Neuroimaging criteria for vascular dementia

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 0 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.