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Utility of Ischemic Scores in the Differential Diagnosis of Alzheimer's Disease and Ischemic Vascular Dementia

Published online by Cambridge University Press:  07 January 2005

Gregory R. J. Swanwick
Affiliation:
Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland Department of Psychiatry, St. James's Hospital, Dublin, Ireland.
Robert F. Coen
Affiliation:
Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
Brian A. Lawlor
Affiliation:
Department of Psychiatry, St. James's Hospital, Dublin, Ireland.
Denis O'Mahony
Affiliation:
Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
J. Bernard Walsh
Affiliation:
Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
Davis Coakley
Affiliation:
Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland

Abstract

Despite new developments in the concept of vascular dementia, the Hachinski Ischemic Score (HIS) and its modified versions continue to be widely used in the clinical differentiation of Alzheimer's disease (AD) and ischemic vascular dementia (IVD). The sensitivity of the HIS and two modified versions in the diagnosis of AD, IVD, and single infarcts in a large, geriatric population with mild cognitive impairment (N = 100) was evaluated. Sensitivity for identification of AD was greater than 90% but was less than 70% for IVD. Over one third of patients with one or more infarcts on computed tomographic brain scans and 63% of mixed cases were classified as having probable AD. It is concluded that ischemic scores may be useful at predicting prevalence rates if individual case accuracy is ignored. Despite being sensitive to identifying AD, ischemic scores are insensitive to both cerebral infarction and IVD and cannot reliably exclude IVD. Finally, patients with mixed dementia should not be expected to have intermediate scores.

Type
Studies on Dementia
Copyright
© 1996 International Psychogeriatric Association

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