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The Consortium to Investigate Vascular Impairment of Cognition: Methods and First Findings

  • Kenneth Rockwood (a1), Heather Davis (a1), Chris MacKnight (a1), Robert Vandorpe (a1), Serge Gauthier (a2), Antonio Guzman (a3), Patrick Montgomery (a4), Sandra Black (a5), David B. Hogan (a6), Andrew Kertesz (a7), Remi Bouchard (a8) and Howard Feldman (a9)...

Abstract

Background:

The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) is a Canadian, multi-centre, clinic-based prospective cohort study of patients with Vascular Cognitive Impairment (VCI). We report its organization and the impact of diagnostic criteria on the study of VCI.

Methods:

Nine memory disability clinics enrolled patients and recorded their usual investigations and care. A case report form included all vascular dementia (VaD) individual criteria for each of four sets (National Institute of Neurological Disorders and Stroke (NINDS-AIREN), Alzheimer’s Disease Diagnostic Treatment Centers (ADDTC), the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) of consensus-based diagnostic criteria and for the Hachinski Ischemia Score (HIS). Investigators, having completed the case report form, were asked to make a clinical judgement about the cognitive diagnosis based on the best available information, including neuroimaging.

Results:

Of 1,347 patients (mean age 72 years; 56% women), 846 (63%) were diagnosed with dementia and 324 (24%) were diagnosed with VCI. The proportion of patients diagnosed with VaD by the diagnostic criteria was: 23.9% (n=322) by DSM-IV, 10.2% (n=137) by HIS, 4.3% (n=58) by ICD-10, 3.8% (n=51) by ADTCC, and 3.6% (n=48) by NINDS-AIREN. Judged against a clinical diagnosis of VaD, the sensitivity/specificity of each was: DSM-IV (0.77/0.80); HIS (0.41/0.92); ICD-10 (0.29/0.98); ADTCC (0.24/0.98); NINDS-AIREN (0.42/0.995). Compared with a clinical diagnosis of VCI, sensitivities were lower for the diagnostic criteria, reflecting the exclusion of patients who did not have dementia.

Conclusions:

Consensus-based criteria for VaD omit patients who do not meet dementia criteria that are modeled on Alzheimer’s disease. Even for patients who do, the proportion identified with VaD varies widely. Criteria based on empirical analyses need to be developed and validated.

RÉSUMÉ: Introduction:

Le consortium pour l’investigation de la détérioration cognitive vasculaire (CIVIC) est une étude prospective, multicentres, de cohorte de patients suivis en clinique pour une détérioration cognitive vasculaire (DCV). Nous rapportons son organisation et l’impact des critères diagnostiques sur l’étude de la DCV.

Méthodes:

Neuf cliniques de la mémoire ont recruté des patients et colligé les évaluations et le traitement habituel. Tous les critères individuels de démence vasculaire (DV) de chacun des quatre ensembles de critères diagnostiques identifiés par consensus (NINDS-AIREN, ADTCC, DSM-IV, ICD-10) et du Hachinski Ischemia Score (HIS) ont été notés sur un formulaire d’exposé de cas (FEC). Après avoir complété le FEC, les investigateurs devaient porter un jugement clinique sur le diagnostic cognitif basé sur la meilleure information disponible dont la neuroimagerie.

Résultats:

846 des 1 347 patients (64%), dont l’âge moyen était de 72 ans et dont 56% étaient des femmes, ont reçu un diagnostic de démence et 324 patients (24%) un diagnostic de DCV. La proportion des patients chez qui on a posé un diagnostic de DV était de 23,9% (n = 322) selon les critères diagnostiques du DSM-IV; de 10,2% (n = 137) selon le HIS; de 4,3% (n = 58) selon le ICD-10; de 3,8% (n = 51) selon l’ADTCC et de 3,6% (n = 48) selon le NINDS-AIREN. En comparant chacun à un diagnostic clinique de démence vasculaire, la sensibilité et la spécificité étaient respectivement de: 0,77/0,80 pour le DSM-IV; 0,41/0,92 pour le HIS; 0,29/0,98 pour l’ICD-10; 0,24/0,98 pour l’ADTCC; 0,42/0,995 pour le NINDS-AIREN. La sensibilité des critères diagnostiques était plus faible que celle du diagnostic clinique de DCV, ce qui reflète l’exclusion des patients qui ne présentent pas de démence.

Conclusions:

Les critères de DV basés sur les consensus ne tiennent pas comptent des patients qui ne rencontrent pas les critères de démence basés sur le modèle de la maladie d'Alzheimer. Même pour les patients qui rencontrent ces critères, la proportion de ceux chez qui on identifie une DV varie beaucoup. Il faudrait développer et valider des critères basés sur des analyses empiriques.

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The Consortium to Investigate Vascular Impairment of Cognition: Methods and First Findings

  • Kenneth Rockwood (a1), Heather Davis (a1), Chris MacKnight (a1), Robert Vandorpe (a1), Serge Gauthier (a2), Antonio Guzman (a3), Patrick Montgomery (a4), Sandra Black (a5), David B. Hogan (a6), Andrew Kertesz (a7), Remi Bouchard (a8) and Howard Feldman (a9)...

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