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NEUROLOGY 1993;43:250
© 1993 American Academy of Neurology

Vascular dementia

Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop* G. C. Román, MD, T. K. Tatemichi, MD, T. Erkinjuntti, MD, J. L. Cummings, MD, J. C. Masdeu, MD, J. H. Garcia, MD, L. Amaducci, MD, J.-M. Orgogozo, MD, A. Brun, MD, A. Hofman, MD, PhD, D. M. Moody, MD, M. D. O'Brien, MD, T. Yamaguchi, MD, J. Grafman, PhD, B. P. Drayer, MD, D. A. Bennett, MD, M. Fisher, MD, J. Ogata, MD, E. Kokmen, MD, F. Bermejo, MD, P. A. Wolf, MD, P. B. Gorelick, MD, K. L. Bick, PhD, A. K. Pajeau, MD, M. A. Bell, DPhil, C. DeCarli, MD, A. Culebras, MD, A. D. Korczyn, MD, J. Bogousslavsky, MD, A. Hartmann, MD and P. Scheinberg, MD

Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.

Address correspondence and reprint requests to Dr. Gustavo C. Román, Neuroepidemiology Branch, NINDS, Federal Building, Room 714, NIH, Bethesda, MD 20892.

*For Workshop participants and affiliations, see Appendix.

Received April 6, 1992. Accepted for publication in final form June 16, 1992.




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L. Mosconi, W. H. Tsui, K. Herholz, A. Pupi, A. Drzezga, G. Lucignani, E. M. Reiman, V. Holthoff, E. Kalbe, S. Sorbi, et al.
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D. J. Libon, C. C. Price, T. Giovannetti, R. Swenson, B. M. Bettcher, K. M. Heilman, and A. Pennisi
Linking MRI Hyperintensities With Patterns of Neuropsychological Impairment: Evidence for a Threshold Effect
Stroke, March 1, 2008; 39(3): 806 - 813.
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S. Benisty, K. Hernandez, A. Viswanathan, S. Reyes, A. Kurtz, M. O'Sullivan, M.-G. Bousser, M. Dichgans, and H. Chabriat
Diagnostic Criteria of Vascular Dementia in CADASIL
Stroke, March 1, 2008; 39(3): 838 - 844.
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R. H. Swartz, D. T. Stuss, F. Gao, and S. E. Black
Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia
Stroke, March 1, 2008; 39(3): 822 - 830.
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D. J. Libon and K. M. Heilman
Assessing the Impact of Vascular Disease in Demented and Nondemented Patients
Stroke, March 1, 2008; 39(3): 783 - 784.
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S. S. Staekenborg, W. M. van der Flier, E. C.W. van Straaten, R. Lane, F. Barkhof, and P. Scheltens
Neurological Signs in Relation to Type of Cerebrovascular Disease in Vascular Dementia
Stroke, February 1, 2008; 39(2): 317 - 322.
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E. E. Smith, S. Egorova, D. Blacker, R. J. Killiany, A. Muzikansky, B. C. Dickerson, R. E. Tanzi, M. S. Albert, S. M. Greenberg, and C. R. G. Guttmann
Magnetic Resonance Imaging White Matter Hyperintensities and Brain Volume in the Prediction of Mild Cognitive Impairment and Dementia
Arch Neurol, January 1, 2008; 65(1): 94 - 100.
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N Purandare, R C Oude Voshaar, C McCollum, A Jackson, and A Burns
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Br. J. Radiol., January 1, 2008; 81(961): 30 - 34.
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M. J. Bos, M. J. E. van Rijn, J. C. M. Witteman, A. Hofman, P. J. Koudstaal, and M. M. B. Breteler
Incidence and Prognosis of Transient Neurological Attacks
JAMA, December 26, 2007; 298(24): 2877 - 2885.
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B. C. Dickerson, R. A. Sperling, B. T. Hyman, M. S. Albert, and D. Blacker
Clinical Prediction of Alzheimer Disease Dementia Across the Spectrum of Mild Cognitive Impairment
Arch Gen Psychiatry, December 1, 2007; 64(12): 1443 - 1450.
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J T O'BRIEN
Role of imaging techniques in the diagnosis of dementia
Br. J. Radiol., December 1, 2007; 80(Special_Issue_2): S71 - S77.
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L BRONGE and L-O WAHLUND
White matter changes in dementia: does radiology matter?
Br. J. Radiol., December 1, 2007; 80(Special_Issue_2): S115 - S120.
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D S KNOPMAN
Cerebrovascular disease and dementia
Br. J. Radiol., December 1, 2007; 80(Special_Issue_2): S121 - S127.
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S MILLS, J CAIN, N PURANDARE, and A JACKSON
Biomarkers of cerebrovascular disease in dementia
Br. J. Radiol., December 1, 2007; 80(Special_Issue_2): S128 - S145.
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A. Borjesson-Hanson, D. Gustafson, and I. Skoog
Five-year mortality in relation to dementia and cognitive function in 95-year-olds
Neurology, November 27, 2007; 69(22): 2069 - 2075.
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M. M. Mielke, P. B. Rosenberg, J. Tschanz, L. Cook, C. Corcoran, K. M. Hayden, M. Norton, P. V. Rabins, R. C. Green, K. A. Welsh-Bohmer, et al.
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Neurology, November 6, 2007; 69(19): 1850 - 1858.
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R. A. Rosenheck, D. L. Leslie, J. L. Sindelar, E. A. Miller, P. N. Tariot, K. S. Dagerman, S. M. Davis, B. D. Lebowitz, P. Rabins, J. K. Hsiao, et al.
Cost-Benefit Analysis of Second-Generation Antipsychotics and Placebo in a Randomized Trial of the Treatment of Psychosis and Aggression in Alzheimer Disease
Arch Gen Psychiatry, November 1, 2007; 64(11): 1259 - 1268.
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A. A. M. van der Veldt, A. J. M. van den Eertwegh, K. Hoekman, F. Barkhof, and E. Boven
Reversible cognitive disorders after sunitinib for advanced renal cell cancer in patients with preexisting arteriosclerotic leukoencephalopathy
Ann. Onc., October 1, 2007; 18(10): 1747 - 1750.
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H. Kolsch, S. Larionov, O. Dedeck, M. Orantes, G. Birkenmeier, W. S. T. Griffin, and D. R. Thal
Association of the Glutathione S-transferase Omega-1 Ala140Asp Polymorphism With Cerebrovascular Atherosclerosis and Plaque-Associated Interleukin-1{alpha} Expression
Stroke, October 1, 2007; 38(10): 2847 - 2850.
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C. Reitz, T. den Heijer, C. van Duijn, A. Hofman, and M.M.B. Breteler
Relation between smoking and risk of dementia and Alzheimer disease: The Rotterdam Study
Neurology, September 4, 2007; 69(10): 998 - 1005.
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