Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias

Moroney, Joan T.; Bagiella, Emilia; Desmond, David W.; Hachinski, Vladimir; Mölsä, P.K.; Gustafson, Lars; Brun, Arne; Fischer, Paul; Erkinjuntti, Timo; Rosen, Wilma G.; Paik, M. C.; Tatemichi, T. K.

doi:10.1212/wnl.49.4.1096

Cited by 263 publications

(153 citation statements)

References 21 publications

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“…As part of the clinical diagnostic workup, patients underwent clinical and laboratory assessments to exclude potentially treatable causes of cognitive decline, such as vitamin B12 deficiency or thyroid dysfunction. The presence of significant cerebrovascular disease was a core exclusion criterion, as evidenced by significant vascular lesion load on imaging (the presence of cortical infarcts, extensive and/or confluent White Matter Hyperintensities (WMH) and WMH >10mm diameter), and/or a Hachinski Ischaemic Score >4 25 . Patient data were compared with that from age-matched healthy controls (HC) without a history of cognitive impairment and with 11 patients with mild AD-related dementia, diagnosed according to the McKhann criteria 26 .…”

Section: Representative Resultsmentioning

confidence: 99%

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

Chan

Gallaher

Moodley

et al. 2016

JoVE

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This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of four mountains within a computer-generated landscape is tested using a delayed match-to-sample paradigm. Allocentric spatial memory is assessed by altering the viewpoint, colors and textures between the initially presented and target images.Allocentric spatial memory is a key function of the hippocampus, one of the earliest brain regions to be affected in Alzheimer's disease (AD) and impairment of hippocampal function predates the onset of dementia. It was hypothesized that performance on the 4MT would aid the diagnosis of predementia AD, which manifests clinically as Mild Cognitive Impairment (MCI).The 4MT was applied to patients with MCI, stratified further based on cerebrospinal fluid (CSF) AD biomarker status (10 MCI biomarker positive, 9 MCI biomarker negative), and with mild AD dementia, as well as healthy controls. Comparator tests included tests of episodic memory and attention widely accepted as sensitive measures of early AD. Behavioral data were correlated with quantitative MRI measures of the hippocampus, precuneus and posterior cingulate gyrus.4MT scores were significantly different between the two MCI groups (p = 0.001), with a test score of ≤8/15 associated with 100% sensitivity and 78% specificity for the classification of MCI with positive AD biomarkers, i.e., predementia AD. 4MT test scores correlated with hippocampal volume (r = 0.42) and cortical thickness of the precuneus (r = 0.55).In conclusion, the 4MT is effective in identifying the early stages of AD. The short duration, easy application and scoring, and favorable psychometric properties of the 4MT fulfil the need for a simple but accurate diagnostic test for predementia AD.

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Section: Representative Resultsmentioning

confidence: 99%

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

Chan

Gallaher

Moodley

et al. 2016

JoVE

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“…Functional activities of daily living were assessed by the Pfeffer 24 scale and the Katz scale 25 . Probable vascular dementia was diagnosed based on the criteria of the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN) 26 and supported by the Hachinski score 27 . A 1.0 Tesla brain MRI was performed in all patients and fluid-attenuated inversion recovery (FLAIR), and T2-and T1-weighted sequences were used to measure the white matter burden by using the Fazekas scale 28 .…”

Section: Scales and Testsmentioning

confidence: 99%

Vascular parkinsonism: a case series of 17 patients

Vale

Caramelli

Cardoso

2013

Arq. Neuro-Psiquiatr.

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Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.

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“…Inclusion criteria were a score of at least 18 (27.6 6 5.5) on the 21-item Hamilton Depression Rating Scale (13), 27 on the Mini-Mental State Examination (14), and no more than 2 on the Hachinski ischemia index (15). The Structured Clinical Interview for DSM-IV (16) was used to evaluate the presence of concurrent and lifetime DSM-IV axis I disorders.…”

Section: Subjectsmentioning

confidence: 99%

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

Kohn

Freedman²,

Lester³

et al. 2007

Journal of Nuclear Medicine

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Compromised regional cerebral blood flow (rCBF) in major depressive disorder may be partly reversed by successful antidepressant treatment. However, it is not known if the reversal of rCBF compromise is dependant on the mode of antidepressant treatment. The current study aimed to address this question. Methods: Thirty-three patients (19 women and 14 men; mean age 6 SD, 53 6 16 y) with moderate major depressive disorder were studied before 6 wk of treatment with tricyclic antidepressants, selective serotonin reuptake inhibitors, or a course of electroconvulsive therapy, and 31 of these patients were also studied afterward. A comparison group of 25 healthy volunteers (13 women and 12 men; mean age, 49 6 15 y) were studied once. rCBF was assessed using 99m Tc-hexamethylpropyleneamine oxime SPECT. Images were analyzed using globally normalized statistical parametric mapping localized to the Montreal Neurologic Institute brain atlas. Results: Baseline rCBF was lower in depressed patients than in controls in the frontal cortex and subcortical nuclei bilaterally. A response to medication was associated with normalization of rCBF deficits, whereas a response to electroconvulsive therapy was associated with an additional rCBF decrease in the parietotemporal and cerebellar regions bilaterally. Conclusion: Hypoperfusion in major depressive disorder largely normalizes after a response to pharmacotherapy. Perfusion changes after a response to electroconvulsive therapy may follow a different course. Earl y functional neuroimaging studies comparing healthy and depressed subjects reported decreases in regional cerebral blood flow (rCBF) and metabolism typically in the frontal and prefrontal regions but also in temporal, parietal, and limbic-subcortical structures (1-3). More recent studies have presented a more diverse and complex picture, replicating but also extending the findings of earlier studies (1,2). These studies distinguished between ventral frontal and prefrontal regions that display increased metabolism or perfusion in depressed patients and more rostral regions within the cingulate gyrus and dorsolateral prefrontal cortex that show decreased perfusion. In other regions postulated to play a role in the pathophysiology of depression, such as the limbic and paralimbic regions and the basal ganglia, findings have been inconsistent (1,2). This diversity in brain imaging findings may reflect the heterogeneity between studies in age of subjects, group size, male-to-female ratio, subtype and severity of psychopathology, and medication status. The choice of imaging technique, radiopharmaceutical, acquisition parameters, and processing parameters also have varied considerably, as have the method of data analysis and choice of reference region.rCBF alterations in depression generally normalize after a response to treatment with medication, interpersonal psychotherapy, or a placebo (2,4) (but a different pattern of perfusion changes is seen in response to venlafaxine (5) or cognitive behavioral therapy (6)). Less consistency i...

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Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias

Cited by 263 publications

References 21 publications

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

Vascular parkinsonism: a case series of 17 patients

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

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