent of vascular lesions on CT reflects the severity of
associated neuropsychological deficts.
