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A Multicenter Study of Comparability and Interrater Reliability

Helena C. Chui, MD; Wendy Mack, MD; J. Edward Jackson, MD; Daniel Mungas, PhD; Bruce R. Reed, PhD; Jared Tinklenberg, MD; Fen-Lei Chang, MD; Kate Skinner, MD, PhD; Cora Tasaki, MD; William J. Jagust, MD

Arch Neurol. 2000;57:191-196.

Background  Several clinical criteria have been developed to standardize the diagnosis of vascular dementia (VaD). Significant differences in patient classification have been reported, depending on the criteria used. Few studies have examined interrater reliability.

Objective  To assess the concordance in classification and interrater reliability for the following 4 clinical definitions of VaD: the Hachinski Ischemic Score (HIS), the Alzheimer Disease Diagnostic and Treatment Centers (ADDTC), National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Methods  Structured diagnostic checklists were developed for 4 criteria for VaD, 2 criteria for Alzheimer disease (AD), and 4 criteria for dementia. Twenty-five case vignettes, representing a spectrum of cognitive impairment and subtypes of dementia, were prepared in a standardized clinical format. Concordance in case classification using different criteria and interrater reliability among 7 ADDTCs given a specific set of criteria was assessed using the statistic.

Results  The frequency of a diagnosis of VaD was highest using the modified HIS or DSM-IV criteria, intermediate using the original HIS and ADDTC criteria, and lowest using the NINDS-AIREN criteria. Scores for interrater reliability ranged from = 0.30 (ADDTC) to = 0.61 (original HIS).

Conclusions  Clinical criteria for VaD are not interchangeable. Depending on the criteria selected, the reported prevalence of VaD will vary significantly. The traditional HIS has higher interrater reliability than the newer criteria for VaD. Prospective longitudinal studies with clinical-pathological correlation are needed to compare validity.

From the Geriatric Neurobehavior and Alzheimer Center, Rancho Los Amigos National Rehabilitation Center, Downey (Dr Chui); the Departments of Neurology (Dr Chui) and Preventive Medicine (Dr Mack), University of Southern California, Los Angeles; Department of Medicine, University of California, San Diego (Dr Jackson); Department of Neurology, University of California, Davis (Drs Mungas, Reed, and Jagust); Martinez Veterans Affairs Medical Center, Martinez (Drs Reed and Jagust); Veterans Affairs Palo Alto Health Care Systems, and Department of Psychiatry, Stanford University, Palo Alto, Calif (Dr Tinklenberg); Departments of Neurology (Dr Chang) and Anatomy (Dr Skinner), University of California, San Francisco; and Department of Neurology, University of California, Irvine (Dr Tasaki). Dr Jackson is deceased.

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