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Unequal distribution of cognitive deficits in vascular dementia--is this a valid criterion in the ICD-10?

P F Boston1, M S Dennis, C Jagger

  • 1Michael Carlisle Centre, Nether Edge Hospital, Sheffield, S11 9BJ, UK.

International Journal of Geriatric Psychiatry
|May 3, 2001
PubMed

Insights

The ICD-10 criterion for vascular dementia, requiring unequal cognitive deficits, may not be clinically useful. This study found no significant differences in cognitive deficit patterns between vascular dementia and Alzheimer's disease patients.

Area of Science:

  • Neurology
  • Gerontology
  • Psychiatry

Background:

  • The International Classification of Diseases, 10th Revision (ICD-10) criterion for vascular dementia (VaD) posits unequal distribution of cognitive deficits.
  • The clinical utility of this criterion in differentiating VaD from other dementias, such as Alzheimer's disease (AD), requires empirical investigation.

Purpose of the Study:

  • To evaluate the appropriateness of the ICD-10 criterion for VaD, specifically the requirement for unequal cognitive deficits across different domains.
  • To compare cognitive deficit patterns in VaD and AD patients.

Main Methods:

  • A cross-sectional comparative study was conducted using data from a specialist memory clinic in Sheffield and a general practice community sample in Melton Mowbray.
  • The Cambridge Mental Disorders of the Elderly Examination (CAMDEX), including the CAMCOG cognitive assessment, was administered to 131 Sheffield subjects and 396 Melton Mowbray subjects.
  • Depression levels were also assessed as a potential confounding factor.

Main Results:

  • After adjusting for age, sex, and depression scores, no significant differences in the total variability of cognitive deficits were found between VaD and AD subjects at either center.
  • There were minimal differences in individual subscale item performance between the diagnostic groups.
  • In Sheffield, VaD subjects exhibited significantly higher depression scores than AD subjects.

Conclusions:

  • The findings cast doubt on the usefulness of the concept of unequal cognitive deficits as a diagnostic criterion for vascular dementia in routine clinical practice.
  • The diagnostic criteria for vascular dementia may need re-evaluation to improve clinical applicability.
Abstract

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