Diagnostic criteria of vascular dementia in CADASIL

作者：Benisty Sarah; Hernandez Karen; Viswanathan Anand; Reyes Sonia; Kurtz Annie; O'Sullivan Michael; Bousser Marie Germaine; Dichgans Martin; Chabriat Hugues^*

来源：Stroke, 2008, 39(3): 838-844.

DOI：10.1161/STROKEAHA.107.490672

• CADASIL
• diagnostic criteria
• leukoariosis
• vascular dementia

Background and Purpose - Subcortical ischemic vascular dementia ( SIVD) is a major subtype of vascular dementia ( VaD). Recently, the diagnostic criteria of VaD have been modified to encompass this entity. Application of these criteria in CADASIL, a genetic model of SIVD, may help to better assess their significance. The aim of this study was to compare different sets of diagnostic criteria of VaD in a population of CADASIL patients.
Methods - Different sets of diagnostic criteria of VaD ( DSMIV, ICD10, standard NINDS-AIREN, modified NINDS-AIREN for SIVD) were applied to 115 CADASIL patients. Diagnosis of VaD was made through 2 steps: ( 1) diagnosis of dementia and ( 2) association of dementia to lesions of vascular origin. The percentage of patients satisfying the different sets and the concordance between these criteria was analyzed.
Results - At least 1 set of criteria was satisfied for diagnosis in 29 subjects with dementia. In this group of patients, the sensitivity of the DSM IV, ICD 10, and standard NINDS-AIREN criteria for VaD was, respectively, 79%, 72%, and 45%. In contrast, the sensitivity of the NINDS-AIREN criteria for SIVD was 90%. The incomplete sensitivity of these last criteria was related to the absence of focal signs in some patients. The neuroimaging criteria were satisfied in all patients with dementia.
Conclusions - The modified NINDS-AIREN criteria of SIVD are the most sensitive VaD criteria in CADASIL. Among these criteria, the neuroimaging criteria, although poorly specific to dementia, have a complete sensitivity. In contrast, focal signs were inconstant in CADASIL patients with dementia.

• 出版日期2008-3