diagnostic criteria for vascular dementia

Definite vascular dementia: 1) clinical criteria for probable vascular dementia 2) autopsy findings consistent with ischemic stroke or hemorrhagic stroke & no other cause of dementia Probable vascular dementia: 1) dementia a) decline from higher previous level of cognitive function b impairment of 2 or more cognitive domains c) deficits severe enough to interfere with ADL -> not due to physical effects of stroke alone d) absence of delirium, psychosis, aphasia, & sensorimotor impairment that precludes neuropsychologic testing & absence of any other disorder capable of causing dementia 2) cerebrovascular disease a) focal neurologic signs consistent with stroke & b) neuroimaging (CT, MRI) consistent with extensive vascular lesions 3) temporal relationship of dementia with cerebrovascular disease a) onset of dementia withiin 3 months of stroke b) abrupt deterioration or fluctuating (TIAs) or stepwise progression of the cognitive deficit Possible vascular dementia: - dementia with focal neurologic signs a) without confirmation of cerebrovascular disease by neuroimaging (CT, MRI) b) without clear temporal relationship of dementia with cerebrovascular disease c) with subtle onset & variable course of cognitive deficits Alzheimer's disease with cerebrovascular disease 1) clinical criteria for possible Alzheimer's disease 2) clinical & neuroimaging (CT, MRI) evidence of cerebrovascular disease Supporting features: 1) subtle onset & variable course of cognitive deficits 2) early course of gait disturbance 3) unsteadiness & frequent falls 4) urinary frequency, urgency & other urinary symptoms not explained by urologic disease 5) pseudobulbar palsy 6) personality & mood changes a) abulia b) depression c) emotional lability d) subcortical deficits including psychomotor retardation & abnormal executive function Also see DSM IV criteria for vascular dementia

References

Cummings JL, The Neuropsychiatry of Alzheimer's Disease and Related Dementias, Martin Dunitz, 2003