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From the Department of Neurology (Drs. Moroney, Desmond, and Tatemichi), the Division of Biostatistics (Drs. Bagiella and Paik), and the Department of Psychiatry (Dr. Rosen), Columbia University, College of Physicians and Surgeons, New York, NY; the Department of Clinical Neurological Sciences(Dr. Hachinski), University of Western Ontario, Canada; the Department of Neurology (Dr. Mölsä), University of Turku, Finland; the Department of Psychogeriatrics (Dr. Gustafson) and the Department of Pathology and Cytology (Dr. Brun), University Hospital, Lund, Sweden; the Department of General Psychiatry (Dr. Fischer), University Hospital for Psychiatry, Vienna, Austria; and the Memory Research Unit (Dr. Erkinjuntti), Department of Neurology, University of Helsinki, Finland.
Dr. Tatemichi died April 22, 1995.
Address correspondence and reprint requests to Dr Desmond, Stroke and Aging Research Project, Neurological Institute, 710 West 168th Street, New York, NY 10032.
Our objectives were to investigate the utility of the Hachinski Ischemic Score (HIS) in differentiating patients with pathologically verified Alzheimer's disease (AD), multi-infarct dementia (MID), and "mixed" (AD plus cerebrovascular disease) dementia, and to identify the specific items of the HIS that best discriminate those dementia subtypes. Investigators from six sites participated in a meta-analysis by contributing original clinical data, HIS, and pathologic diagnoses on 312 patients with dementia (AD, 191; MID, 80; and mixed, 41). Sensitivity and specificity of the HIS were calculated based on varied cutoffs using receiver-operator characteristic curves. Logistic regression analyses were performed to compare each pair of diagnostic groups to obtain the odds ratio (OR) for each HIS item. The mean HIS (± SD) was 5.4 ± 4.5 and differed significantly among the groups (AD, 3.1 ± 2.5; MID, 10.5 ± 4.1; mixed, 7.7 ± 4.3). Receiver-operator characteristic curves showed that the best cutoff was 
4 for AD and 
7 for MID, as originally proposed, with a sensitivity of 89.0% and a specificity of 89.3%. For the comparison of MID versus mixed the sensitivity was 93.1% and the specificity was 17.2%, whereas for AD versus mixed the sensitivity was 83.8% and the specificity was 29.4%. HIS items distinguishing MID from AD were stepwise deterioration (OR, 6.06), fluctuating course (OR, 7.60), hypertension (OR, 4.30), history of stroke(OR, 4.30), and focal neurologic symptoms (OR, 4.40). Only stepwise deterioration (OR, 3.97) and emotional incontinence (OR, 3.39) distinguished MID from mixed, and only fluctuating course (OR, 0.20) and history of stroke(OR, 0.08) distinguished AD from mixed. Our findings suggest that the HIS performed well in the differentiation between AD and MID, the purpose for which it was originally designed, but that the clinical diagnosis of mixed dementia remains difficult. Further prospective studies of the HIS should include additional clinical and neuroimaging variables to permit objective refinement of the scale and improve its ability to identify patients with mixed dementia.
Supported in part by grant RO1-NS26179 (Drs. Moroney, Bagiella, Desmond, Paik, and Tatemichi) from the National Institutes of Health, Bethesda, MD; the Swedish Medical Research Council (grant no. 3950), the Alzheimer Foundation of Sweden, and the Greta and Johan Kock Foundation, Sweden (Drs. Brun and Gustafson); and the Medical Council of the Academy of Finland and the Finnish Alzheimer Foundation for Research, Helsinki, Finland (Dr. Erkinjuntti).
Presented in part at the 47th annual meeting of the American Academy of Neurology, Seattle, WA, May 1995.
Received February 14, 1997. Accepted in final form April 21, 1997.
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