Validation Study of a CT-Based Weighted Rating Scale for Subcortical Ischemic Vascular Disease in Patients with Mild Cognitive Deterioration
| Autor: | Samantha Galluzzi, Cristina Geroldi, Orazio Zanetti, Cristina Testa, Giovanni B. Frisoni |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Ischemia Neurological disorder Neuropsychological Tests Sensitivity and Specificity White matter Central nervous system disease Rating scale Internal medicine medicine Humans Dementia Aged Aged 80 and over Psychiatric Status Rating Scales Vascular disease Dementia Vascular Cognitive disorder Brain Reproducibility of Results Middle Aged medicine.disease Surgery Cerebrovascular Disorders medicine.anatomical_structure Neurology Cardiology Female Neurology (clinical) Cognition Disorders Tomography X-Ray Computed Psychology |
| Zdroj: | European Neurology. 49:193-209 |
| ISSN: | 1421-9913 0014-3022 |
| Popis: | Objectives: Subcortical ischemic vascular disease (SIVD) is frequently associated with cognitive impairment. Rating scales to grade cerebrovascular disease are available, but their sensitivity to the clinical features of mild SIVD is unclear. The aim of the study is to devise and validate a computed tomography (CT)-based visual rating scale sensitive to SIVD in patients with mild cognitive deterioration. Methods: Subjects were 122 consecutive outpatients of a memory clinic (mean age ± SD 77 ± 8 years, 71% females, mean ± SD score of mental state exam 22 ± 3, 61% with clinical dementia rating of 0.5 and 39% of 1). Diffuse leukoaraiosis, fuzzy and patchy lesions, and lacunes were assessed on ordinary CT films and weights were computed based on clinical indicators of SIVD. A continuous score and an ordinal class (0–3) with higher values indicating higher vascular damage were derived. Results: Intraclass correlation coefficients for intra- and interrater reliability of the subcortical vascular score and class ranged from 0.84 to 0.88. Convergent validity versus the scale of Wahlund et al. was good (Spearman’s correlation coefficient between 0.53 and 0.73, p < 0.0005). Known-group validity was assessed versus clinical diagnoses of degenerative (mild cognitive impairment determined by Petersen et al. and NINCDS-ADRDA probable Alzheimer’s disease; n = 58), mixed (possible Alzheimer’s disease with cerebrovascular disease; n = 21), and vascular cognitive impairment (criteria of Erkinjuntti et al. for subcortical vascular dementia and cognitive impairment; n = 43). Patients with degenerative cognitive impairment were more often in the lower subcortical vascular classes (43% in class 0, 43% in class 1, 14% in class 2, and 0% in class 3), while patients with mixed (0, 24, 24, and 52%) and vascular cognitive impairment were in increasingly higher subcortical vascular classes (0, 12, 35, 53%; p < 0.00005). Criterion-related validity was assessed versus clinical indicators of cerebrovascular disease. Hypertension, platelet aggregation inhibitor use, balance, gait, and bradykinesia increased linearly with increasing subcortical vascular class (p for trend Conclusions: This rating scale is valid and sensitive to capture different degrees of SIVD associated with mild cognitive deterioration. |
| Databáze: | OpenAIRE |
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