Our results show that the classification according to different diagnostic guidelines yields rather distinct groups of patients. The reasons responsible for these findings are as follows: (1) different criteria for dementia, (2) limitation to ischemic VD in the ADDTC criteria, (3) no further differentiation of VD into subtypes according to CT or MRI findings (DSM-IV), and (4) the multifactorial etiopathology of VD. Major diagnostic difficulties ensue from the very frequent cases with white matter lesions, since their etiology and classification remain widely unknown.
Five patients (aged 19-52 years) were treated for a midbrain syndrome due to acute carbon monoxide poisoning and had clinical follow-up investigations for up to 18 months. Three patients recovered with minor neurological and neuro-psychological deficits and resumed their premorbid life-style. One patient had normal findings, while the fifth remained in a permanent vegetative state. Initial CT of the brain may fail to detect low-density lesions in the globus pallidus. If present, these lesions may either have disappeared, diminished, or remained unchanged at follow-up. Long-term outcome seems to show a closer link to white matter changes, which are at present best investigated by magnetic resonance imaging. The additional value of determining visual evoked responses at repeated follow-up is suggested by the present investigation.
The World Health Organization recently introduced the new ICD-10. Chapter V (‘Mental and behavioural disorders including disorders of psychological development’) contains operationalized diagnostic guidelines for the classification of psychiatric disorders, i.e. the term vascular dementia is clearly defined. Furthermore, the criteria of the ICD-10 allow a differentiation of vascular dementia into subtypes (vascular dementia of acute onset, multi-infarct dementia, subcortical vascular dementia, and mixed or unspecified types). The clinical feasibility of the ICD-10 criteria for subtypes of vascular dementia is proven in an investigation of 72 demented patients (75.0 ± 8.3 years) showing vascular lesions of the computed tomography scan. Only 18 cases (25.0%) fulfill the ICD-10 criteria for vascular dementia. 61.1% of the cases could be sufficiently classified into subtypes. These results suggest that the ICD-10 criteria for vascular dementia are rather selective.
The clinical feasibility of the ICD-10 criteria for subtypes of vascular dementia were examined in an investigation of 61 demented patients (74.4, SD 8.2 years) showing CT appearances of vascular lesions. Only 15 cases (24.6%) fulfilled the ICD-10 criteria of vascular dementia. Of these cases, 66.6% could adequately be classified in subtypes. The most frequent types of vascular dementia were multi-infarct dementia and subcortical vascular dementia. Our findings suggest that the ICD-10 criteria of vascular dementia are more selective than the classical 'ischaemic scales'.
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