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Optimizing the Hachinski Ischemic Scale
Vladimir Hachinski1, Shahram Oveisgharan, A Kimball Romney
1Department of Clinical Neurological Sciences, University Hospital, University of Western Ontario, London, Ontario, Canada. vladimir.hachinski@lhsc.on.ca
Insights
The Hachinski Ischemic Score (HIS) was optimized, yielding 5-item and 7-item versions. These reduced HIS versions accurately diagnose vascular dementia, performing as well as or better than the original 13-item HIS.
Area of Science:
- Gerontology
- Neurology
- Epidemiology
Background:
- Vascular factors are a significant, preventable cause of cognitive disorders in the elderly.
- The Hachinski Ischemic Score (HIS) is widely used for diagnosing vascular dementia.
Purpose of the Study:
- To consolidate and validate the Hachinski Ischemic Score (HIS).
- To identify optimal scaling and a minimal set of HIS items for improved variance explanation.
Main Methods:
- Utilized data from the Canadian Study for Health and Aging (CSHA) cohort study (1991-2002).
- Applied correspondence analysis to a 13-item HIS from 2968 participants in CSHA phases 2 and 3.
- Identified optimal item sets and scoring for HIS validation.
Main Results:
- Two optimized HIS versions (5-item and 7-item) were developed.
- The 7-item HIS, using binary scoring, performed comparably to the original 13-item HIS.
- A 5-item composite HIS model demonstrated improved classification of vascular vs. nonvascular dementia.
Conclusions:
- Reduced HIS versions (5-item composite or 7-item single-question) offer comparable or superior diagnostic accuracy.
- These optimized HIS versions provide flexibility for different clinical settings.
- The study validates and refines the HIS for diagnosing vascular dementia.
Background:
Vascular causes and factors remain the most significant preventable component of cognitive disorders of elderly individuals. The Hachinski Ischemic Score (HIS) is the questionnaire most commonly used for diagnosis of vascular dementia.
Objective:
To consolidate and further validate the HIS.
Design:
The Canadian Study for Health and Aging was used for this study. It was a cohort study conducted in 3 waves in 1991, 1996-1997, and 2001-2002. The HIS containing 13 items was subjected to correspondence analysis to identify its optimal scaling of item scores and minimal set of items while maximizing the explainable variance.
Setting:
A community-based cohort study.
Patients:
For this analysis, we used 2968 of 3054 well-characterized and well-diagnosed cases with complete HIS data (86 cases had ≥1 item missing) from Canadian Study for Health and Aging phases 2 (1996-1997; n = 2431) and 3 (2001-2002; n = 623).
Results:
Two optimized HIS versions were identified that classify patients with vascular dementia vs those with nonvascular dementia as well as or more accurately than the original HIS instrument. Assuming the HIS instrument measures only a single dimension, correspondence analysis identified the 7 most discriminative HIS items. Binary scoring (0, 1) of these items led to a 7-item HIS model that classified as well as the original 13-item HIS instrument. By merging highly similar HIS items and applying correspondence analysis, a 5-item composite HIS model was created that measures 2 meaningful dimensions of information and classified vascular vs nonvascular dementia better than the original HIS instrument. Each HIS version developed has specific advantages and disadvantages in terms of simplicity, scoring, generalizability, and accuracy.
Conclusion:
Depending on the specific setting, 2 reduced HIS versions consisting of 5 composite-question items or 7 single-question items classify as well as or better than the original HIS instrument.